126185919 Referat Sindrom Nefrotik

7/25/2019 126185919 Referat Sindrom Nefrotik

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DAFTAR ISI

Halaman

KATA PENGANTAR .......................................................................... I

DAFTAR ISI ...................................................................................... ii

BAB I. PENDAHULUAN ........................................................... 1

BAB II. ANATOMI DAN FISIOLOGI DINJAL ............................. 2

II.1. Anatomi Ginjal ...................................................... 2

II.2. Fiiolo!i Daa" Ginjal ............................................ #

BAB III. SINDROMA NEFROTIK ................................................ $

III.1. D%&inii .................................................................. $

III.2. Ini'%n ................................................................ $

III.#. Etiolo!i .................................................................. (

III.). Pato&iiolo!i .......................................................... *

III.$. Mani&%tai Klini .................................................. 1(

III.(. Klai&i+ai Hito,atolo!i ...................................... 1*

III.-. Kom,li+ai ............................................................ #2

III.*. P%natala+anaan .................................................. #)

III.. P"o!noi .............................................................. #*

BAB I/. KESIMPULAN ............................................................... )0

DAFTAR PUSTAKA


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BAB I

PENDAHULUAN

Sin'"oma N%&"oti+ m%",a+an ,%na+it an! %"in! 'it%m+an 'a"i

3%3%"a,a ,%na+it !injal 'an al"an +%mi4.

Sin'"oma N%&"oti+ 5SN6 'a,at t%"ja'i %7a"a ,"im%" 'an %+n'%"8 ,"im%"

a,a3ila ti'a+ m%n%"tai ,%na+it it%mi+. S%+n'%" a,a3ila tim3l %3a!ai

3a!ian 'a"i,a'a ,%na+it Sit%mi+ ata an! 3%"43n!an '%n!an o3at 9 To+in.

Pa'a ana+:ana+ +i"a:+i"a 0; 'i%3a3+an ol%4 ,ana+it Glom%"l

,"im%" 'an 10; a'ala4 %+n'%" 'i%3a3+an ol%4 ,%na+it Sit%mi+.

R%i+o ,%na+it jantn! +o"on%" ata At%"o+l%"oi ,a'a ,%n'%"ita

Sin'"oma N%&"oti+ ana+ 3%lm 'i+%ta4i '%n!an j%la. Dalam la,o"an:la,o"an

,%m%"i+aan ,ot mo"t%m ,a'a ana+:ana+ 'an '%


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BAB II

ANATOMI DAN FISIOLOGI GINJAL

II. 1. Anatomi Ginjal

Ginjal t%"l%ta+ 'i 'alam "an! "%t"o,%"iton%m %'i+it 'i ata

+%tin!!ian m3ili+ 'an +ia"an ,anjan! %"ta 3%"atna 3%"t"t:t"t 'a"i

+i"a:+i"a ( 7m 'an 2) ! ,a'a 3ai 7+, 3lan am,ai 12 7m ata l%3i4

'a"i 1$0 ! ,a'a o"an! '%8 %"ta 'i la,ian 'alam8 medula an! m%n!an'n!

3a!ian:3a!ian t3l an! l"8 l%n!+n! 5ana6 H%ni%8 >aa "%+ita 'an

'+t +oli!%n t%"minal.

Pao+an 'a"a4 ,a'a %tia, !injal 3iaana t%"'i"i 'a"i a"t%"i "%nali

tama an! +%la" 'a"i ao"ta ? a"t%"i "%nali mlti,%l 3+anna ti'a+ la@im

'ijm,ai. A"t%"i "%nali tama m%m3a!i m%nja'i m%'la +% 3ata anta"a

+o"t%+ 'an m%'la. Pa'a 'a%"a4 ini8 a"t%"i int%"lo3a"i 3%"7a3an!

m%m3%nt+ a"t%"i a"+ata8 'an m%m3%nt+ a"t%"iol% a&%"%n !lom%"l.

S%l:%l otot a!n t%",%ialiai 'alam 'in'in! a"t%"iol% a&%"%n8 3%"ama

'%n!an %l la7i 'an 3a!ian 'ital t3l 5m+la '%na6 an!

3%"'%+atan '%n!an !lom%"l8 m%m3%nt+ a,a"at j+ta!lom%"l%"

a!n m%n!%n'ali+an %+"%i "%nin. A"t%"iol% a&%"%n m%m3a!i m%nja'i

anaman +a,il%" !lom%"l8 an! +%m'ian 3%"!a3n! m%nja'i a"t%"iol%

%&%"%n. A"t%"iol% %&%"%n !lom%"l '%+at m%'la 5!lom%"l

j+tam%'lla"i6 l%3i4 3%a" 'a"i ,a'a a"t%"iol% 'i +o"t%+ %3%la4 la" 'an

m%m3%"i+an ,ao+an 'a"a4 5>aa "a+ta6 +% t3l 'an m%'la.

S%tia, !injal m%n!an'n! %+ita" at j!a n%"on 5!lom%"l 'an

t3l t%"+ait6. Pa'a mania8 ,%m3%nt+an n%&"on t%la4 %m,"na ,a'a

aat la4i"8 t%ta,i mat"ai &n!ional 3%lm t%"ja'i am,ai 'i +%m'ian 4a"i.

Ka"%na ti'a+ a'a n%&"on 3a" a!n 'a,at 'i3%nt+ %'a4 la4i"8 4ilan!na

n%&"on %7a"a ,"o!"%i& 'a,at m%n%3a3+an in&ii%ni !injal.

