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Pemicu 1 Blok Urogenital “Oh, tubuhku bengkak”

 

Adrian Pratama - 405100018

LO 1.1

  • Menjelaskan anatomi traktus urinarius

Kidneys

  • Primary retroperitoneal structures on the posterior abdominal wall

  • Kidneys’ layers

    • Perinephric fat (the perirenal fat capsule)

    • renal fascia

    • paranephric fat (or the pararenal fat body)

  • Relations:

    • Superior diaphragm

    • Posterior quadratus lumborum muscle, subcostal nerve and vessels and the iliohypogastric and ilioinguinal nerves

    • Anterior

      • Right kidney liver, duodenum, and ascending colon

      • Left kidney stomach, spleen, pancreas, jejunum, and descending colon

  • External & internal appearance of kidneys

    External & internal appearance of kidneys

    Arterial & venous supply

    Arterial & venous supply Renal artery  segmental arteries (anterosuperior, anteroinferior, superior, inferior, posterior)  interlobar

    Renal artery segmental arteries (anterosuperior, anteroinferior, superior, inferior, posterior) interlobar arteries

    • arcuate arteries

    interlobular arteries afferent arteriole glomerulus efferent arteriole peritubule

    capillary fasa recta interlobular veins arcuate veins

    • interlobar veins segmental

    veins renal vein

    Arterial & venous supply Renal artery  segmental arteries (anterosuperior, anteroinferior, superior, inferior, posterior)  interlobar

    Ureters & kidneys’ lymph nodes

    Ureters & kidneys’ lymph nodes

    Nerves

    Nerves
    Nerves

    Ureters

    • muscular tubes; 25-30 cm long; connect the kidneys to the urinary bladder

    • Pars

      • Abdominalis

      • Pelvica (As the ureters cross the bifurcation of the common iliac artery or the beginning of the external iliac artery)

    Lymphatic drainage

    Lymphatic drainage

    Arterial supplies & innervations

    Arterial supplies & innervations
    Arterial supplies & innervations

    Urinary bladder

    • hollow viscus with strong muscular walls, is characterized by its distensibility

    • lying partially superior to and partially posterior to the pubic bones, separated from pubic bones by the potential retropubic space (of Retzius)

    • Parts

      • apex of the bladder

      • fundus of the bladder

      • body of the bladder

      • neck of the bladder

    Position of urinary bladder & its lymph drainage

    Position of urinary bladder & its lymph drainage
    Position of urinary bladder & its lymph drainage
    Position of urinary bladder & its lymph drainage

    Arterial supply & innervation

    Arterial supply (male)

    Arterial supply & innervation Arterial supply (male) -. superior vesical arteries  anterosuperior parts of the

    -. superior vesical arteries anterosuperior parts of the bladder

    -. inferior vesical

    arteries fundus and neck of the

    bladder

    Arterial supply (female)

    -. vaginal arteries = the inferior vesical arteries and send small branches to posteroinferior parts

    Arterial supply & innervation Arterial supply (male) -. superior vesical arteries  anterosuperior parts of the

    of the bladder

    Proximal male urethra

    • muscular tube; conveys urine from the internal urethral orifice of the urinary bladder to the external urethral orifice

    • Arterial supply

      • prostatic branches of the inferior vesical and middle rectal arteries

    • Venous & lymphatic drainage

      • prostatic venous plexus

      • internal iliac lymph nodes (mainly), external iliac lymph nodes (few)

  • Innervations

    • derived from the prostatic plexus (mixed sympathetic, parasympathetic, and visceral afferent fibers); arising as organ- specific extensions of the inferior hypogastric plexus

  • Distal male urethra

    • The intermediate (membranous) part of the urethra

      • surrounded by the external urethral sphincter

      • It then penetrates the perineal membrane, ending as the urethra enters the bulb of the penis

      • Posterolateral to this part of the urethra are the small bulbourethral glands

  • The spongy urethra

    • it is expanded in the bulb of the penis to form the intrabulbar fossa and in the glans of the penis to form the navicular fossa

