Sindroma nefrotik vs nefritik

SINDROM NEFRITIK VS SINDROM NEFROTIK

Preseptor : dr.. Santoso dr Santo so Chandra. C handra. SpPd Sp Pd

GLOMERULAR Sindrom Nefritik ±

Azotemia,

±

Hipertensi,

±

DISEASE

Sindrom Nefrotik ±

atau 40-50 40-50 mg/kg/hari mg/kg /hari / +3-+ +3-+4 4)

Edema,

±

Hematuria (RBC cast),

±

proteinuria (< 3 g/hr) ,

±

terkadang oliguria.

Proteinuria masif (> 3.5 gram / 24 jam / 1,73 m 2

±

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.

Etiologi : 1.

2.

3.

Glomerulopati (GP) idiopatik /primer a. GP akut proliferatif  b. GP mesangio proliferatif (IgA) (penyakit Burger) c. GP membranoproliferatif. Infeksi : a. post-infection streptococcus F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. Sistemik : Lupus Nephritis, Vaskulitis, Good pasteur syndrome.

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.

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

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 ( 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 , 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