Gejala dan cara diagnosis tumor ginjal

Dr. Titiek Sunaryati, M.Ked

 Tumor ginjal merupakan tumor saluran kencing terbanyak ketiga setelah tumor prostat dan tumor kandung kencing. Semakin meluasnya penggunanaan ultrasonografi (USG) di poliklinik rawat jalan mempermudah deteksi dini kasus-kasus tumor ginjal. Banyak faktor yang diduga menjadi penyebab timbulnya tumor ginjal. Merokok merupakan salah satu faktor resiko yang menyebabkan tumor ginjal. Semakin lama merokok dan semakin muda seseorang mulai merokok semakin besar kemungkinan menderita tumor ginjal. Gejala khas tumor ginjal berupa tiga tanda trias klasik yaitu: nyeri pinggang, kencing berdarah dan benjolan atau massa pada pinggang atau perut yang merupakan tanda tumor dalam stadium lanjut. Hipertensi (tekanan darah tinggi) dan anemia (kurang darah) tanpa sebab yang jelas terutama di usia muda juga merupakan gejala yang penting untuk dicurigai sebagai tanda adanya tumor ginjal. Terapi tumor ginjal yang masih dalam stadium dini dilakukan nefrektomi radikal yaitu mengambil organ ginjal. Terapi lain berupa hormon, radiasi dan kemoterapi.

Tumor ginjal
Tumor jinak

Renal papillary adenoma Renal fibroma/hamartoma Angiomyolipoma Oncocytoma

Tumor ganas Renal cell carcinoma Urothelial carcinomas of the renal pelvis

Gejala tumor ginjal

Abdominal mass Abdominal swelling Fever Abdominal pain Nausea Vomiting Apetite loss Weigth loss Blood in urine

High blood pressure Usually only one kidney affected Palpable upper abdominal mass Anemia Heart murmur Ascites Prominent veins Pallor Mild fever Lethargy Pain Hemihypertrophy Genitourinary defects

 Physical exam: The doctor checks general signs of health and tests for fever and high blood pressure. The doctor also feels the abdomen and side for tumors. Urine tests: Urine is checked for blood and other signs of disease. Blood tests: The lab checks the blood to see how well the kidneys are working. The lab may check the level of several substances, such as creatinine. A high level of creatinine may mean the kidneys are not doing their job. Intravenous pyelogram (IVP): The doctor injects dye into a vein in the arm. The dye travels through the body and collects in the kidneys. The dye makes them show up on x-rays. A series of x-rays then tracks the dye as it moves through the kidneys to the ureters and bladder. The x-rays can show a kidney tumor or other problems. CT scan (CAT scan): An x-ray machine linked to a computer takes a series of detailed pictures of the kidneys. The patient may receive an injection of dye so the kidneys show up clearly in the pictures. A CT scan can show a kidney tumor.

 Ultrasound test: The ultrasound device uses sound waves that people cannot hear. The waves bounce off the kidneys, and a computer uses the echoes to create a picture called a sonogram. A solid tumor or cyst shows up on a sonogram. Biopsy: In some cases, the doctor may do a biopsy. A biopsy is the removal of tissue to look for cancer cells. The doctor inserts a thin needle through the skin into the kidney to remove a small amount of tissue. The doctor may use ultrasound or x-rays to guide the needle. A pathologist uses a microscope to look for cancer cells in the tissue. Surgery: In most cases, based on the results of the CT scan, ultrasound, and x-rays, the doctor has enough information to recommend surgery to remove part or all of the kidney. A pathologist makes the final diagnosis by examining the tissue under a microscope.

Wilmstumor=nephroblastoma=embryonal mixed tumor Biasa pada anak < 10tahun (tut <3) 25% tumor ganas pada anak Merupakan tumor campur shg td bermacam komponen, tetapi asalnya dari 1 germ layer yaitu mesodermal Gros: o Tumor btk bola sangat besar,shg ginjal jadi kerdil o Berat bisa mencapai 15 kg o Pada irisan td macam-macam komponen

Antara lain: Jar.miksomatik Jar.sarkomatik spt daging ikan Konsistensi lunak/padat Jar.tulang rawan Daerah nekrosis+perdarahan PA: 1.Glomerulus abortif/primitif dg ruang bowman yg terbentuk kurang baik 2.Tubulus abortif seluruhnya terkurung dalam stroma sel spindel 3.Blastem sel-sel ginjal yg masih primitif 4.Otot bergaris, tulang rawan dll

Klinis: px anak2 dgn tumor yang besar sekali Prog: sangat baik Tx: surgical, nefrektomi radioterapi chemoterapi