    • many minute openings of the ducts of mucus-secreting urethral glands

    • Arterial supply

      • from branches of the dorsal artery of the penis

    • Venous & lymphatic drainage

      • accompany the arteries and have similar names

      • Lymphatic vessels from the intermediate part of the urethra drain mainly into the internal iliac lymph nodes; the spongy urethra pass to

    the deep inguinal lymph nodes

    • Innervations

      • autonomic (efferent) innervation via the prostatic nerve plexus, arising from the inferior hypogastric plexus

      • sympathetic innervation is from the lumbar spinal cord levels via the lumbar splanchnic nerves, and the parasympathetic innervation is from the sacral levels via the pelvic splanchnic nerves

      • dorsal nerve of the penis, a branch of the pudendal nerve, provides somatic innervation of the spongy part of the urethra

    Scrotum

    • cutaneous fibromuscular sac for the testes and associated structures

    • Arterial supply

      • Anterior scrotal arteries; posterior scrotal arteries

    • Venous & lymphatic drainage

      • scrotal veins

      • superficial inguinal lymph nodes

  • Innervation

    • Anterior lumbar plexus: anterior scrotal nerves, derived from the ilioinguinal nerve, and the genital branch of the genitofemoral nerve

    • Posterior sacral plexus: posterior scrotal nerves, branches of the superficial perineal branches of the pudendal nerve, and the perineal branch of the posterior femoral cutaneous nerve

  • Penis

    • male copulatory organ and, by conveying the urethra, provides the common outlet for urine and semen

    • consists of a root, body, and glans

    • Arterial supply

      • Dorsal arteries of the penis; Deep arteries of the penis; Arteries of the bulb of the penis

    • Venous & lymphatic drainage

      • deep dorsal vein of the penis; superficial dorsal vein

      • Lymph from the skin of the penis drains initially to the superficial inguinal lymph nodes; glans & spongy urethra drain to the deep inguinal and external iliac nodes; from the cavernous bodies and proximal spongy urethra drain to the internal iliac nodes

    • Innervation of penis

     Innervation of penis

    Female urethra

    • approximately 4 cm long and 6 mm in diameter; passes anteroinferiorly from the internal urethral orifice of the urinary bladder

    • The urethra passes with the vagina through the pelvic diaphragm, external urethral sphincter, and perineal membrane

    • Urethral glands are present, particularly in the superior part of the urethra

    • One group of glands on each side, the paraurethral glands, are homologues to the prostate

    • Arterial supply

      • internal pudendal and vaginal arteries

    • Venous & lymphatic drainage

      • veins follow the arteries and have similar names

      • sacral and internal iliac lymph nodes (mainly); inguinal lymph nodes (few)

  • Innervations

    • vesical (nerve) plexus and the pudendal nerve

  • Female external genitalia

    Female external genitalia
    • Arterial supply (vulva)

      • internal pudendal artery supplies most of the skin, external genitalia, and perineal muscles. The labial arteries are branches of the internal pudendal artery, as are those of the clitoris

    • Venous & lymphatic drainage (vulva)

      • labial veins are tributaries of the internal pudendal veins

      • superficial inguinal lymph nodes

    • Innervation (vulva)

      • Anterior lumbar plexus: the anterior labial nerves, derived from the ilioinguinal nerve, and the genital branch of the genitofemoral nerve

      • Posterior derivatives of the sacral plexus: the perineal branch of the posterior cutaneous nerve of the thigh laterally and the pudendal nerve centrally

      • posterior labial nerves labia

      • deep and muscular branches of the perineal nerve supply the orifice of the vagina and superficial perineal muscles

      • dorsal nerve of the clitoris supplies deep perineal muscles and sensation to the clitoris

      • The bulb of the vestibule and erectile bodies of the clitoris receive parasympathetic fibers via cavernous nerves from the uterovaginal nerve plexus

    LO 1.2

    • Menjelaskan histologi traktus urinarius

    Kidney

    Kidney

    Nephrons

    The smallest fungsional units of kidney

    Blood circulation (Kidney)

    Blood circulation (Kidney)

