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swollen: albuminaria causes hypoalbuminemia, so it will affect the decrease in intravascular plasma
oncotic pressure and the fluid will move to the interstitial space.

It is also possible that this may occur due to heart problems or kidney function which cannot produce
urine while fluid intake is still large.

weak: due to lack of energy can occur due to insufficient intake or the body's aerobic respiration process
is disrupted due to lack of oxygen in the body (can occur due to hematuria).

shortness of breath: as the body's compensation for the condition of the body's metabolic acidosis or
lack of oxygen. can also occur due to a disruption in the respiratory organs or the occurrence of edema
in the lungs.

heart palpitations: can occur due to hypovolemic body (less stroke volume due to edema) or accelerate
efforts to fulfill oxygen by diffusion in the lungs or abnormalities in the heart.

2. gender: Women seem to generally mount a greater inflammatory response than men when their
immune system is triggered, increasing the risk of autoimmunity. The involvement of sex steroids is
demonstrated by the fact that autoimmune diseases tend to fluctuate according to hormonal changes,
for example, during pregnancy, in the menstrual cycle, or when using oral contraceptives. A history of
pregnancy also seems to leave an increased risk of persistence for autoimmune diseases. The slight
exchange of cells between mothers and their children during pregnancy can lead to autoimmune. This
will tip the gender balance in the female direction.

3. albuminuria

The normal amount of protein in the urine is <150 mg / day. Most of the protein is the result of thick
glycoproteins secreted physiologically by tubular cells, which are called "Tamm-Horsfall proteins". Large
amounts of protein are identified with significant kidney disease (Davey, 2005).

Proteinuria is the presence of protein in human urine that exceeds its normal value of more than 150 mg
/ 24 hours or in children more than 140 mg / m². Under normal circumstances, protein in the urine up to
a certain amount is still considered functional. There is a literature that writes that urine protein is still
considered physiological if the amount is less than 150 mg / day in adults (in children 140mg / m2), but
there are also those who write, the amount is not more than 200 mg / day.

Urinary tract infection. This condition occurs when bacteria enter the body through the urethra and
multiply in the bladder. Other symptoms besides hematuria are the desire to continue urinating, pain
and burning sensation during urination, and strong-scented urine.

Kidney infection. Other symptoms are fever and also pain in the lower back.

Kidney stones. If the stone is small enough, this condition does not cause pain. But if the stone is large
and blocks one of the kidneys, it can cause severe pain.
Swelling of the prostate gland. This common condition is not related to prostate cancer and tends to
occur in adult men. This condition can cause difficulty urinating and frequent urination.

Prostate cancer. This condition can be cured if known and treated early. Tend to occur in men over the
age of 50 years. The development of this condition is very slow.

Bladder cancer. This condition is more common in those aged over 50 years.

Kidney cancer. This condition usually occurs in people over the age of 50 years. This cancer can be cured
if detected and treated early.

Inflammation of the urethra. Conditions that are generally caused by sexually transmitted diseases such
as chlamydia, due to infection with the chlamydia bacteria.

Genetic disorders. Sickle cell anemia is damage to hemoglobin in blood cells due to hereditary factors.
This condition can cause the appearance of blood in the urine. In addition to sickle cell anemia, Alport's
syndrome can also cause hematuria. This syndrome affects the filter tissue in the kidneys.

Drugs. Anti-cancer drugs such as cyclophosphamide and penicillin can cause hematuria. Sometimes, the
appearance of blood in the urine can also be influenced by anticoagulant drugs such as aspirin and
blood-thinning drugs such as heparin.

Excessive exercise. This condition may rarely occur and it is not known why it can cause hematuria, but
one of the links is due to trauma to the bladder that is dehydrated due to excessive physical activity.

4. The most common symptom of interstitial nephritis is a decrease in the amount a person urinates. In
some cases, urine output may increase. At times, people can have no symptoms.

Other symptoms of interstitial nephritis include:

a fever

blood in the urine

exhaustion

confusion

fatigue

nausea

vomiting
a rash

water retention

swelling

weight gain from water retention

feeling bloated

elevated blood pressure

5. The following blood tests are used to evaluate kidney function:

a complete blood count

a blood urea nitrogen test

a blood creatinine test

a blood gas test, used to check an acid-base imbalance and the levels of oxygen and carbon dioxide in
the blood

Other tests that can be used to detect kidney problems include:

urinalysis

abdominal ultrasound

kidney biopsy

6. because autoimmune attacks can interfere with the process of blood filtering in the nephron system,
for example the buildup of immune complexes in the glomerulus will cause disruption of capillary
permeability in the glomerulus.

7. because the attack of anti interstitial nephritis attacks the nephron system so that kidney function is
disrupted

8. Nephrotic syndrome results from damage to the glomerulus, which is the part of the kidney that
functions to filter blood and form urine. As a result, proteins that should remain in the blood actually
leak into the urine. Under normal conditions, urine should not contain protein.
Damage to this part of the kidney can be caused by kidney cells that thicken or form scar tissue. Until
now it has not been known the cause of the glomerulus to thicken or form scar tissue. Nephrotic
syndrome caused by glomerulus that thickens or forms scar tissue is also called primary nephrotic
syndrome.