#


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Anaman +a,il%" !lom%"l an! t%",%ialiai 3%",%"an %3a!ai

m%+anim% ,%na"in!an !injal. Ka,il%" !lom%"l 'ila,ii ol%4 %n'ot%lim

a!n m%m,nai ito,lama an!at ti,i a!n 3%"ii 3ana+ l3an!

5&%n%t"ai6. M%m3"ana 3aali !lom%"l 5BMG6 m%m3%nt+ la,ian

3%"+%lanjtan anta"a %n'ot%l 'an %l m%an!im ,a'a at ii '%n!an %l

%,it%l ,a'a ii an! lain. M%m3"an m%m,nai # la,ian. 516 lamina

'%na an! %nt"alna ,a'at:%l%+t"on8 526 lamina "a"a int%"na8 a!n

t%"l%ta+ 'i anta"a lamina '%na 'an %l:%l %n'ot%lian ? 'an 5#6 lamina "a"a

%+t%"na8 an! t%"l%ta+ 'i anta"a lamina '%na 'an %l:%l %,it%l. S%l %,it%l

>it%>i7%"a m%nt,i +a,il%" 'an m%nonjol+an tonjolan +a+i it,lama8

a!n m%l%+at ,a'a lamina "a"a %+t%"nal. Di anta"a tonjolan +a+i a'a

"an!an ata 7%la4 &ilt"ai. M%an!im 5%l m%an!im 'an mat"i+6

t%l%ta+ 'i anta"a +a,il%":+a,il%" !lom%"l ,a'a ii %n'ot%l m%m3"ana

3aali 'an m%n3%nt+ 3a!ian t%n!a4 'in'in! +a,il%". M%an!im 'a,at

3%",%"an %3a!ai t"+t" ,%n'+n! ,a'a +%,il%" !lom%"l 'an

mn!+in m%main+an ,%"an 'alam ,%n!at"an ali"an 'a"a4 !lom%"l8

&ilt"ai 'an ,%m3an!nan ma+"omol%+l 5%,%"ti +om,l%+ imn6 'a"i

!lom%"li8 m%lali &a!oitoi int"a%ll%" ata '%n!na ,%n!a+tan

m%lali al"an int%"%ll%" +% 'a%"a4 j+ta!om%"l. Ka,la Bo


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Fun!i Utama Ginjal

Fun!i E"!"#$!i

M%m,%"ta4an+an omolaliti ,lama %+ita" 2$* m omol '%n!na

m%n!3a4:3a4 %+"%i ai".

M%m,%"ta4an+an ,H ,lama +ita" -8) '%n!na m%n!%la"+an +%l%3i4an H C

'an m%m3%nt+ +%m3ali H=O#.

M%n!%++"%i+an ,"o'+ a+4i" nit"o!%n 'a"i m%ta3olim% ,"ot%in8 t%"tama

"%a8 aam "at 'an +"%atinin.

Fun!i Non%$"!"#$!i

M%n!4ail+an "%nin:,%ntin! nt+ ,%n!at"an t%+anan 'a"a4.

M%n!4ail+an %"it"o,oi%tin:&a+to" ,%ntin! 'alam timlai ,"o'+ %l 'a"a4

m%"a4 ol%4 mm tlan!.

M%ta3olim% >itamin D m%nja'i 3%nt+ a+ti&na.

D%!%n%"ai inlin

M%n!4ail+an ,"ota!lan'in

$


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BAB III

SINDROM NEFROTI&

III.1. DEFINISI

Sin'"om n%&"oti+ 3+an at ,%na+it t%"%n'i"i8 m%lain+an

m%",a+an +om,l% !%jala +lini+ an! 'a,at 'i%3a3+an ol%4 3%"3a!ai

,%na+it8 '%n!an 7i"i:7i"i %3a!ai 3%"i+t

: edema umum 5anaa"+a68 t%"tama j%la ,a'a m+a 'an ja"in!an

,%"io"3ital.

: Proteinuria, t%"ma+ albuminuria ; %3a!ai 3ata 3iaana iala4 3ila

+a'a" ,"ot%in ,lama total +"an! 'a"i ( !"am ,%" 100 ml 'an &"a+i

al3min +"an! 'a"i # !"am ,%" 100 ml.

: Hiperlipidemi,+4na hiperchlolesterolemi ; %3a!ai 3ata 3iaana

iala4 3ila +a'a" 74ol%t%"ol ,lama total l%3i4 'a"i #00 mili!"am ,%" 100

ml.

: Lipiduria ; 'a,at 3%",a l%ma+ 3%3a8 %l %,it%l 3lat an!

m%n!an'n! l%ma+ 5o>%l &at 3o'i%68 to"a+ l%ma+.Ka'an!:+a'an! ti'a+ %ma !%jala t%"%3t 'i ata 'it%m+an. A'a

a!n 3%",%n'a,at 3a4


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K%lom,o+ ti'a+ "%,oni& t%"oi' ata "%it%n t%"oi' t%"'i"i 'a"i ana+:

ana+ '%n!an +%lainan !lom%"l lain. Di%3t in'"om n%&"oti+ %+n'%"

a,a3ila ,%na+it 'aa"na a'ala4 ,%na+it it%mi+ +a"%na8 o3at:o3atan8

al%"!%n 'an to+in8 'll. Sin'"om n%&"oti+ 'a,at tim3l 'an 3%"i&at

%m%nta"a ,a'a tia, ,%na+it !lom%"l '%n!an +%la"na ,"ot%in 'alam

jmla4 an! 7+, 3ana+ 'an 7+, lama.

III.'. ETIOLOGI

S%3a3 an! ,ati 3%lm 'i+%ta4i ? a+4i":a+4i" ini 'ian!!a, %3a!ai

at ,%na+it atoimn. Ja'i m%",a+an at "%a+i anti!%n:anti3o'i.

