dr. Muhammad Riza Kurniawan, Sp.

A(K)
 Acute to chronic
 Short time to long life treatment
 Ranging from treatable disorders without long-term consequences to life-
threatening conditions
 Long term consequences:
• Negative self-image
• Relationship, behavior & learning problems
• Trouble concentrating
• Delayed language & motor skills development
 Renal corpuscle  blood filtering

Renal tubule  winding tube

responsible for modifying the filtrate
 Proximal tubule
 Loop
 Distal tubule

Juxtaglomerular apparatus regulates blood

pressure and glomerular filtration rate
Glomerular filtration
Blood passes through the glomerular capillaries membrane &
some plasma filtered into the surrounding glomerular space

Tubular reabsorption
Reclaiming substances from the filtrate (water, glucose, amino
acids, electrolytes) & returning them to the blood

Tubular secretion
 Substances moved from peritubular capillary blood into
filtrate to eventually be excreted
 Maintain electrolyte & acid-base homeostasis, removes
toxins from the blood that did not enter the filtrate via
filtration
 Removal of metabolic wastes
 Regulation of fluid and electrolyte balance
 Regulation of acid-base balance
 Maintenance of blood pressure
 Regulation of erythropoiesis
 Performing metabolic functions
 Urine and active vitamin D
• Renal impairment
• Birth defects
• Hereditary diseases
• Infection
• Nephrotic syndrome (Glomerulonephritis)
• Systemic diseases
• Urine blockage or reflux
• Renal agenesis
Single kidney
• Renal dysplasia
In general they lives healthy, until…..
Dysfunction of one kidney
• Ectopic kidney
Unusual kidney position
Polycystic kidney disease
Many grapelike clusters of fluid-filled cysts abnormal sacs
both kidneys larger over time

Alport syndrome
Collagen mutation in glomerular  scarring of kidneys
Good Pasture syndrome
Antibodies directed against certain epitopes of type IV collagen,
located within the alveolar basement membrane in the lung
& glomerular basement membrane in kidney
• Urinary tract infection
Infection that can affects the urinary system
• Hemolytic uremic syndrome
Eschericia coli toxins enter bloodstream  destroy RBC & damage blood vessel lining
(including glomeruli)
• Post infection glomerulonephritis
 The immune system identifying & destroying bacteria, viruses & other potentially harmful
foreign substances
 Presence of extra antibodies circulate in blood & finally deposit in the glomeruli, the
kidneys can be damaged
 Massive proteinuria, hypoalbuminemia, edema, dislypidemia
Biopsy results
 Minimal change nephrotic syndrome
 Focal segmental glomerulosclerosis
 Membranoproliferative glomerulonephritis
 Membranous nephropathy

 Congenital nephrotic syndrome

 Lupus nephritis
 Henoch-Schonlein purpura
 Diabetes mellitus
 Sarcoidosis
 Spina bifida
 Neurogenic bladder
 Ureterovesical junction stenosis
 Pelviureteric junction obstruction
 Kidney stone
 Hydronephrosis
Urine
 Macroscopic test
Clarity, pH, odour, specific gravity (SG), volume
 Microscopic test
o Organic elements
Cell, cylinder, oval fat bodies, microorganism (bacteria, yeast, parasite)
o Inorganic elements
Amorph, crystal, lipid
 Chemical test
pH, SG, glucose, bilirubin, urobilinogen, ketone, protein (Esbach, Bence Jones),
leukocyturia, nitrite, bacteriuria, haematuria
 Urine culture
Blood
 BUN, creatinine, albumin, lipid profile, electrolyte, uric acid
 C3, C4, ANA, anti ds-DNA
 Anti-streptolysin O (ASTO)
 Vitamin D, parathyroid hormone, erythropoietin
 Schwartz Formula

 Autoregulation
 Hormonal mechanism
 Neural mechanism
KIDNEY INJURY
AcuteKidney injury Chronic KidneyDisease
Kidney biopsy
Indications
Absolute Relative
• Dependent & resistant steroid nephrotic • Acute kidney failure with unknown
syndrome etiology
• Rapid progressive glomerulonephritis • Treatment evaluation
• Nonresolving or atypical acute
glomerulonephritis
• Suspicious of acute tubulointerstitial
nephritis
• Recurrent haematuria syndrome
• Persitent nonorthostatic proteinuria
• Diagnosis of kidney allograft rejection
• Systemic diseases with kidney involvement
• Disease follow up
Kidney biopsy
Contraindications
Absolute Relative
• Solitary kidney • End stage renal failure
• Coagulation or bleeding disorder • Kidney structure anomaly
• Uncontrolled severe hypertension • Chronic pyelonephritis
• Uncooperative patient or inadequate • Hydronephrosis
sedation
• Acute pyelonephritis or UTI
• Kidney cancer
• ESRD
• Contracted kidney
• Under anti-coagulant treatment
Kidney tissues inspection:
1. Light microscope
2. Immunofluorescence
3. Electron microscope
Imaging
 Plain abdomen
 IVP
 Reflux study
 Abdominal ultrasonography

 Dimercapto Succinic Acid (DMSA) Scan

 CT-Scan
 MRI
 Definitive
Steroid, surgery, antibiotics
 Symptomatic
Dialysis, anti-hypertension, transfusion,
erythropoietin
 Lifestyle modification
Exercise, nutrition
 Growth & development
Growth and developmental screening,
psychological counseling