In addition to thickening and formation of scar tissue in the kidney, nephrotic syndrome can be caused
by other diseases that cause damage to the kidneys. This condition is called secondary nephrotic
syndrome. There are several diseases that can cause secondary nephrotic syndrome, including:

Diabetes.

Lupus

Infectious diseases, such as leprosy, syphilis, HIV, malaria, or hepatitis B and hepatitis C.

Rheumatoid arthritis.

Henoch-Schonlein purpura.

Amyloidosis.

Cancer, such as leukemia or lymphoma.

Sjogren's Syndrome.

Erythema multiforme.

In addition to some of the diseases above, taking drugs that affect the work of the kidneys, such as
nonsteroidal anti-inflammatory drugs or alpha interferon, can also increase a person's risk of developing
nephrotic syndrome. Abusing heroin also carries the risk of causing nephrotic syndrome.

Nefritis lupus

As mentioned earlier, lupus nephritis occurs when the immune system or immune system attacks healthy
kidney cells, so the kidneys cannot function properly.

Under normal conditions, the immune system will only attack germs that enter the body. But in patients
with lupus nephritis, the immune system experiences abnormalities and actually attacks the body's own
cells, including kidney cells.
These immune system disorders are known as autoimmune. Until now, the cause of autoimmune
occurrence in a person has not been known with certainty. However, there are several risk factors that
can cause a person more easily experienced autoimmune, namely female sex and aged between 15-45
years.

A person suffering from lupus nephritis can experience a recurrence of symptoms of lupus nephritis
(flare) due to exposure to lupus triggers. There are several types of triggers for recurrence of lupus
nephritis symptoms, namely:

Exposure to sunlight.

Medications, such as antibiotics and anti-seizure medications.

Hormonal changes, for example when pregnant or menstruating.

Infection, either by bacteria or viruses

Glomerulonefritis

Glomerulonephritis can occur due to various conditions, such as infections, immune system disorders,
and blood vessel disorders. Generally, acute glomerulonephritis has more obvious causes than chronic
glomerulonephritis. Some things that can cause acute glomerulonephritis include:

Infection. Glomerfulonephritis can occur due to bacterial or viral infections. Infection that occurs in the
body results in excessive immune reactions resulting in inflammation of the kidneys and
glomerulonephritis. Examples of infections that can cause glomerulonephritis include streptococcal
bacterial infections of the throat, dental infections, bacterial endocarditis, HIV, hepatitis B and hepatitis
C.

Immune system disorders. An example is lupus which causes inflammation in various organs of the body,
including the kidneys. Besides glomerulonephritis can also be caused by other immune system disorders,
such as Goodpasture's syndrome which resembles pneumonia and causes bleeding in the lungs and
kidneys, and IgA nephropathy which causes deposition of one of the body's defense system proteins
(IgA) in the kidney glomerulus.

Vasculitis. Vasculitis can occur in various organs, including the kidneys. Examples of vasculitis that attack
kidney blood vessels and cause glomerulonephritis are polyarteritis and Wegener's granulomatosis.

Chronic glomerulonephritis often has no specific cause. One genetic disease, Alport's syndrome can
cause chronic glomerulonephritis. Exposure to hydrocarbon solvent chemicals and a history of cancer are
also thought to trigger chronic glomerulonephritis.
9. Toxic substances and systemic diseases trigger the activation of the body's immune complex and can
trigger gene mutations in the body.

10. because the disease occurs because of an aotoimmune attack on the body

11. these drugs as immunosuppressants. inhibits and decreases the body's immune response so that
attacks on autoimmune can be minimized.

12. suspected urinary tract obstruction, whether caused by stones, infections or tumors.

13. Imaging that can be done:

Abdominal CT scan without contrast or also called CT KUB, is a modality that has high sensitivity and
specificity. This examination is able to show the position of the stone, measure the size of the stone, and
rule out a differential diagnosis such as appendicitis or pancreatitis.

A plain abdominal radiograph can show a picture of opaque on radioopaque stones, namely calcium
stones, other types of stones such as gout and cystine, not visible in this photo.

Renal ultrasound can be performed in patients with Xray contraindications as in pregnancy. This
examination may not find stones but can see the presence of hydrinefrosis. The disadvantage of renal
ultrasound is that the results depend on the ability of the operator and the patient's posture. May be an
option if the differential diagnosis is suspected to be related to ovarian or adnexal lesions, such as
torsion ovarian cysts or salphingitis, or even torsion of the testis.

The combination of plain abdominal radiographs and renal ultrasound is recommended for patients who
cannot undergo CT scans

Intravenous Pyelography (IVP) can provide anatomical and functional information, but is rarely used if
possible CT-Scan.

14. painkillers and alfacbloker will overcome colic pain that occurs. the alpha-blockers will vasodilate
blood vessels and reduce muscle spasms when colic pain occurs.

15. provision of medicines, including

- analgesics

- antiemetic

- antibiotics

- antidiuretic
- Medical Expulsive Therapy (MET)

if the stone does not come out on its own, the last resort is by the surgical process