Ummna ,a"a a4li m%m3a!i %tiolo!ina m%nja'i

I. Sin'"om n%&"oti+ 3a


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III. Sin'"om n%&"oti+ i'io,ati+ 5ti'a+ 'i+%ta4i %3a3na6.

B%"'aa"+an 4ito,atolo!i an! tam,a+ ,a'a 3io,i !injal '%n!an

,%m%"i+aan mi+"o+o, 3iaa 'an mi+"o+o, %l%+t"on8 =4"! '++.

M%m3an!i 'alam ) !olon!an ait

1. Kelainan minimal

D%n!an mi+"o,o+ 3iaa !lom%"l tam,a+ no"mal8 %'an!+an

'%n!an mi+"o+o, %l%+t"on t%"'a,at I!G ata imno!lo3lin 3%t:1=

,a'a 'in'in! +a,il%" !lom%"l.

Golon!an ini l%3i4 3ana+ t%"'a,at ,a'a ana+ 'a"i,a'a o"an!

'%i%"al.

*


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'. Glom%"lon%&"iti m%m3"ano,li&%"ati&.

P"oli&%"ai %l m%an!ial 'an ,%n%m,aan &i3"in an! m%n%",ai

m%m3"ana 3aali 'i m%an!im. Tit%" !lo3lin 3%ta:1= ata 3%ta

1A "%n'a4.

%. Lain:lain.

Mialna ,%"3a4an ,"oli&%"ai an! ti'a+ +4a.

I/. Glom%"lo++l%"oi &o+al %!m%ntal.

Pa'a +%lainan ini an! m%nolo+ +l%"oi !lom%"l. S%"in! 'i%"tai

'%n!an at"o&i t3l.

P"o!noi 3"+.

III.(. PATOFISIOLOGI

P#ot$inu#ia

P"ot%in"ia mna 'it%"ima +%lainan tama ,a'a SN8 %'an!+an

!%jala +lini lainna 'ian!!a, %3a!ai mani&%tai %+n'%". P"ot%in"ia

'inata+an 3%"at nt+ m%m3%'a+an '%n!an ,"ot%in"ia an! l%3i4

"in!an ,a'a ,ai%n an! 3+an in'"om n%&"oti+. E+"%i ,"ot%in amaata l%3i4 3%a" 'a"i )0 m!9jam9m2 la ,%"m+aan 3a'an8 'ian!!a,

,"ot%in"ia 3%"at.

S$l$"ti)ita! *#ot$in

J%ni ,"ot%in an! +%la" ,a'a in'"om n%&"oti+ 3%">a"iai

3%"!antn! ,a'a +%lainan 'aa" !lom%"l. Pa'a SNKM ,"ot%in an!

+%la" 4am,i" %l"4na t%"'i"i ata al3imin 'an 'i%3t %3a!ai

,"ot%in"ia %l%+ti&. D%"ajat %l%+ti>ita ,"ot%in"ia 'a,at 'it%ta,+an %7a"a

%'%"4ana '%n!an m%m3a!i "aio I!G "in t%"4a'a, ,lama 5BM 1$0.0006

'%n!an "aio "in ,lama t"an&%"in 5BM **.0006. Raio an! +"an! 'a"i

0.2 m%nnj++an a'ana ,"ot%in"ia %l%+ti&. Pai%n SN '%n!an "aio

"%n'a4 mmna 3%"+aitan '%n!an KM 'an "%,oni& t%"4a'a, t%"oi'.


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Namn +a"%na %l%+ti>ita ,"ot%in ,a'a SN an!at 3%">a"iai ma+a a!a+

lit nt+ m%m3%'a+an j%ni KM 'an BKM 5B+an +%lainan minimal6

'%n!an ,%m%"i+aan ini 'ian!!a, ti'a+ %&ii%n.

P$#u+a,an *a-a ilt$# "a*il$# lom$#ulu!

Ummna +a"a+t%"iti+ ,%"3a4an ,%"m%a3ilita m%m3"an 3aal

3%"!antn! ,a'a ti,% +%lainan !lom%"l ,a'a SN. Pa'a SNKM t%"'a,at

,%n"nan +li"%n ,"ot%in n%t"al '%n!an %ma 3%"at mol%+l8 namn

t%"'a,at ,%nin!+atan +li"%n ,"ot%in 3%"matan n%!ati& %,%"ti al3min.

K%a'aan ini m%nnj++an 3a4


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Hi*oal+umin$mia

Jmla4 al3min 'i 'alam 'it%nt+an ol%4 ma+an 'a"i int%i

4%,a" 'an ,%n!%la"an a+i3at '%!"a'ai m%ta3oli+8 %+"%i "%nal 'an

!at"oint%tinal. Dalam +%a'aan %im3an!8 laj int%i al3min8 '%!"a'ai

ini 4ilan!na 'a"i 3a'an a'ala4 %im3an!. Pa'a ana+ '%n!an SN t%"'a,at

43n!an t%"3ali+ anta"a laj %+"%i ,"ot%in "in 'an '%"ajat

4i,oal3min%mia. Namn +%a'aan ini ti'a+ "%,oni& t%"oi'8 al3min

%"mna 'a,at +%m3ali no"mal ata 4am,"i no"mal '%n!an ata tan,a

,%"3a4an ,a'a laj %++"%i ,"ot%in. Laj int%i al3min ,a'a SN

'alam +%a'aan %im3an! t%"nata ti'a+ m%n"n8 3a4+an m%nin!+at ata

no"mal.

