KIDNEY STONES

• Penyakit ini tidak ditularkan

• Batu ginjal dapat terbentuk
ketika bahan kimia tertentu
dalam urin membentuk kristal
yang saling menempel.
• Batu juga dapat berkembang
dari infeksi ginjal yang persisten
• Minum sedikit cairan.
• Lebih sering dalam cuaca panas
• Batu ginjal akan menyebabkan
nyeri bila bergerak ke bawah
melewati ureter – v.u -- urethra
• Peningkatan risiko: Volume urin rendah,
oksalat, asam urat, Sodium, PH asam,
stasis, Kalsium
• Risiko menurun: Volume dan aliran urin
tinggi, sitrat, glikoprotein, magnesium
• Penyebab dasar tidak diketahui
• Faktor-faktor yang berhubungan dengan
urin atau lingkungan saluran kemih
berkontribusi terhadap pembentukan
• Batu-batu besar terbentuk dari satu dari
tiga zat:

Kalsium

Struvite

Asam urat
 A. ENVIRONMENTAL FACTOR
1. CALSIUM ( 96%)
N  eksresi 100 –175 mg
hipersecresion  : high intake Ca, high Vit.D
long imobilisasion, hiperparathyroid
renal tubular asidosis, high calsiurie idiopatik
Dietary factors associated with risk of calsium stones :
Increased risk ( animal protein, oxalate, sodium )
Decreased risk ( calsium, potassium, Magnesium, fluid intake
2. CYSTEIN ( herediter )
homozygous cystinuria
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Others :

- Urid acid

End product of purin metabolism

- Struvite

Magnesium ammonium phosphate, carbonate apatite  Triple

phosphate or Infection stones

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 B. TRACTUS UROGENITAL

• CHANGED OF URINE PHYSICALLY

• CHANGED OF URINE CONCENTRATION

• CHANGED OF URINE BALANCED

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C. MATRIX BATU ORGANIK

• RECURRENT INFECTION
• DEFICIENCY OF VITAMIN A
( DESQUAMATION OF CEL EPITHEL)

• DOT CALCIFICATION
RANDALL’S PLAQUE

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Treatment for kidney stones
• Small stones may pass with no pain
• Larger stones may pass but cause extreme of
pain, requiring a lot pain medication
• Stones that are too large to pass may require
surgical treatment including ureteroscope,
nephroscope, shock wave litotripsy
 Risk Factors

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2006 by Mosby, Inc.
 Calcium Stones
• 70%-80% of kidney stones are composed of calcium oxalate
• Almost half result from genetic predisposition
• Other causes:
 Excess calcium in blood (hypercalcemia) or urine (hypercalciuria)
 Excess oxalate in urine (hyperoxaluria)
 Low levels of citrate in urine (hypocitraturia)
 Infection

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2006 by Mosby, Inc. Slide 11
 Examples of Food Sources of
Oxalates
• Fruits: berries, Concord grapes, currants, figs,
fruit cocktail, plums, rhubarb, tangerines
• Vegetables: baked/green/wax beans,
beet/collard greens, beets, celery, Swiss chard,
chives, eggplant, endive, kale, okra, green
peppers, spinach, sweet potatoes, tomatoes
• Nuts: almonds, cashews, peanuts/peanut butter
• Beverages: cocoa, draft beer, tea
• Other: grits, tofu, wheat germ

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2006 by Mosby, Inc. Slide 12
 Struvite Stones
• Composed of magnesium ammonium phosphate
• Mainly caused by urinary tract infections rather than specific
nutrient
• No diet therapy is involved
• Usually removed surgically

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2006 by Mosby, Inc. Slide 13
 Other Stones
• Cystine stones
 Caused by genetic metabolic defect
 Occur rarely

• Xanthine stones
 Associated with treatment for gout and family history of gout
 Occur rarely

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2006 by Mosby, Inc. Slide 14
 Kidney Stones: Symptoms and
Treatment
• Clinical symptoms: severe pain, other urinary symptoms, general
weakness, and fever
• Several considerations for treatment
 Fluid intake to prevent accumulation of materials
 Dietary control of stone constituents
 Achievement of desired pH of urine via medication
 Use of binding agents to prevent absorption of stone
elements
 Drug therapy in combination with diet therapy

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2006 by Mosby, Inc. Slide 15
VARIATION DIET

