Download - Dr Dian-tractus Urinarius
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 1/72
TRACTUS URINARIUS
dr. Dian. Y. Lestari
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 3/72
Disorder of Kidney
• Congenital – Malformasi, ectopic, cysta, dysplasia
• Acquired – Glomeruli disease
– Tubulointersitial disease
– Renal calculi
– Neoplasma
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 6/72
• Primary – Acute diffuse post streptococcal
– Lipoid nephrosis or minimal change
– gA nephropathy
• Secondary – !L", Diabetes, #ypertension etc
• Immune, Toxic, metabolic
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 7/72
Cyst Disease of Kidney
• Simle cyst
• Adult olicystic !idney disease
• C"ild"ood olycystic !idney disease
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 9/72
Pat"ogenesis
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 11/72
Clinical Syndrome
• #efritic syndrome
• #efrotic syndrome
• Acute $enal %ailure &$P'#(• C"ronic $enal %ailure
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 12/72
#efritic Syndrome
Penya!it yang memacu reson eradanganroliferatif &sel endotel, sel mesangial)eitel(
• *ematuria ¯os)micros(• +liguria a-otemia
• *iertensi
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 13/72
Patofisiologi .
Proliferasi sel radang dlm glomeruli / infiltrat
le!ositi! merusa! dinding !ailer
eleasan sel dara" mera"
!elainan"emodinami! la0u '%$ menurun
oliguri, retensi cairan, a-otemia
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 14/72
• Diffuse Proliferati1e '#Diffuse Proliferati1e '# – $ost !treptococcal.
• $aidly Progressi1e '# &or Crescentic($aidly Progressi1e '# &or Crescentic(
–$ost !treptococcal, Goodpasture%s,
• %ocal 'lomerulone"ritis%ocal 'lomerulone"ritis
– $rimary& 'ergers disease (gA Nephritis)
– !econdary gA nephritis, #enoch !chonlein
purpura, !'", *oeliac Disease etc
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 15/72
$P'# ) '# Cresentic
• 2enurunnya fungsi gin0al dg ceat rogresif
• +liguri berat gagal gin0al
• Sindrom $P'# . – $asca infe+si (streptococcus)
– GN disertai penya+it sistemi+
– R$GN $rimer idiopati+
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 17/72
2acroscois
• 'in0al membesar, ucat
• Perdara"an tec"ie
• 'lomeruli necrosis focal, roliferasidifuse)focal, roliferasi mesangial
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 18/72
2icroscois
• 3ulan SA3IT &cresentic( ada glomeruli
o! roliferasi dari sel4sel eitel arietal
!asula bo5man infiltrasi monosit dan
macrofag
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 19/72
normal
!resnti!
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 20/72
Post Stretococcal '#
• 647 5ee!s follo5ing stretococcal infection
by ne"ritogenic strains &time for Ab
formation(
• Immune mediated
• 'ranular deosits of Ig',Ig2 C8 in '32,
&subeit"elial location common(
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 21/72
normal
inflamasi
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 22/72
Diffuse Proliferati1e '#.