Jmla4 al3min a3olt a!n 'i'%!"a'ai mai4 no"mal ata 'i

3a


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&$lainan m$ta+oli!m$ li*i-

Pa'a ,ai%n SN ,"im%" tim3l 4i,%"+ol%t%"ol%mia 'an +%nai+an ini

tam,a+ l%3i4 nata ,a'a ,ai%n '%n!an KM. Ummna t%"'a,at +o"%lai

t%3ali+ anta"a +on%nt"ai al3min %"m 'an +ol%t%"ol. Ka'a" t"i!li%"i'

l%3i4 3%">a"iai 'an 3a4+an 'a,at no"mal ,a'a ,ai%n '%n!an

4i,oal3min%mia "in!an. Pa'a ,ai%n '%n!an anal3min%mia +on!%nital

'a,at j!a tim3l 4i,%"li,i'%mia an! m%nnj++an 3a4


13/33

3%nt+ titi+ l%ma+ o>al 'an maltase cross. Titi+ l%ma+ it m%",a+an

t%t%an li,i' 'i 'alam %l t3l an! 3%"'%!%n%"ai. altese cross

t%"%3t a'ala4 %t%" +ol%t%"ol an! 3%"3%nt+ 3lat '%n!an ,alan! 'i

t%n!a4 a,3ila 'ili4at '%n!an 7a4aa ,ola"ial.

E-$ma

K%t%"an!an +lini+ ,%m3%nt+an %'%ma ,a'a i'n"om n%&"oti+

'a4 'ian!!a, j%la 'an %7a"a &iiolo!i+ m%ma+an8 namn 3%3%"a,a

'ata m%nnj++an 3a4a+la". K%a'aan ini m%n%3a3+an m%nin!+atna 7ai"an

t"an'at m%l%a+la" +% "an!int%"tial an! m%n%3a3+an t%"3%nt+na %'%ma.

1#


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&$lainan lom$#ulu!

Al3min"ia

Hi,oal3min%mia

T%+anan on+oti+ 4i'o",ati+ +oloi' ,lama

/olm% ,lama

R%t%ni Na "%nal %+n'%"

E'%ma

T$#+$ntu"n/a $-$ma m$nu#ut t$o#i underfilled

S%3a!ai a+i3at ,%"!%%"an 7ai"an >olm% ,lama total 'an >olm%

'a"a4 a"t%"i 'alam ,%"%'a"an m%n"n 'i3an'in! '%n!an >olm% i"+lai

%&%+ti&. M%n"nna >olm% ,lama ata >olm% i"+lai %&%+ti&

m%",a+an timlai tim3lna "%t%ni ai" 'an nat"im "%nal. R%t%ni

nat"im 'an ai" ini tim3l %3a!ai a4a 3a'an nt+ m%nja!a >olm% 'an

t%+anan int"a>a+la" a!a" t%ta, no"mal 'an 'a,at 'ian!!a, %3a!ai

,%"iti


15/33

ini j%la m%m,%"3%"at %'%ma am,ai t%"'a,at +%%im3an!an 4in!!a

%'%ma ta3il.

D%n!an t%o"i underfilled ini 'i'!a t%"ja'i t%"ja'i +%nai+an +a'a"

"%nin ,lama 'an al'ot%"on %+n'%" t%"4a'a, a'ana 4i,o>ol%mia. Hal

ini ti'a+ 'it%m+an ,a'a %ma ,ai%n '%n!an SN. B%3%"a,a ,ai%n SN

m%nnj++an m%nin!+atna >olm% ,lama '%n!an t%"t%+anna a+ti>ita

"%nin ,lama 'an +a'a" al'ot%"on8 %4in!!a tim3l +on%, t%o"i o!erfilled.

M%n"t t%o"i ini "%t%ni nat"im "%nal 'an ai" t%"ja'i +a"%na m%+anim%

int"a"%nal ,"im%" 'an ti'a+ 3%"!antn! ,a'a timlai it%mi+ ,%"i&%".

R%t%ni nat"im "%nal ,"im%" m%n!a+i3at+an %+,ani >olm% ,lama 'an

7ai"an %+t"a%ll%". P%m3%nt+an %'%ma t%"ja'i %3a!ai a+i3at o!erfilling

7ai"an +% 'alam "an! int%"tiaial. T%o"i o!erfilled ini 'a,at m%n%"an!+an

a'ana >olm% ,lama an! tin!!i '%n!an +a'a" "%nin ,lama 'an

al'ot%"on m%n"n %+n'%" t%"4a'a, 4i,%">ol%mia.

&$lainan lom$#ulu!

R%t%ni Na "%nal ,"im%"i

/olm% ,lama

E'%ma

T%"ja'ina %'%ma m%n"t t%o"i o!erfilled

M%l@%" '++ m%n!l+an 2 3%nt+ ,ato&iolo!i SN8 ait ti,%

n%&"oti+ 'an ti,% n%&"iti+. Ti,% n%&"oti+ 'itan'ai '%n!an >olm% ,lama

"%n'a4 'an >ao+ont"i+i ,%"i&%" '%nan +a'a" "%nin ,lama 'an

1$

Al3min"iaHi,oal3min%mia


16/33

al'ot%"on an! tin!!i. Laj &ilt"ai !lom%"l 5LFG6 mai4 3ai+ '%n!an

+a'a" al3min an! "%n'a4 'an 3iaana t%"'a,at ,a'a SNKM.