1. LOW CALCIUM HIGH ASH ACID

2. HIGH DIET ASH ALKALIS

3. LOW PURINE DIET

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Acid ash and alkaline ash diet
• Dietary intake can influence the acidity or alkalinity of the urine
• The acid forming : chloride, phosphorus, sulfur ( high protein
food, breads, cereal )
• The base forming : sodium, potassium, calsium, magnesium
( Fruit, vegetables )

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 Nutrition Therapy:
Calcium Stones
• Low-calcium diet (approx. 400 mg/day) recommended for those
with supersaturation of calcium in the urine and who are not at
risk for bone loss
• If stone is calcium phosphate, sources of phosphorus (meats,
legumes, nuts) are controlled
• Fluid intake increased
• Sodium intake decreased
• Fiber foods high in phytates increased

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2006 by Mosby, Inc. Slide 18
 LOW CALCIUM DIET HIGH ASH ACID

• FLUID > 2500 cc/day

• Low calcium
• Limitation food intake contains:
PROTEIN : milk, cheese, schrimp, crab, rilis, salt fish, sarden, animal
brain, ren, liver, cor
CHO : potatoes, sweet potatoes, cassava, biscuit, cake
contain milk
VEGETABLE : Spinach, mangkok leaf, melinjo leaf, papaya leaf,
lamtoro leaf, cassava leaf, talas (taro) leaf, d.katuk leaf, kelor leaf, jtg pisang,
melinjo, sawi, leunca
FRUITS : All Fermented Fruits
OTHERS : SOFT DRINK contains soda, alcohol, coclate, yeast

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 Low-Calcium Diet

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2006 by Mosby, Inc.
 Nutrition Therapy:
Uric Acid Stones
• Low-purine diet sometimes recommended
• Avoid:
 Organ meats
 Alcohol
 Anchovies, sardines
 Yeast
 Legumes, mushrooms, spinach, asparagus, cauliflower
 Poultry

Mosby items and derived items ©

2006 by Mosby, Inc. Slide 21
LOW PURINE DIET

LIMIT FOOD SOURCES OF URIC ACID

LOST WEIGHT TO IDEAL

BODYWEIGHT

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 Nutrition Therapy:
Cystine Stones
• Low-methionine diet (essentially a low-protein diet) sometimes
recommended
• In children, a regular diet to support growth is recommended
• Medical drug therapy is used to control infection or produce
more alkaline urine

Mosby items and derived items ©

2006 by Mosby, Inc. Slide 23
HIGH DIET ASH ALKALIS

Especially for Cysteine stone and Uric acid

1. Fluid > 2500 cc/day
2. Low AA (contain Sulfur)
3. Vegetables < 300 gr/day
4. Fruit < 300 gr/day

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General Dietary Principles: Kidney Stones

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2006 by Mosby, Inc. Slide 25
 Diet & Fluid Advice
• High Fluid Intake

• Restrict Salt (Na)

• Oxalate Restrict

• Avoid high intake of Purine food

• Increased citrus fruits may help

• If hypercalciuria restrict Ca intake

Role of Potassium Citrate in preventing Cal Oxalate stone ds – KCit

lowers urinary calcium whereas Na Citrate does not lower Calcium due
to Sodium load
 General measures to prevent recurrent stone
formation

• Increase fluid intake to maintain urine output of 2-3 l/day:

 increase in urine sodium as a result of increased sodium
intake. (Higher fluid intake alone will not prevent recurrent
stones in patients with hypercalciuria)

• Decrease intake of animal protein ( ≤ 52 g/day): Reduces

production of metabolic acids, resulting in a lower level of acid
induced calcium excretion; increases excretion of citrate that
forms a soluble complex with calcium; and reduces
supersaturation with respect to calcium oxalate and limits the
excretion of uric acid
• Restrict salt intake ( ≤ 50 mmol/day of sodium chloride):
Dietary and urinary sodium is directly correlated with urinary
calcium excretion, and lower urinary excretion of sodium
reduces urinary calcium excretion
• Normal calcium intake ( ≥ 30 mmol/day): Low calcium diets
increase urinary oxalate excretion, which may result in more
stone formation and possibly a negative calcium balance
• Decrease dietary oxalate: Reduce the intake of foods rich in
oxalate—spinach, rhubarb, chocolate, and nuts
• Cranberry juice: Decreases oxalate and phosphate excretion
and increases citrate excretion
* Low Purin Diet
Goal :

1. Eliminate uric acid development

2. Lost weight ----obese or maintain ideal

body weight or normal weight

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 Requirement
1. Low purin contain 120-150 mg

2. Adequate calorie, protein, mineral and vitamin

3. High carbohydrate

4. Mild fat

5. High fluid

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Terimakasih