    Renal Corpuscles & Blood Filtration

    Glomerular filtration barrier

    Glomerular filtration barrier Filtration slit  slit diaphragms are a highly specialized type of intercellular junction

    Filtration slit slit diaphragms are a highly specialized type of intercellular junction in which the large transmembrane protein nephrin

    Mesangial cells in renal corspuscles

    Functions: -. Physical support and contraction -. Phagocytosis

    Mesangial cells in renal corspuscles Functions: -. Physical support and contraction -. Phagocytosis -. Secretion (cytokines,

    -. Secretion (cytokines, prostaglandins, and other factors

    important for immune defense and repair in the glomerulus)

    Proximal & distal convulated tubules

    Proximal & distal convulated tubules
    Proximal & distal convulated tubules

    Differences

    Differences

    Nephron loop (of henle)

    Nephron loop (of henle)

    Juxtaglomerular Apparatus

    Juxtaglomerular Apparatus Components: -. macula densa -. juxtaglomerular granular (JG) cells -. lacis cells

    Components:

    -. macula densa

    -. juxtaglomerular granular (JG) cells -. lacis cells

    Collecting tubules & ducts

    Collecting tubules & ducts
    Collecting tubules & ducts
    Collecting tubules & ducts

    Ureter

    Ureter Components of urothelium : -. a single layer of small basal cells resting on a

    Components of urothelium:

    -. a single layer of small basal cells resting on a very thin basement membrane

    -. an intermediate region containing from one to several layers of more columnar cells

    -. a superficial layer of very

    large, polyhedral or bulbous

    cells called umbrella cells which are occasionally bi- or multinucleated and are highly differentiated to protect underlying cells against the

    cytotoxic effects of hypertonic urine (uroplakins on apical

    Ureter Components of urothelium : -. a single layer of small basal cells resting on a

    side)

    Urinary bladder

    Urethra

    Urethra  In male:  The prostatic urethra , 3 – 4 cm long, extends through
    • In male:

    The prostatic urethra, 34 cm long, extends through the prostate gland and is lined by

    urothelium

     

    The membranous urethra, a short segment, passes through an external sphincter of striated muscle and is lined by stratified

    columnar and pseudostratified

    epithelium

    The spongy urethra, 15 cm in length, is enclosed within erectile tissue of the penis and is lined by stratified columnar and

    pseudostratified columnar

    epithelium, with stratified squamous distally

    LO 1.3

    • Menjelaskan fisiologi ginjal & traktus urinarius

    Fungsi spesifik ginjal

    • Mempertahankan keseimbangan H2O dlm tubuh

    • Mengatur jumlah & konsentrasi sebagian besar ion CES

    • Memelihara volume plasma yg sesuai

    • Membantu memelihara keseimbangan asam basa tubuh

    • Memelihara osmolaritas

    • Mengekskresikan produk2 sisa dari metabolisme tubuh

    • Mengekskresikan banyak senyawa asing

    • Mensekresikan eritropoietin

    • Mensekresikan renin

    • Mengubah vitamin D menjadi bentuk aktif

    Nefron sbg satuan fungsional ginjal

    Nefron sbg satuan fungsional ginjal
    Nefron sbg satuan fungsional ginjal

    Tipe nefron

    Tipe nefron

    3 proses dasar ginjal

    3 proses dasar ginjal

    Filtrasi glomerulus

    • 3 lapisan pembentuk membran glomerulus

      • Dinding kapiler glomerulus

      • Lapisan gelatinosa aseluler yg dikenal sbg membran basal

      • Lapisan dalam kapsul bowman

    Tekanan darah kapiler glomerulus

    Tekanan darah kapiler glomerulus Faktor lain yg mempengaruhi tekanan darah kapiler glomerulus (koefisien filtrasi) -. Luas

    Faktor lain yg mempengaruhi tekanan darah kapiler glomerulus (koefisien filtrasi)

    -. Luas permukaan glomerulus yg

    tersedia utk filtrasi

    -. Permeabilitas membran glomerulus

    • Faktor penyebab perubahan tekanan darah kapiler glomerulus perubahan tekanan darah kapiler glomerulus