Ka"a+t%"iti+ ,ato&iiolo!i +%lom,o+ ini %ai '%n!an t%o"i t"a'iional

underfilled ait "%t%ni nat"im 'an ai" m%",a+an &%nom%na %+n'%". Di

,i4a+ lain8 +%lom,o+ +%'a ata ti,% n%&"iti+8 'itan'ai '%n!an >olm%

,lama tin!!i8 t%+anan 'a"a4 tin!!i 'an +a'a" "%nin ,lama 'an

al'ot%"on "%n'a4 an! m%nin!+at %'a4 ,%"%'iaan nat"im 4a3i.

+%lom,o+ +%'a ini 'ijm,ai ,a'a !lom%"lon%&"iti +"oni+ '%n!an LFG

an! "%lati& l%3i4 "%n'a4 'an al3min ,lama l%3i4 tin!!i 'a"i +%lom,o+

,%tama. Ka"a+t%"iti+ ,ato&iiolo!i +%lom,o+ +%'aini %ai '%n!an t%o"i

o!erfilled ,a'a SN '%n!an "%t%ni ai" 'an nat"im an! m%",a+an

&%nom%na ,"im%" int"a"%nal.

P%m3%nt+an %'%ma ,a'a SN m%",a+an at ,"o% an!

'inami 'an mn!+in aja +%'a ,"o% underfilled 3%"lan!n!

3%"amaan ata ,a'a a+la" a+an m%"an!an!

+%la"na "%nin 'an m%nim3l+an "an!an!an non omoti+ nt+ +%la"na

4o"mon >olm% "in an! %'i+it 'an ,%+at '%n!an %'i+it nat"im.

Ka"%na ,ai%n '%n!an 4i,o>ol%mia 'i%"tai "%nin 'an al'ot%"on

an! tin!!i mmna m%n'%"ita ,%na+it SNKM 'an "%,oni& t%"oi'8

%'an!+an m%"%+a '%n!an >olm% 'a"a4 no"mal ata m%nin!+at 'i%"tai

"%nin 'an al'ot%"on "%n'a4 mmna m%n'%"ita +%lainan BKM 'an ti'a+

"%,oni& t%"oi'8 ma+a ,%m%"i+aan "%nin 'a,at m%",a+an ,%tan'a an!

3%"!na nt+ m%nilai %o"an! ana+ '%n!an SN "%,oni& t%"4a'a, t%"oi'

ata ti'a+ 'iam,in! a'ana SNKM. Namn '%"ajat tm,an! tin'i4a

t%"lal 3%a"8 %4in!!a +a" nt+ m%m3%'a+an ,ai%n anta"a +%'a

+%lom,o+ 4itolo!i t%"%3t ata 'aa" ,%m%"i+aan "%nin. P%"an ,%,ti'a

1(


17/33

nat"i"%ti+ at"ial 5ANP6 'alam ,%m3%nt+an %'%ma 'an 'i"%i mai4

3%lm ,ati.

III.0. MANISFESTASI &LINIS

EDEMA

Di maa lal o"an!ta m%n!an!!a, ,%na+it SN ini a'ala4 %'%ma.

Na& ma+an an! +"an!. M'a4 t%"an!an! a'ana !an!!an

!at"oint%tinal 'an %"in! t%"+%na in&%+i 3%"at m%",a+an +%a'aan an!

an!at %"at 43n!anna '%n!an 3%"atna %'%ma8 %4in!!a 'ian!!a,

!%jala:!%jala ini %3a!ai a+i3at %'%ma.

ala,n ,"ot%in"ia +am34 ,a'a 4am,i" 29# +a8 +am34na

%'%ma 'a,at 'i7%!a4 ,a'a mmna '%n!an ,%n!o3atan %!%"a. Namn

%'%ma ,%"it%n '%n!an +om,li+ai an! m%n!!an! m%",a+an maala4

+lini+ tama 3a!i m%"%+a an! m%nja'i non "%,on'%n 'an ,a'a m%"%+a

an! %'%mana ti'a+ 'a,at %!%"a 'iatai. E'%ma mmna t%"li4at ,a'a

+%'a +%lo,a+ mata. E'%ma minimal t%"li4at ol%4 o"an!ta ata ana+ an!

3%a" %3%lm +%'o+t%" m%li4at ,ai%n nt+ ,%"tama +ali 'an

m%mati+an +%lainan ini. E'%ma 'a,at m%n%ta, ata 3%"ta3a48 3ai+lam3at ata 7%,at ata 'a,at m%n!4ilan!+an 'an tim3l +%m3ali. S%lama

,%"io'% ini %'%ma ,%"io"3ital %"in! 'i%3a3+an ol%4 7a7a 'in!in ata

al%"!i. Lam3at lan %'%ma m%nja'i m%n%l"48 ait +% ,in!!an!8 ,%"t

'an tn!+ai 3a


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Ganuan a!t#oint$!tinal

Gan!!an ini %"in! 'it%m+an 'alam ,%"jalanan ,%na+it SN.

Dia"% %"in! 'ialami ,ai%n 'alam +%a'aan %'%ma an! mai& 'an

+%a'aan ini ",ana ti'a+ 3%"+aitan '%n!an in&%+i namn 'i'!a

,%n%3a3na a'ala4 %'%ma 3m+oa 'i m+oa . H%,atom%!ali

'a,at 'it%m+an ,a'a ,%m%"i+aan &ii+8 mn!+in 'i%3a3+an int%i

al3min an! m%nin!+at8 ata %'%ma ata +%'ana. Pa'a 3%3%"a,a

,ai%n8 n%"i 'i ,%"t an! +a'an!:+a'an! 3%"at8 'a,at t%"ja'i ,a'a

+%a'aan SN an! +am34. K%mn!+inan a'ana a3'om%n a+t ata

,%"itoniti 4a" 'iin!+i"+an '%n!an ,%m%"i+aan &ii+ 'an ,%m%"i+an

lainna. Bila +om,li+ai ini ti'a+ a'a8 +%mn!+inan ,%n%3a3 n%"i ti'a+

'i+%ta4i namn 'a,at 'i%3a3+an +a"%na %'%ma 'in'in! ,%"t ata

,%m3%n!+a+an 4ati. Ka'an! n%"i 'i"aa+an t%"3ata ,a'a 'a%"a4

+a'"an ata +anan a3'om%n. Na& ma+an +"an! 3%"43n!an %"at

'%n!an 3%"atna %'%ma an! 'i'!a %3a!ai a+i3atna. Ano"%+ia 'an4ilan!na ,"ot%in 'i 'alam "in m%n!a+i3at+an malnt"ii 3%"at an!

