CITICOLINE 2018

BIMBINGAN BELAJAR KEDOKTERAN

 Gejala gangguan ginjal anak
yang sering dijumpai
• Edema
• Renal
• Kardial
• Hepatal
• Nutrisional
• Hematuria
• Proteinuria
• Hipertensi
• Penurunan Laju
filtrasi glomerulus
(AKI/PGK).
 Nephritic edema Nephrotic edema
Renal salt and water Alteration of Starling forces
retention (Capillary colloid osmotic
pressure )
Expansion of
circulatory volume Edema formation

Alteration of Starling forces Volume contraction

(Capillary hydraulic pressure )

Edema formation Renal salt and water

retention

Proposed scheme of edema formation in patiens with

glomerular disease
 Nephrotic Syndrome
Massive Proteinuria
- ≥ 50 mg/kg body weight /day, or
- ≥ 40 mg/m2/hour, or
- Urine protein/creatinin ratio > 2 mg/mg,
- dipstick ≥ +2)

Heavy Hypoalbuminemia
< 2,5 g/dL
Edema

Hyperlipidemia (>200mg%)
Roth KS. Nephrotic syndrome: Pathogenesis and management. Ped in Rev 2002;23(7):237-47
Classification of Nephrotic syndrome

Response to
Histopathology:
steroid

Sensitive Minimal

Non
Resistant minimalM
ainly FSGS
Barratt TM. Steroid responsive nephrotic syndrome. In: Barratt TM, editor. Pediatric nephrology. 4th edition. Baltimore:
Lippincot Wiliams & Wilkins;1999. p. 732.
Etiologi
• Kongenital :
• < 3 bulan
• Primer/idiopatik
• Terbatas hanya ginjal saja
• Sekunder
• Mengikuti penyakit sistemik :
• Lupus eritematosus sistemik
• Purpura Henoch Schonlein
• dll
 IDIOPATHIC/PRIMARY
NEPHROTIC SYNDROME

Etiologi
90 % idiopathic nephrotic syndrome
75 % minimal change nephrotic syndrome (MCNS)
10 % focal segmental glomerulosclerosis (FSGS)
< 5 % membranous nephropathi

10 % Membrano proliferative glomerulonephritis

(MPGN)
 Pathophysiology

The underlying pathogenetic abnormality of NS is

proteinuria due to an increase in glomerular capillary
wall permeability.
1. The capillary wall loss the negative charge
glycoprotein barries
2. Increase glomerular permeability to proteins
Yang hilang ada 2!

• Selective : LMWP  Albumin, globulin

• Non selective : IgG IgM dll!

 TREATMENT
1. Medication
1. STEROID
2. DIURETICS
3. IMMUNOSUPRESSIVE AGENTS

2. Dietary (nephrotic diet)

LOW SALT (1-2 g/day)
PROTEIN 2-3 g/kg/day