    • Tekanan osmotik koloid plasma & tekanan hidrostatik kapsul bowman tetap tdk berubah dalam keadaan normal (kec patologis)

    • Perlunya mekanisme kontrol terhadap perubahan GFR

      • Kontrol jangka pendek u/ mencegah perubahan spontan GFR

        • otoregulasi

      • Kontrol jangka panjang tekanan darah arteri kontrol simpatis ekstrinsik

    Otoregulasi GFR

    • Mekanisme miogenik

    Otoregulasi GFR  Mekanisme miogenik
    • Mekanisme umpan balik tubulo-glomerulus

     Mekanisme umpan balik tubulo-glomerulus

    Kontrol simpatis ekstrinsik GFR

    Kontrol simpatis ekstrinsik GFR
    Kontrol simpatis ekstrinsik GFR

    Reabsorpsi tubulus

    • Cairan filtrasi yg mengandung nutrien, elektrolit, dan zat lain yg digunakan o/ tubuh & bersifat esensial dikembalikan ke dalam darah

    • proses yg sangat selektif

    Reabsorpsi tubulus  Cairan filtrasi yg mengandung nutrien, elektrolit, dan zat lain yg digunakan o/ tubuh

    Transportasi transepitel pada proses reabsorpsi

    tubulus

    Transportasi transepitel pada proses reabsorpsi tubulus

    Mekanisme transportasi natrium di bagian tubulus

    • Reabsorpsi natrium di tubulus proksimal berperan penting dalam reabsorpsi glukosa, asam amino, H2O, Cl-, dan urea

    • Reabsorpsi natrium di lengkung Henle bersama dgn reabsorpsi Cl- berperan penting dalam kemampuan ginjal menghasilkan urin dgn konsentrasi & volume berbeda2

    • Reabsorpsi natrium di bagian distal nefron bersifat variabel & berada dibawah kontrol hormon, serta berkaitan dgn sekresi K+ & H+

    Proses reabsorpsi natrium

    Proses reabsorpsi natrium
    Proses reabsorpsi natrium

    Transpor reabsorpsi glukosa & asam amino

    • Transpor glukosa & asam amino menggunakan kotranspor (proses transpor aktif sekunder)

    • Proses reabsorpsi glukosa

    Transpor reabsorpsi glukosa & asam amino  Transpor glukosa & asam amino menggunakan kotranspor (proses transpor

    Reabsorpsi fosfat & kalsium

    • Tubulus mereabsorpsi fosfat sampai konsentrasi plasma normal, kelebihannya akan segera dikeluarkan melalui urin = semakin besar fosfat yg dimakan semakin besar yg akan dikeluarkan tubuh

    • Reabsorpsi fosfat & kalsium berada di bawah kontrol

    hormon (PTH)

    Reabsorpsi klorida

    • Reabsorpsi / perpindahan ion klorida berjalan melewati gradien listrik menuju tubulus

    • Jumlah klorida yg direabsorpsi tergantung pada kecepatan reabsorpsi Na+ & tidak dikontrol langsung o/ ginjal

    Reabsorpsi air

    • Air secara pasif akan berdifusi melalui osmosis yg terjadi karena proses reabsorpsi natrium & reabsorpsi zat2 terlarut lainnya

    • 65% air direabsorpsi di tubulus proksimal

    • 15% air direabsorpsi secara obligatorik di ansa henle

    • 20% air direabsorpsi di tubulus distal dibawah pengaruh hormon ADH

    Reabsorpsi urea

    Reabsorpsi urea
    Reabsorpsi urea

    Mekanisme kerja aldosteron pd tubulus distal

    Mekanisme kerja aldosteron pd tubulus distal

    Sekresi tubulus

    • Sekresi ion hidrogen

      • Bergantung pada keasaman cairan tubuh

    • Sekresi ion kalium

    Sekresi tubulus  Sekresi ion hidrogen  Bergantung pada keasaman cairan tubuh  Sekresi ion kalium

    Aldosteron dapat mengubah kecepatan sekresi K+

    Sekresi tubulus  Sekresi ion hidrogen  Bergantung pada keasaman cairan tubuh  Sekresi ion kalium