+a'an! 'it%m+an ,a'a ,ai%n SN non:"%,oni& t%"oi' 'an ,%"it%n.

Pa'a +%a'aan ait% t%"ja'i 4%"nia m3ili+ali 'an ,"ola, ani.

Ganuan *$#na*a!an

Ol%4 +a"%na a'ana 'it%ni a3'om%n '%n!an ata tan,a %&i

,%l"a ma+a ,%"na,aan %"in! t%"!an!!8 3a4+an +a'an!:+a'an!

m%nja'i!a


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Ganuan un!i *!i"o!o!ial

K%a'aan ini %"in! 'it%m+an ,a'a ,ai%n SN8 %,%"ti 4alna

,a'a ,%na+it 3%"at mmna an! m%",a+an t"% non,%i&i+

.P%"aaan:,%"aaan ini m%m%"l+an 'i+i8 ,%nj%laan 'an +%,atian

nt+ m%n!ataina.

III.. &LASIFI&ASI HISTOPATOLOGIS

Klai&i+ai +%lainan 4ito,atolo!i !lom%"l ,a'a SN an!

'i!na+an %ai '%n!an "%+om%n'ai Komii Int%"naional 51*26.

K%lainan !lom%"l ini %3a!ian 3%a" 'it%!a++an '%n!an ,%m%"i+aaan

mi+"o+o, 7a4aa8 'itam3a4 '%n!an ,%m%"i+aan mi+"o+o, %l%+t"on 'an

imno&lo"%%ni. Pa'a ta3%l 'i 3a


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Glom%"lon%&"iti +"oni+ lanjt 5GNKL6

MORFOLOGI &ELAINAN GLOMERULUS PRIMER

A. P$n/a"it"$lainan minimal &M3

ISKD= 51-*6 mala,o"+an ,a'a ,%n%litianna 'ianta"a $21 ,ai%n SN8

-(8); m%n'%"ita KM. Pa'a ,%n%litian 'i Ja+a"ta 5ila Ei"a8 126

'ianta"a #() ,ai%n an! 'i3io,i ))82; m%nnj++an Km.

B. Glom$#ulo!"l$#o!i! o"al !$m$ntal GSFS3

P%na+it !lom%"l &o+al m%",a+an at ,"o% ,%na+it an!

m%n!%nai 4ana 3%3%"a,a !lom%"l8 %'an! an! lainna tam,a+

no"mal. P%na+it !lom%"la" %!m%ntal m%nata+an 3%3%"a,a lo3

!lo%m"l t%"+%na8 %'an!+an an! lain mai4 no"mal. K%lainan ini 'a,at

'ijm,ai ,a'a 3%3%"a,a +%lainan !lom%"l ata 3a4+an ,a'a +%lainan

t3lo int%"tiial. Namn +%lainan ini 'it%m+an t%"%n'i"i ,a'a ,ai%n

'%n!an SN. A,a+a4 +%lainan ini m%",a+an ,%na+it t%"%n'i"i ata at

,"o!"%i>ita ,%na+it KM 3%lm 'a,at 'i,ati+an. K%mn!+inan iala43a4


21/33

D. Glom$#ulon$#iti! m$m+#ano*#oli$#ati GNMP3

Di+%nal # 3ti,% ,a'a +%lainan ini ait ti,% I an! m%",a+an ti,% +lai+

'an ti,% III an! %"at 43n!anna8 4ana 3%"3%'a ,aa'a l%ta+ '%,oit

imnna. S%'an! ti,% II8 ata ,%na+it '%,oit ,a'at 5denso"deposit

disease6


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,%"toniti ,"im%"8 %llita in&%+i al"an +%mi48 3"on+,n%monia 'an

in&%+i >i".

2. T"om3o%m3oli 'an !an!!an +oa!lai

,a'a ,%n'%"ita SN t%"ja'i 4i,%"+oa!lai 'an 'a,at m%nim3l+an

t"om3o%m3oli 3ai+ ,a'a ,%m3l4 'a"a4 >%na ma,n a"t%"i. K%a'aan

ini 'i%3a3+an ol%4 &a+to":&a+to"

,%"3a4an @mo!%n 'an +o&a+to" 'alam 4al ini ,%ni!n+atan &a+to

/../II. Fi3"ino!%n 'an &a+to >on ill%3"an'.

,%"3a4an &n!i ,lat%l%t +a"%na 4i,oal3min%mai8 4i,%"li,o'%mia

,%"3a4an &n!i %l %n'ot%lial +a"%na ,%"3a4an i"+lai li,i'

P%"an o3at +o"ti+ot%"oi' a+ni m%nin!+at+an +on%nt"ai F7. /III

'an m%m,%",%n'%+ P"ot"om3in tim% 'an PTT Namn 'alam 'oii

3%a" +oti+ot%"oi' a+an m%ni!n+at+an AT III 'an m%n7%!a4

a!"%!ai t"om3ot.

