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SALURAN
KEMIH
Renal Functions
• Glomerular Filtration
GFR normal : 120 ml / min, measured by : the clearence of exo –
genous inulin ( Inulin Clearance Test ) or endogenous creatinine
( Creatinine Clearance )
• Tubular Reabsorption
Ur in e F orma tion
Glomerular filtration
Tubular reabsorption
Tubular secretion
Urinary excretion :
glomerular filtration + tubular secretion
- tubular reabsorption
The normal renal cortex contains glomeruli, other vessels, tubules and
interstitium. When evaluating a renal specimen by light microscopy on
an H&E stained section
In the glomerular diagram,
The different colors indicate the
various cell types that are of interest
in assessing the pathologic changes
that occur in a glomerulus
(green = epithelial cells, yellow =
endothelial cells, red = mesangial
cells).
Special stains that often are used in evaluating renal biopsy
specimensI from left to right: PAS, trichrome, H&E, Jones silver stains).
Diagram of a single glomerular capillary and illustrates the ultrastructural
features that are assessed when evaluating renal biopsy specimens.
Electron micrograph that shows a portion of 1 capillary loop with
adjacent mesangium
Much higher magnification electron micrograph.
The urinary space and the foot processes are at the top.
Gejala Klinis Penyakit Ginjal :
• Sakit
- Parenkhim ginjal : tanpa ujung saraf rasa sakit
- Rasa sakit Ok :
> Meregangnya fascia ginjal
> KOntraksi otot ureter : pd obstruksi ( urethral collic )
• Hematuria
- Dengan / tanpa rasa sakit
- Severe : urin merah, tkt rendah : tidak terlihat, tetqpi dengan mikr’kop
pd sedimen urin eritrosit (+)
- Penyebab :
> Penyakit Ginjal : glomerulonefritis, pyelonefritis, neoplasma,
trauma, calculi, dll
> Penyakit2 pada kndung kemih, ureter, uretra : cystitis, uretri-
tis, calculi, dll
> Penyakit sistemik yg menyebabkan perdarahan saluran
kemih : malignant hypertension, emboli sistemik pd endo –
karditis, diathesis, terapi antokoagulan,
Osler-Weber-Randu Diseade
Proteinuria
Pyuria
Adanya neutrofil pd urin
Sindroma nefrotik
> 3,5 gr/d + hipoproteinemia + edema
Hipertensi
Pemeriksaan :
• Fisik diagnostik
• Radiologi
- foto abdomen polos
- intravenous pyelography
- ultrasonography
- renal arteriography
• Pemeriksaan urin
• Pemeriksaan darah
• Biopsi ginjal
Kelainan Ginjal Kongenital
•asymptomatic proteinuria
•nephrotic syndrome
(proteinuria, hypoproteinemia, hyperlipidemia, edema)
•asymptomatic hematuria
•glomerulonephritis
(hematuria, proteinuria, hypertension, renal failure)
•acute glomerulonephritis
(neprhitis with short term renal failure)
•crescentic glomerulonephritis
(nephritis with rapidly progressive renal failure)
•chronic glomerulonephritis
(chronic progression of renal failure)
•End Stage Renal Disease
(irreversible renal failure)
Penyakit Yang Terutama Mengenai Glomerulus
Glomerulonefritis proliferatif
kelainan minimal
nefropati mebranosa (epimembranosa atau
ekstramembranosa).
glomerulosklerosis fokal
glomerulonefritis menahun (khronik)
• Glomerulonephritis fokal yang mungkin berasal imunologik, tetapi bukan
oleh infeksi sistemik
Kelainan itu secara klinik dibagi atas :
- glomerulonephritis fokal idiopatik,
- hematuria recurrens
- kerusakan ginjal sebagai bagian penyakit komplex imun
sistemik seperti lupus erythematosus, periarteritis
nodosa, dan purpura Schonelein-Henoch (purpura
anafilaktoid).
PENYAKIT – PENYAKIT GLOMERULUS :
Glomerulonephritis acute.
Etio : Streptococcus
Virus
Staphylococcus
Pneumococcus
Patogenesis :
* Biasanya didahului oleh infeksi ISPA, tonsi -
litis, pharingitis, otitis, mastoiditis, infeksi
kulit.