    Ringkasan transportasi pada tubulus

    Ringkasan transportasi pada tubulus
    Ringkasan transportasi pada tubulus

    Kemampuan ginjal mensekresikan urin dgn berbagai

    kepekatan

    • Countercurrent multiplications

    • Countercurrent exchange

     Countercurrent exchange
    • Peran hormon ADH pada tubulus koligentes

     Peran hormon ADH pada tubulus koligentes
     Peran hormon ADH pada tubulus koligentes

    Daur ulang urea di medula ginjal

    Daur ulang urea di medula ginjal

    Mikturisi

    Mikturisi Saraf simpatis dari plexus hypogastricus tidak berperan langsung pada proses mikturisi / perkemihan

    Saraf simpatis dari plexus hypogastricus tidak berperan langsung pada proses mikturisi / perkemihan

    LO 2

    • Menjelaskan kelainan pada ginjal

    LO 2.1 Nephritic syndrome

    • Glomerular diseases presenting with a nephritic syndrome are often characterized by inflammation in the glomeruli

    • Clinical presentations

      • hematuria,

      • red cell casts in the urine,

      • azotemia,

      • oliguria,

      • mild to moderate hypertension

      • Proteinuria and edema are common, but these are not as severe as those encountered in the nephrotic syndrome

  • may occur in such multisystem diseases as SLE

  • Acute Poststreptococcal Glomerulonephritis

    • acute nephritic syndrome characterized by the sudden onset of gross hematuria, edema, hypertension, and renal

    insufficiency

    • most common glomerular causes of gross hematuria in children

    • Etiology

      • follows infection of the throat or skin by certain "nephritogenic" strains of group A β-hemolytic streptococci

    • Epidemiology

      • commonly follows streptococcal pharyngitis during cold weather months and streptococcal skin infections or pyoderma during warm weather months

      • epidemics of nephritis have been described in association with both throat (serotype 12) and skin (serotype 49) infections

    • Pathology

     Pathology -. all glomeruli appear enlarged and relatively bloodless and show diffuse mesangial cell proliferation
     Pathology -. all glomeruli appear enlarged and relatively bloodless and show diffuse mesangial cell proliferation

    -. all glomeruli appear enlarged and relatively bloodless and show diffuse mesangial cell proliferation with an increase in mesangial matrix -. Polymorphonuclear leukocytes are common in glomeruli during the early stage of the disease

    • Pathogenesis

      • Mediated by immune complexes

    • Clinical course

      • a young child abruptly develops malaise, fever, nausea, oliguria, and hematuria 1 to 2 weeks after recovery from a sore throat / 3-6 wk after a streptococcal pyoderma

      • red cell casts in the urine, mild proteinuria (usually less than 1 gm/day), periorbital edema, and mild to moderate hypertension

      • acute phase generally resolves within 6-8 wk

      • urinary protein excretion and hypertension usually normalize by 4-6 wk after onset

      • persistent microscopic hematuria may persist for 1-2 yr after the initial presentation

     Pathogenesis  Mediated by immune complexes  Clinical course  a young child abruptly develops
    • Clinical manifestations

      • various degrees of edema, hypertension, and oliguria

      • Patients may develop encephalopathy and/or heart failure owing to hypertension or hypervolemia

      • malaise, lethargy, abdominal or flank pain, and fever are common

    • Diagnosis

      • Urinalysis red blood cells (RBCs), frequently in association with RBC casts, proteinuria, and polymorphonuclear leukocytes

      • mild normochromic anemia

      • low-grade hemolysis

      • The serum C3 level is usually reduced in the acute phase

      • A positive throat culture

      • antistreptolysin O titer is commonly elevated after a pharyngeal infection

      • to document cutaneous streptococcal infection is the deoxyribonuclease (DNase) B antigen

      • renal biopsy is considered when hematuria and proteinuria, diminished renal function, and/or a low C3 level persist more than 2 mo after onset

    • Complications

      • Hypertension is seen in 60% of patients and may be associated with hypertensive encephalopathy in 10% of cases