Di"%ti+ a+an m%n"n+an >ol%m ,lama %4in!!a m%nin!!i+an

an!+a 4%mato+"it '%n!an '%mi+ian >i+oita 'a"a4 'an +on%nt"ai

&i3"ino!%n a+an m%nin!+at.

#. P%"3a4an m%ta3olim% l%ma+8 +a"3o4i'"at 'an ,"ot%in

Pa'a ,%n'%"ita SN t%"ja'i ,%nin!+atan total +ol%t%"ol8 LDL 'an /LDL

%ta a,oli,o,"ot%in 'i 'alam ,lama %m%nta"a HDL 'a,t no"mal ata

t"n +4na HDL 2. Hi,%"li,i'%mia ini 3%"lan!n! lama 'an ti'a+

t%"+ont"ol 'a,at m%m,%"7%,at ,"o% at%"o+l%"oi ,%m3l4 'a"a4+o"on%". Ao"ta 'an a"t%"ia "%nali. Hal ini 'a,at m%n%3a3+an t%"ja'ina

,%na+ti jantn! %+%mi+ ata,n t"om3oi a"t%"i R%nali.

Ti'a+ %,%ti ,a'a l%ma+8 ,%n%litian m%n!%nai ,%"3a4an m%ta3olim%

+a"3o4i'"at 3%lm +om,"%4%ni&. Namn t%la4 'i+%ta4i ,a'a 4ati an!

22


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m%nint%i ,"ot%in l%3i4 3%a" a+an m%nin!+at+an ,ti+o!%nolii8

%lain it 'i'a,at+an ,%ni!n+atan am3an! >%,in t%"4a'a, inlin 'an

!l+oa. Hal ini 'a,at t%"ja'i 4i,oal3min%mia ,a'a +%a'aan malnt"ii

+"oni+. S%jmla4 ,"ot%in ,lama an! ,%ntin! ,a'a t"an,o"t 3%i8

4o"mon 'an o3at:o3atan8 +a"%na mol%+lna +a7il8 '%n!an m'a4

+%la" m%lali "in8 +%4ilan!an @at:@at t%"%3t a+an m%n!a+i3at+an

4al:4al %3a!ai 3%"i+t

T"an&%"in ion an! m%n"n m%n%3a3+an an%mia

P%n"nan %"lo,lamin 3%lm 'ila,o"+an a+i3at +linina

B%"+"an!na al3min ,%n!i+at %n! 'an 3%i m%n%3a3+an

4i,o!%nia 'an ,%n"nan %l:%l imnita.

B%"43n!an ,"ot%in ,%n!i+at >itamin D a+an m%m,%n!a"4i

m%ta3olim% +alim %4in!!a t%"ja'i ot%omalaia 'an 4i,%"

,a"ati"oi'.

B%"+"an!na ,"ot%in ,%n!i+at +otiol m%n%3a3+an 'i3t4+anna

'oi l%3i4 3%a" t%"4a'a, +o"ti+ot%"oi'.

K%4ilan!an %jmla4 3%a" ,"ot%in ini a+an m%n%3a3+an ,%n'%"ita

jat4 'alam +%a'aan malnt"ii. Ka"%na it 'ilanjt+an 'i%t tin!!i

,"ot%in 'i3%"i+an 2:# $ !"am9+!92) jam nt+ m%m,%"ta4an+an

+%%im3an!an nit"o!%n. Di%t "%n'4a ,"ot%in8 m%+i 'a,at m%n!"an!i

,"ot%in"ia 'alam jan!+a ,%n%+ m%m,nai "ii+o +%im3an!an n%!ati&

'i maa m%n'atan!.

). Ga!al Ginjal A+t 5GGA6

Kom,li+ai ini m%+anim%na 3%lm j%la. Namn 3ana+ 'it%m+an

,a'a ,%n'%"ita SN '%n!an l%i minimal 'an !"om%"lo+l%"oi &o+al.

'i,%"+i"a+an a+i3at 4i,o>%l%mia 'an ,%n"nan ,%"&i +% !injal. a+i3at

2#


24/33

'a"i GG ,a'a ,%n'%"ita SN 7+, %"i. 1*; m%nin!!al. 20; 'a,t

3%"ta4an ta,i ti'a+ a'a ,%"3ai+an &n!i !injal 'an m%m%"l+an 'ialii.

III.6. PENATALA&SANAAN

Ka SNP '%n!an KM ,a'a ,%m%"i+aan 4itolo!ina 'a,at

%m34 '%n!an ,%n!o3atan ,"%'nion 'alam


25/33

o3at 'i4%nti+an #(; +a ,a'a ,%m3%"ian 12 min!! 'i3an'in!+an

'%n!an *1; +a '%n!an 7a"a ,%m3%"ian 3a+ ISKD= * min!!.

Bila t%"ja'i +am34 %t%la4 ,%n!o3atan 'i4%nti+an8 ma+a ,%n!o3atan

'ilan! '%n!an 7a"a 3+ ISKD= ait 'oi ,%n4 tia, 4a"i am,%l

t%"ja'i "%mii 'an 'ilanjt+an '%n!an ) min!! 'oi int%"mit%n ata

%lan! %4a"i. M%n"t E4"i74 '++. '%n!an m%m,%",anjan! ,%m3%"ian

,"%'nion t%"%3t 'i4a"a,+an a+an m%n!"an!i t%"ja'ina +am34

%"in!8 tan,a m%nam3a4 "ii+o %&%+ am,in! t%"oi'.

