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.
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 proliferatif
b. GP mesangio proliferatif (IgA)
(penyakit Burger)
c. GP membranoproliferatif.
2. Infeksi :
a. post-infection streptococcus b haemolitik
b. 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.

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 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.
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. Edema
3. Oliguria
4. Physical examination :
a. SLE  Malar Rash, Oral ulcers
b. Henoch-schonlein purpura and
cryoglobulinemia  palpable purpura

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 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.
• Biopsi
Kontroversi  Standar procedure determining
the cause of proteinuria.
 TERIMA KASIH

• From Current diagnosis & treatment Nephrology & Hypertension

Chapter 23. nephrotic syndrome vs nephritic

• Harrison manual of medicine