SINDROM NEFRITIK VS

SINDROM NEFROTIK

Preseptor : dr. Santoso Chandra. SpPd

GLOMERULAR DISEASE

Sindrom Nefritik

– Azotemia,– Hipertensi, – Edema,– Hematuria (RBC

cast),– proteinuria (< 3

g/hr), – terkadang

oliguria.

Sindrom Nefrotik– Proteinuria masif (> 3.5

gram / 24 jam / 1,73 m2

atau 40-50 mg/kg/hari / +3-+4 )

– Hipoalbuminemia, – Edema anasarka, – Hiperlipidemia,– Lipiduria.

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Sindroma Nefritik

Glomerulonefritis akut (GNA) Sindroma Nefritik / GNA adalah sindroma klinik yg ditandai kelainan :

– Azotemia, – Hipertensi, – Edema,– Hematuria (RBC cast),– proteinuria (< 3 g/hr), – terkadang oliguria.

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Etiologi :1. Glomerulopati (GP) idiopatik /primer

a. GP akut proliferatifb. GP mesangio proliferatif (IgA) (penyakit Burger)c. GP membranoproliferatif.

2. Infeksi :a. post-infection streptococcus haemolitikb. Non Streptococcal :

endokarditis bakterialis (nefritis Lohlein)sepsis, pneumococcal pneumonia, thypoid fever,

etc.c. parasit : malaria, toxoplasmosis, etc.d. Viral : hepatitis B, mumps, measles, varicella, etc.

3. Sistemik : Lupus Nephritis, Vaskulitis, Good pasteur syndrome.

Patogenesis

• Inflamatory process– Degree of glomerular inflamation the sverity of

renal dysfunction and associated clinical manifestations.

– Poststreptococcal glomerulonephritis tissue injury or result in inflammatory reaction.

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Patofisiologi

1. Kel. urinalisis: ok. Kerusakan dd. Kapiler glomerulus selektif proteinuri < 3 g/hr, hematuria disertai silinder eritrosit.

2. LFG menurun, disertai reabsorbsi Na. dan air sehingga terjadi oliguri ,edema, edema paru dan hipertensi.

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Gejala klinis:

1. hipertensi (malignant in some cases).2. Edema3. Oliguria4. Physical examination :

a. SLE Malar Rash, Oral ulcersb. Henoch-schonlein purpura and

cryoglobulinemia palpable purpura

Laboratorium

Urinalisis•Macroscopic hematuria (tea – cola colored urine)•Microscopic urine reveals RBCs•Proteinuria (< 3gr/hari)

• Hematologi– Anemia – Underlying disease :• Trombocytopenia or leukopenia (SLE)• Blood cultures fever & murmur• Streptozyme & ASO sore throat • etc

Imaging

Pulmonary Edema Wagener’s Granulomatosis & good pasteur disease

Echocardiogram pericardia effusion or endocarditis

USG Renal Kidney Size ( <9 cm Extensive renal Scarring)

Biopsi

• Untuk diagnosis dan membedakan antara penyebab primer dan sekunder.

KOMPLIKASI

• Fluid retention Edema dan Hipertensi• Short and long therm renal replacement

therapy Renal Insufficiency• Resistance to erythropoietin or decreased

production anemia

SINDROM NEFROTIK

• Merupakan salah satu gambaran klinik penyakit glomerulus yang ditandai dengan :– Proteinuria masif (> 3.5 gram / 24 jam / 1,73 m2)

atau 40-50 mg/kg/hari

– Hipoalbuminemia, – Edema anasarka, – Hiperlipidemia, dan – Lipiduria.

ETIOLOGI

Glomerular disease :•Membranous Nephropathy(40%)•Minimal change disease (15%)•Focal glomerulosclerosis (15%)•Membarnoproliferative GN (7%)•Masangioproliferatif GN (5%)•Immunotactoid and Fibrilary GN

Systemic Causes•Diabetes mellitus, SLE, Amyloidosis, HIV-associated nephropathy•Drugs : Gold, Penicillamine, probenecid, street heroin, captopril, NSAIDs•Infection : bacterial endocarditis, hepatitis B, shunt Infection, shypilis, malaria, hepatic schistosomiasis•Malignancy : multiple myeloma, light chain deposition disease, hodgkin’s and other lymphomas, leukemia, carcinoma of breast, GI tract.

Patogenesis

• Reflects noninflammatory damage glomerular capillary wall.

• Proteinuria from alterations in the charge or size selectivity of the glomerular capillary wall.

Patofisiologi

Gejala Klinik

• Proteinuria Asymptomatic – Edema• Edem (High Intravascular hydrostatic pressure

and tissue hydrostatic pressure) edem anasarka.

Laboratorium

Urinalisis•Proteinuria (urine dipstick +3 to +4 dan 24 hour urine collection >3.5 g protein/1.73 m2)•Few cells or cast and •Urinary lipid in sediment

• Polarized light maltese crosses

Hematologi•Serum albumin <3 g/dL•Total serum protein <6 g/dL•Hyperlipidemia•BUN dan Kreatinin >> , GFR normal.•Anemia, Elevated erythrocyte sedimentation Rate (ESR), Hypocalcemia nad Vit. D deficiency.

• BiopsiKontroversi Standar procedure determining

the cause of proteinuria.

TERIMA KASIH

• From Current diagnosis & treatment Nephrology & HypertensionChapter 23. nephrotic syndrome vs nephritic

• Harrison manual of medicine