Patofisiologi Penyakit

Ginjal
Dr. Eka Roina Megawati
Departemen Fisiologi FK USU

Penyakit Ginjal
 Berdasarkan tempat kerusakan ; glomerulopathy
dan tubulointerstisial disease
 Berdasarkan penyebab ; imunologik, metabolik,
infiltratif, infeksius, hemodinamik dan toksik
 Berdasarkan gambaran klinis ; nephrotic
syndrome dan nephritic syndrome

Gagal Ginjal  Kehilangan kemampuan mempertahankan volume dan komposisi cairan tubuh  Gagal ginjal kronik : secara progresif & lambat (beberapa tahun)  Gagal ginjal akut : beberapa hari .minggu .

akibat aliran darah ke ginjal yang inadekuat  Intrarenal . kelainan struktur maupun fungsi . Penyebab gagal ginjal  Prerenal . akibat obstruksi saluran kemih baik akibat batu ginjal. kerusakan pada nefron baik langsung ataupun tidak  Postrenal .

Nonsteroid anti – inflamatory drugs. Bilateral renal artery stenosis ( particulary after therapy with an angiotensin converting inhibitor ) . or sweat losses or bleeding. Heart failure. renal. MAJOR CAUSES OF KIDNEY DISEASE PRERENAL DISEASE True Volume depletion Gastrointestinal. Nephrotic syndrome ( particulary after diuretic therapy for edema ) Hypotension. Hepatic cirrhosis ( including the hepatorenal syndrome ).

INTRARENAL DISEASE Vascular disease Acute :  vasculitis  malignant hypertension  scleroderma  thromboembolic disease Chronic :  nephrosclerosis Glomerular disease Glomerulonephritis Nephrotic syndrome Tubular disease Acute :  acute tubular necrosis  multiple myeloma  hypercalcemia  uric acid nephropathy Chronic :  polycystic kidney disease  Medullary sponge kidney .

interstitial nephritis ( usually drug – induced ) Chronic : .analgesic abuse POSTRENAL DISEASE Obstructive uropathy Prostatic disease Malignancy Calculi Congenital abnormalities .pyelonephritis ( due primarily to vesicoureteral reflex ) .pyelonephritis .INTERSTITIAL DISEASE Acute : .

edema congestion hypertension Chronic renal failure Azotemia for > 3 months Hematuria. edema. proteinuria. polyuria. Initial clinical and laboratory data base for defining major syndromes in nephrology syndrome Important clues to Common findings not diagnosis Of diagnostic value Acute or rapidly progressive renal Anuria Hypertension failure Oliguria Hematuria. Documented recent decline in cast sedema GFR Acute nephritis Hematuria. casts Prolonged symptoms or signs of oliguria. circulatory Azotemia.pyuria. pyuria. uremia hypertension Symptoms or signs of renal Electrolyte disorder osteodystropy Kidneys reduced in size bilaterally Broad casts in urinary sediment . red cell casts Proteinuria. oliguria. nocturia. proteinuria.

casts Urinary tract infection Bacteriuria > 10 colonies/ ml Hematuria Other infection agent document in Mild azotemia urine Mild proteinuria Pyuria.5 g/ 1. urgency Bladder tenderness Flank tenderness .73 m² per 24 Casts edema hours Hypoalbuminemia Hyperlipidemia lipiduria Asymptomatic urinary Hematuria abnormalities Proteinuria ( below nephrotic range ) Sterile pyuria.Nephrotic syndrome Proteinuria > 3. leukocyte casts fever Frequency.

urinary retention Pyuria . full bladder after voiding . nocturia. oliguria. large Enuresis prostate. nocturia Mild azotemia Symptoms and signs of renal Mild proteinuria osteodystrophy Fever Large kidneys Renal transport defects hypertension Systolic / diastolic hypertension Proteinuria Casts azotemia Nephrolitiasis History of stone passage Hematuria Or removal Pyuria Stone seen by X – ray Frequency. flank Dysuria tenderness. urgency Renal colic Urinary tract obstruction Azotemia . anuria Hematuria Polyuria.Renal tubular defects Electrolyte disordes Hematuria Polyuria. large kidneys. slowing of urinary stream.

peningkatan BUN dan serum creatinin secara cepat dan dapat disertai dengan oliguria  Penyebab : . Gagal ginjal akut  Gambaran klinis .

pancreatitis. oxalic acid. prostatic. surgical accident Medication. peritonitis ) Cardiovascular failure Impaired cardiac output ( infarction. vesical. methotrexate ) . calculi. Plus blood clots Intrarenal obstruction Crystal ( uric acid. sepsis. drugs ) Extra renal obstruction Urethral occlusion. or retroperitoneal neoplasm. or kidney. Sequestration of extracellular fluid ( burns. Major causes of acute renal failure Hypovolemia Volume loss via the skin. sulfonamides. gastrointestinal tract. pelvic. tamponade ) Vascular pooling ( anaphylaxis. Hemorhage.

hypercalsemia. Interstitial nephritis Drugs. scleroderma.Bladder rupture Trauma Vascular disease Vasculitis. malignant hypertension Thrombotic thrombocytopenia purpura. infection idiopathic . arterial or venous occlusion glomerulonephritis Immune complex disease Anti GBM disease.

uterine hemorrhage. Contras material. anesthetic agent.induced Antibiotics. heat stroke. muscle disease. Heavy metals. Pregnancy . eclamsia . severe exercise.postischemiic All condition listed above under hypovolemia and cardiovascular failure Pigment . potassium or phosphate depletion) Poison .related Septic abortion.induced Hemolysis ( transfusion reaction. coma. Organic solvents. malaria ) Rhabdomyolysis ( trauma.

Pathophysiology of ischemia – induced 10 acute renal failure .

Gagal ginjal kronik Stadium I : penurunan cadangan ginjal Serum kreatinin dan BUN normal Asimtomatik Stadium II : insufisiensi ginjal >75% nefron rusak GFR 25% dari normal Serum kreatinin dan BUN > normal nokturia dan poliuria .

Stadium III : Gagal ginjal stadium akhir = Uremia >90% nefron rusak GFR 10% dari normal Creatinine clearance ≤ 5 – 10 ml/menit Oligura Sindroma uremik .

namun sisa nefron yang masih utuh tetap bekerja normal  pola adaptasi fungsional – homeostasis  >75% nefron yang rusak . maka seluruh unitnya akan hancur. Patofisiologi Gagal Ginjal  Semua unit nefron telah terserang penyakit namun dalam stadium yang berbeda-beda dan bagian tertentu yang rusak  Hipotesis Bricker (Hipotesis nefron yang utuh) : bila nefron terserang penyakit.

POLYCYSTIC KIDNEY DISEASE. HYPERTENSION COMMON 3. LESS COMMON OBSTRUCTION & INFECTION .COMMON CAUSE OF CHRONIC RENAL FAILURE 1. GLOMERULO NEPHRITIS 4.DIABETES MELLITUS 2.

12 Pathogenesis of bone diseases in chronic renal failure .

CLINICAL ABNORMALITIES IN UREMIA 13 .

14 .

Major causes of renal stones .