* Kemudian timbul reaksi agab
* Agab complex melekat ke glomerulus menim
bulkan reaksi radang terutama pada membran
basalis glomerulus
* Glomerulus kehilangan foot processus
Etiologi :
* Sindroma neprotik primer ok. Glomerulopati
* Sindroma neprotik secunder akibat :
- Penyakit-penyakit sistemik misalnya : DM.
Amiloidosis,lupus, Hodgkin, dsb
- Gangguan sirkulasi darah trombosis vena renalis
D.C
- Keracunan : logam berat, obat-obatan, gigitan ular,
lebah
- Infeksi/parasit : sipilis,malaria
- Genetik, familial
Patogenesis :
A. Nefrosis toksik
- Nefrosis kimiawi
- Nefrosis cholemik
- Nefrosis osmotic
- Nefrosis vakuoler
B. Nefrosis hipoksik
Etiologi Hidroneprosis :
1. Obstruksi :
Ureter : batu , tumor
Dinding ureter : striktura
Penekenan dari luar : tumor, prostat hiper
tropi, fibrosis
Klinis :
Nyeri pinggang
Teraba tumor pada sudut costo vertebral.
Payah ginjal
Pyelonephritis
Makroskopis : - Kortex menipis dan atrofi
- Ginjal membesar
- Pelvis dan calyces melebar
UROLITIASIS
Faktor Predisposisi :
> Konsentrasi kristaloid dalam urine
> Lesi pada dinding tract.urinarius atau perubahan
fisiokimiawi air kemih
> Stasis urine
Misalnya :
1.Dehidrasi
2.Hiperkalsemia, hipercalciuria pada hiperparathyroid,
resopsi tulang, hipervitaminosis D, diet calcium meninggi,
antasida.
3.Penyakit-penyakit gout
4.pH kurang dari 6
5.Defisiensi Vit. A
6.Infeksi kuman, parasit
Klinis :
Ulserasi dan perdarahan
Colic ginjal / ureter
Pyelonephritis, cystitis
Hidronephrosis
Carcinoma
Jenis2 Batu Sqaluran Kemih
Br oad classi ficati on
Age
Gender
Season/climate
Fluid Intake
Stress/diet
Occupation
Mobility
Metabolic disorders
Genetic disorders
Anatomical abnormality
Family history
Occupation, Low Urine Volume and Urolithiasis
Paraneoplastic
syndromes: erythrocytosis,
hypercalcemia
Backgro un
d
Higher incidence in cigarette smokers
This system predicts the clinical outcome and survival for patients who
had surgical resection of their kidney tumor
Metastatic / high-risk = 0%
Prognosi s (Rathmell 2004)
Incidence
There are approximately 55,000 new cases of bladder, ureter and renal
pelvis cancers in the United States with approximately over 13,000
deaths each year.
Epidemiology
Gender
Men have more incidence of bladder cancer than women and
increased incidence in 7th decade of life.
Race
Cancers are more common in whites than blacks – 2:1.
Etiology and Risk Fact ors
Cigarette smoking
Analgesic abuse
Analgesic compounds, especially Phenacetin, has been
associated with increased risk of bladder cancer
Chronic urinary inflammation
Occupational exposures
Workers with organic chemicals, rubber, paint, and dye
industries have increased risks of urothelial cancers.
Balkan nephropathy
Increase of cancer with renal pelvis and ureters in patients in
Balkan nephropathy, unknown cause that results in
progressive inflammation of the renal parenchyma
Genetic factors
Families with higher risk of transitional cell carcinoma, no
genetic basis has been found as of yet
Si gns and Sym ptoms
Hematuria
Urinary voiding symptoms
Symptoms of advanced disease usually involve swelling in lower
extremities secondary to a lymphatic obstruction
Pain and frank hematuria
Diagnostic Work-up
CT scan
Ultrasound
Intravenous pyelogram
Urine cytology from both ureters at time of cystoscopy
Bone scan
Chest x-ray
Pathol ogy
T1 Tumor in wedge
Subepithelial connective tissue