      • heart failure

      • Hyperkalemia

      • Hyperphosphatemia

      • Hypocalcemia

      • Acidosis

      • Seizures

      • Uremia

    • Prevention

      • Early systemic antibiotic therapy for streptococcal throat and skin infections does not eliminate the risk of glomerulonephritis

      • Family members of patients with acute glomerulonephritis should be cultured for group A β-hemolytic streptococci and treated if culture positive

  • Treatment

    • a 10-day course of systemic antibiotic therapy with penicillin is recommended to limit the spread of the nephritogenic organisms

    • Hypertension treatment

    • Prognosis

      • Complete recovery occurs in more than 95% of children

      • Mortality in the acute stage can be avoided by appropriate management of acute renal failure, cardiac failure, and hypertension

      • Infrequently, the acute phase may be severe and lead to glomerular hyalinization and chronic renal insufficiency

      • Recurrences are extremely rare

    LO 2.2 Nephrotic syndrome

    • Certain glomerular diseases virtually always produce the nephrotic syndrome

    • Pathophysiology

      • Manifestations

        • Massive proteinuria, with the daily loss of 3.5 gm or more of protein (less in children)

        • Hypoalbuminemia, with plasma albumin levels less than 3 gm/dL

        • Generalized edema

        • Hyperlipidemia and lipiduria

    • Causes

     Causes

    Idiopathic nephrotic syndrome

    • Diagnosis

      • urinalysis reveals 3+ or 4+ proteinuria

      • Microscopic hematuria (20%)

      • A spot urine protein:creatinine ratio exceeds 2.0

      • urinary protein > 40 mg/m2/hr

      • serum albumin level is <2.5 g/dL

      • serum cholesterol, triglyceride levels are elevated

    • Treatment

    • Prednisolone 60 mg/m2/day (maximum daily dose, 80 mg) a

    single daily dose for 4-6 consecutive wk prednisone dose should be

    tapered to 40 mg/m2/day given every other day as a single daily dose for at least 4 wk

    Secondary nephrotic syndrome

    Secondary nephrotic syndrome

    Congenital nephritic syndrome

    • nephrotic syndrome manifesting at birth or within the first 3 mo of life

    Congenital nephritic syndrome   nephrotic syndrome manifesting at birth or within the first 3 mo
    Congenital nephritic syndrome   nephrotic syndrome manifesting at birth or within the first 3 mo
    • Other genetic causes

     Other genetic causes

    LO 2.3 Acute renal failure

    • rapid decline in glomerular filtration rate (GFR) over hours to days

    • usually asymptomatic and diagnosed when biochemical monitoring of hospitalized patients reveals a new increase in blood urea and serum creatinine concentrations

    • Categories

      • that cause renal hypoperfusion, resulting in decreased function without frank parenchymal damage (prerenal ARF, or azotemia) (~55%)

      • diseases that directly involve the renal parenchyma (intrinsic ARF) (~40%)

      • diseases associated with urinary tract obstruction (postrenal ARF) (~5%)

    Prerenal ARF (Prerenal Azotemia)

    • Etiology

    • Pathophysiology

      • Hypovolemia leads to a fall in mean systemic arterial pressure

      • detected as reduced stretch by arterial (e.g., carotid sinus) and cardiac baroreceptors

      • activation of the sympathetic nervous system and renin-angiotensin- aldosterone system

      • salt loss through sweat glands is inhibited, and thirst and salt appetite are stimulated. Renal salt and water retention also occur

      • In response to the reduction in perfusion pressure, stretch receptors in afferent arterioles trigger afferent arteriolar vasodilatation through a local myogenic reflex

      • constriction of efferent arterioles

      • GFR is preserved more severe hypovolemia AFR

    Intrinsic ARF

    • Etiology

    Postrenal ARF

    • Etiology

    Clinical assesment

    • Prerenal ARF

    • Intrinsic ARF

    • Complication

      • Expansion of extracellular fluid volume hypoosmolality and hyponatremia lead to neurologic abnormalities, including seizures