• 9nlarged "yercellularglomeruli:
• *yerlasia of eit"elium endot"elium: Cell
S5elling:• Inflammatory cells:
• Collased caillaries:+bstruction to blood flo5:
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 23/72
#9%$+TIC S;#D$+2
Penya!it yang memengaru"i !eutu"andinding !ailer glomeruus &23'(
• 9dema generalisata• Proteinuria masif &< 7 g)"ari(
• *ioalbuminemia &= 8 g)6>>ml(
• *ierliidemia "ierliiduria
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 24/72
#9%$+TIC S;#D$+2
• ?ioid nefrosis• #efroati membranosa
• 'lomerulosis segmental focal
• 'lomerulonefritis Proliferasi membranosa&2P'#(
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 32/72
Disease $enal intersitium tubulus
• #efritis intersitial tubulus &TI#( –yelonefritis
– a+ut
–croni+
• #e!rosis tubuler a!uta
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 33/72
$Y"L-N"RT! A/0T
• Infe!si ba!teri – 9: coli <<< roteus, !lebsiella, seudomonas
• @alur – ascending, "ematogen
• Predisosisi – #amil 1 '$#
– 'atu 1 DM
– Tumor 12esicouretral refle+
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 34/72
macroscopis
• 'in0al # ) <<
• 3atas 0elas
• Ke!uningan
• microabcess
microscopis
• #ecrosis suuratif
• #ecrosis aila renalis
&necroti-ing yelonefritis(
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 36/72
microabces
Paila
necrosi
s
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 38/72
Cronic Pyelonefritis
Pembentu!an 0aringan arut intersitial
aren!im gin0al yang disertai embentu!an
0aringan arut deformitas sistem el1is
calyces
P# !ronis obstructi1e
nefroati reflu!s
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 39/72
#efroati reflu!s
• Paling sering• Bnilateral ) bilateral
• 2acros!ois . mengecil tida! sama rata
0aringan arut yang td! rata• 2icros . c"ronic inflammation, fibrosis,
tubular atro"y
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 41/72
ACBT9 TB3B?A$ #9C$+SIS
• Destru!si sel tubulus dan suresi a!ut fungsigin0al
• Penyebab A$%
• $e1ersible• 9tiologi . trauma berat, ancreatitis acut,
seti!emia
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 49/72
TB2+$ 'I#@A?
• Ca sel gin0al
• ilms tumor
• Tumor calyces el1is
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 50/72
Ca Sel 'in0al
• E> – F>G tumor ganas gin0al• H G !an!er ada de5asa
• De!ade – II
• ? . P J H . 6• Adeno Ca dari sel sel tubulus
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 51/72
macroscois
• 3esar, massa bulat , diameter 8 – 6 cm• Irisan . !uning – abu4abu – uti"
• ?una!, !isti!
• Perdara"an &/(• 3atas 0elas
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 53/72
microscois• Sel ber1acuol &lema! ) 0erni"(
• Selaut dinding sel &/(• Inti !ecil terdesa! !e basal
• Sel odosit miri tubulus dengan inti bulat,
!ecil, teratur
• Analasia &/(
• 2itosis <<
• Sel datia &/(
• Stroma ==L erdara"an &/(
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 55/72
'e0ala !linis
• Trias. – #ematuria tanpa nyeri
– Demam lama
– Nyeri tumpul pinggang
• Kadang .
– $olisitemia
– #ipercalcemia, hipertensi, cushing syndroma,
feminisasi masculinisasi
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 59/72
I?2S TB2+$
• Kan!er !e48 ada ana! = 6> t"
• Penyebab utama !ematian ada ana!
• Isi . mesoderm
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 60/72
macroscois
• 2assa bentu! bulat, sangat besar • Irisan .
– Daerah mi+somati+, luna+ spt daging i+an
– ;aringan hialin abu: padat spt tulang ra<an
– Necroti+ yang hemorrhagi+
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 62/72
microscois
• K"as . – Glomerulus primitif abortif
– *apsula bo<man tida+ terbentu+
– Tubulus primitif ter+urung stroma sel
spindle
– (=) >aring mesoderm & otot luri+ (??), otot
polos, tulang ra<an, dll
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 64/72
'e0ala !linis
• 2assa tumor teraba di abdomen• Kadang . anas ) nyeri abdomen
Prognosis . H ysr F>G
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 67/72
Tumor Pengumul Brin
• Calyces renalis, el1is renalis, Breter, B,Bret"ra
• 9itel transitional ola miri morfologinya
• 7 ola .
– *a papiloma papiler
– *a papiler in7asif
– *a datar non in7asif
– *a datar in7asif
8/19/2019 Dr Dian-tractus Urinarius
http://slidepdf.com/reader/full/dr-dian-tractus-urinarius 71/72
'e0ala !linis
• *ematuria tana nyeri• ? . P J H . 6
• De!ade – II
• Predisosisi
– !igaret, +onta+ beta1naftilamin
– !istitis +ronis
– !+istosomiasis
– si+lofosfamid