penyakit ginjalll.ppt

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Diseases of the Kidney


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Major Determinants of Disease

Disease of one renal structure usually affects others The urinary tract is especially susceptible to bacterial

infection Most primary glomerular disease is caused by

autoimmune reactions High blood pressure is a common cause of kidney

disease The kidney collects, concentrates, & excretes toxins,

some of hich may cause neoplasms or damage to the

kidney or urinary tract !enal tubules are metabolically "ery acti"e & therefore

especially susceptible to oxygen depri"ation or toxicdamage


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renal failure# loss of ability of kidneys to excrete, concentrate

aminoaciduria anuria

# little or no urine output bacteruria diuresis

# increased urine output

dysuria# painful urination

glycosuria hematuria

# !$%s in urine

hemoglobinuria lipiduria nocturia

oliguria# less than normal urine output

polyuria# more than normal urine output

proteinuria pyuria


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yndromes

'cute nephritic syndrome# autoimmune glomerular disease ith HT( & hematuria 'cute renal failure ')otemia

# renal failure detectable only ith lab tests

%hronic renal failure (ephrolithiasis (ephrotic syndrome

# renal fialure ith marked proteinuria & edema

*ccult hematuria

*ccult proteinuria +remia

# renal failure ith clinical signs & symptoms

+T

+rinary tract obstruction


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')otemia

(o clinical signs

%aused by almost any type of underlying

renal disease

Disco"ered incidentally

ncreased $+( & creatinine


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+remia

%linical signs & symptoms

'ccumulation of aste products in blood

%aused by almost any type of underlyingrenal disease

HT(, anemia, edema, oliguria

-ericarditis, gastroenteritis, bleeding,neuropathies


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'cute (ephritic yndrome

%aused by acute glomerulonephritis

# autoimmune

Hematuria, HT(, a)otemia, oliguria,edema

'cute glomerular inflammation & reacti"e

hyperplasia of glomerular cells


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(ephrotic yndrome

%aused by "arious

glomerular diseases

Marked proteinuria,

hypoalbuminemia,generali)ed edema,

hyperlipidemia


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'cute !enal .ailure

'cute oliguria or anuria associated ith

a)otemia

Most common cause is acute tubular necrosis

from shock 'lso due to

# damage from drugs or toxins

#se"ere hemolysis

# muscle necrosis

# acute glomerular diseases or "ascular diseases


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%hronic !enal .ailure

/o urine output & prolonged uremia

0nd result of all serious chronic renal

disease

%auses

# diabetes

#chronic glomerulonephritis# HT(

# unknon


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imple %yst


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-olycystic Disease

1enetic

.airly common

+sually not

symptomatic untilafter 23

Hematuria, chronic

+T, HT(


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1lomerular Disease

(amed according to

# etiology

# microscopic findings

# clinical syndrome

Most common clinical presentations

# acute nephritic syndrome

# nephrotic syndrome

Most common cause is autoimmune


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'utoimmune !eactions

ome progress as either focal segmental glomerulosclerosis or

tubulointerstitial nephritis


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-oststreptococcal

1lomerulonephritis 'utoimmune injury initiated by beta4hemolytic

streptococcus aka acute proliferati"e glomerulonephritis -resents as acute nephritic syndrome

# hematuria# HT(# increased $+( & creatinine# lo urine output# edema

'ntibodies produced by strep throat deposit inglomerulus Most fully reco"er but about 536 e"ol"e into rapidly

progressi"e glomerulonephritis


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!apidly -rogressi"e

1lomerulonephritis +nknon causes or secondary

to poststreptococcalglomerulonephritis

'utoimmune

aka crescentric

glomerulonephritis ome present as acute

nephritic syndrome & others asrenal failure

%aused by deposition of 'n4'b

complexes 'll but a fe progress to renal

failure


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Membranous 1lomerulonephritis

'utoimmune

Most common causeof nephrotic syndrome

in adults 'bout 536 proceed to

renal failure ithin 53yrs, 786 reco"er

completely, mostprogress sloly ithproteinuria, HT(, lossof renal function


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Minimal %hange1lomerulonephritis

# "ery subtle changes# presents as nephrotic

syndrome

# unknon etiology

# relati"ely benign# sudden appearance of

proteinuria & edema

g' 1lomerulonephritis

#'utoimmune

# Most commonorldide

# aka $erger disease

# +sually presents as

hematuria#'bout 9 of adultsde"elop chronic renalfailure


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%hronic 1lomerulonephritis

ncidental disco"ery of occult proteinuria

or HT(

+sually presents as chronic renal failure or

occult proteinuria

1lomerulus has scar tissue

Dialysis & transplant


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econdary 1lomerulonephritis

Diabetes most common cause

# most common cause of renal failure

# glycoproteins deposit in basement membrane

:ascular disease

# atherosclerosis

# HT(

# "ascultitis


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$enign (ephrosclerosis


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Malignant (ephrosclerosis

n patients ith malignant

HT(

:icious cycle of renin

release

!enal failure, "ascular

stress, increased

intracranial pressure

Medical emergency

'bout 786 die ithin 8

yrs


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'cute Tubular (ecrosis

Most common cause of acute renal failure

%onse;uence of shock or chemicals


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Tubulointerstitial (ephritis


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Hydronephrosis


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+rinary Tract nfection

%ommon & tend to recur


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'cute -yelonephritis

econdary to loer +T

'cute neutrophilic

inflammatory exudates

mall abcesses

-resents as

# flank pain

# fe"er

# high


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%hronic -yelonephritis

%hronic urinary reflux or obstruction

cars & shrinks kidney

'bout 536 of patients on dialysis Most not diagnosed until late in the

disease


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Tubulointerstitial (ephritis

Drugs

# antibiotics

# ('Ds

# diuretics

%an be caused by

# protein deposits

# uric acid crystal deposits

# renal calcium deposits


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!enal tones

%alcium

nfection

+ric acid

ymptoms

# hematuria

# renal colic


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taghorn %alculus


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!enal %ell %arcinoma

'bout >36 of renalmalignancies

7? risk in smokers

+sually presents as

hematuria Metastasi)es to lung &

bone

8 yr sur"i"al

# @86 ithout metastasis# 836 ith metastasis

# 586 ith renal "einin"asion


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