      • Hyperkalemia

      • metabolic acidosis

      • Hyperphosphatemia

      • Anemia

      • uremic syndrome

      • A vigorous diuresis can occur during the recovery phase of ARF

    • Prevention

      • Adjusting drug dosage (estimate the GFR using the Cockcroft- Gault formula)

     Prevention  Adjusting drug dosage (estimate the GFR using the Cockcroft- Gault formula)  Diuretics,
    • Diuretics, NSAIDs, ACE inhibitors, ARBs, and vasodilators should be used with caution in patients with suspected true or "effective" hypovolemia or renovascular disease

    • Treatment

      • Causative treatment

    • Indications for dialysis in ARF include the following:

      • Volume overload with evidence of hypertension and/or

    pulmonary edema refractory to diuretic therapy

    • Persistent hyperkalemia

    • Severe metabolic acidosis unresponsive to medical management

    • Neurologic symptoms (altered mental status, seizures)

    • Blood urea nitrogen greater than 100-150 mg/dL (or lower if rapidly rising)

    • Calcium/phosphorus imbalance, with hypocalcemic tetany

    LO 2.4 Chronic kidney disease

    • Chronic renal failure (CRF) is defined as an irreversible reduction in GFR

    • Etiology

      • result of congenital, acquired, inherited, or metabolic renal disease

      • children younger than 5 yr is most commonly a result of congenital abnormalities such as renal hypoplasia, dysplasia, and/or obstructive uropathy

      • After 5 yr of age, acquired diseases (various forms of glomerulonephritis) and inherited disorders (familial juvenile nephronophthisis, Alport syndrome) predominate

      • related to metabolic disorders (cystinosis, hyperoxaluria) and certain

    inherited disorders (polycystic kidney disease) may present throughout the childhood years

    • Classification

      • Mild chronic renal insufficiency: GFR 50-75 mL/min/l.73 m 2

      • Moderate chronic renal insufficiency: GFR 25-50 mL/min/l.73

        • m 2

      • Chronic renal failure (CRF): GFR 10-25 mL/min/l.73 m 2

      • End stage renal disease (ESRD): GFR < 10 mL/min/l.73 m 2

    • Clinical Manifestations

      • Anemia in patients with CRF is primarily the result of inadequate erythropoietin production by the failing kidneys and usually becomes manifest at a GFR less than 35 mL/min/1.73 m 2

      • The term renal osteodystrophy is used to indicate a spectrum of bone disorders seen in patients with CRF.

      • The most common condition seen in children is high-turnover bone disease caused by secondary hyperparathyroidism

    • Acidosis maintain the serum bicarbonate level above 22 mEq/L sodium bicarbonate tablets (650 mg equals 8 mEq of base)

    • Children with high blood pressure, edema, or heart failure sodium restriction and diuretic therapy

    • Hyperkalemia restriction of dietary potassium intake, administration of oral alkalinizing agents, and/or treatment with Kayexalate.

    • Nutritions

      • Dietary phosphorus, potassium, and sodium should be restricted according to the individual patient's laboratory studies and fluid balance.

      • Protein intake should be 2.5 g/kg/24 hr and should consist of proteins of high biologic value that are metabolized primarily

    to usable amino acids rather than to nitrogenous wastes. The

    proteins of highest biologic value are those of eggs and milk, followed by meat, fish, and fowl.

    • Tatalaksana

      • replacing absent/ diminished renal functions, which progressively increase in parallel with the progressive loss of GFR,

      • slowing the progression of renal dysfunction

    Daftar pustaka

    • Dalley, Arthur F. Keith L Moore. Clinically Oriented Anatomy. 5 th edition. Lippincott Williams & Wilcins; 2006

    • Nelson Textbook of Pediatric, 19th edition

    • Sherwood,Lauralee. Fisiologi Manusia dari Sel ke Sistem. Cetakan pertama edisi 2. Jakarta: EGC; 2001

    • Fauci. Braunwald. Dkk. Harrison’s Principles of Internal Medicine. 17 th edition. United State: The McGraw-Hills;
      2008

    • Guyton and Hall medical physiology