2. Sito!tati"a

P%n!!naan o3at itotati+a ,a'a +a SNP:KS 'an SNP:DS t%la4

'ila,o"+an ol%4 3%3%"a,a ,%n%liti 'an 'a,at m%m,%",anjan! "%mii8

3a4+an ,a'a 3%3%"a,a ,%n'%"ita m%nim3l+an "%mii ,%"man%n.

A,a3ila 'i3an'in!+an ,%n!o3atan itotati+a ,a'a ,%n'%"ita SNP:DS

'%n!an SNP:KS8 4ailna l%3i4 3ai+ ,a'a +am34 %"in! 'a"i,a'a

an! '%,%n'%n t%"oi'.

Si+lo&o&ami' 'an +lo"am3il m%",a+an o3at an! 3ana+

'i,a+ai '%n!an %&%+ an! 4am,i" ama.a. Si"loo!ami-

Si+lo&o&ami' 'i3%"i+an '%n!an 'oi 2:# m!9+!BB %lama *

min!! 'ila,o"+an %&%+ti& 'alam m%n!"an!i jmla4 +am34 ,a'a

SNP:KS. S%+ita" (0; +a an! 'i3%"i i+lo&o&ami' t%ta, "%mii

%lama 2 ta4n %t%la4 o3at 'i4%n'i+an 'an )0; +a t%ta, "%mii

%lama $ ta4n.

+. &lo#am+u!il

Klo"om3il m%m,nai %&%+ ama '%n!an i+lo&o&ami'

'alam m%m,%",anjan! maa "%mii SNP:KS 'an SNP:DS. St'i

+ola3o"ati& J%"man m%n'a,t+an "%mii *-; +a %lama #0 3lan

,a'a ,%n'%"ita +am34 %"in!.

2$


26/33

Alata '++. 'alam at t'i +ont"ol ,a'a 20 +a SNP:KS

m%la,o"+an ,a'a +%lom,o+ an! 'i3%"i +lo"am3il 5* min!!6 '%n!an

,"%'nion int%"mint%n %lama ,%n!o3atan 12 3lan 4ana 12; +a

an! m%n!alami +%+am34an8 %'an!+an ,a'a +%lom,o+ +ont"ol an!

'i3%"i ,la%3o '%n!an ,"%'nion int%"mit%n8 **; +a m%n!alami

+%+am34an.

'. Si"lo!*o#in A

Si+lo,o"in A 5Si A6 a'ala4 at imno,"%an an! 3ana+

'i!na+an ,a'a t"an,lantai !injal8 m%",a+an o3at alt%"nati& lain 'i

am,in! t%"oi'. SiA 3%i&at m%n!4am3at" !%n%"ai 'an a+ti>al %l T

itoto+i+. A+4i":a+4i" ini SiA 'i7o3a ,a'a SNP:KS 'an "%it%n t%"oi'.

Pa'a +a SNP:KS 'an SNP:DS. T%jani '++ m%la,o"+an 11 'a"i 1#

+a m%n!alami "%mii '%n!an ,%m3%"ian SiA %lam * min!!.

Nia'%t '++ m%m3%"i+an SiA 2:* 3lan8 *0; 'ila,o"+an m%n!alami

"%mii. Namn 3ila o3at 'i4%nti+an a+an t%"ja'i +%+am34an +%m3ali8

%4in!!a 'i+ata+an o3at ini m%nim3l+an %&%+ '%,%n'%n SiA. Pa'a+a SNP:RS ,%m3%"ian SiA ti'a+ m%m3%"ia+n 4ail m%ma+an.

Doi an! 'i,a+ai a'ala4 $ m!9+!BB94a"i8 'i%ai+an '%n!an +a'a"

SiA 'a"a4 200:)00 9ml. O3at ini 'a,at m%nim3l+an n%&"iti

int%"tiiali %4in!!a ,a'a ,%m3%"ian jan!+a ,anjan! ,%"l 'ila++an

,%mantaan '%nan 3io,i !injal. +a"%na o3at ini ma4al 4a"!ana 'an

4ailna +"an! m%ma+an8 ,%ma+aian o3at ini ,a'a +a SN 3%lm

'a,at 'it%"ima %3a!ai ,%n!o3atan alt%"nati&. Ji+a SiA a+an 'i,a+ai

%3ai+na nt+ +a an! 'a4 ti'a+ m%m,an '%n!an o3at

itotati+a lainna.

2(


27/33

(. L$)ami!ol

L%>amiol a'ala4 at anti 4%minti+ an! t%"nata

m%m,nai %&%+ imnolo!i m%ntimloai %l T. %ai '%n!an t%o"i

S4al4o3 ,a'a in'"om n%&"oti+ 'it%m+an a'ana !an!!an &n!i %l

T. a+4i":a+4i" ,%"4atian ,a'a l%>amiol mn7l +%m3ali '%n!an


28/33

2*


29/33

BAB I8

&ESIMPULAN

T%la4 'i3i7a"a+an ,%na+it in'"oma n%&"oti+ an! m%",a+an ,%na+it

!injal an! t%"3ana+. Ummna m%n%!a++an 'ia!noi 'i,%"l+an ,%m%"i+aan

+lini 'an ,%m%"i+aan la3o"ato"im t%"4a'a, in'"oma n%&"oti+ t%"%3t.

P%n%3a3 an! ,alin! %"in! 'ijm,ai a'ala4 in'"oma n%&"oti+ ,"im%". K%lainan

minimal m%m3%"i+an "%,on an! 3ai+ t%"4a'a, ,%n!o3atan 'an m%m,nai

,"o!noi 3ai+. Unt+ m%m,%"ol%4 4ail ,%n!o3atan an! o,timm ,%"l +%"ja

ama anta"a ,%n'%"ita 'an 'o+t%" an! m%n!o3atina.

2


30/33

DAFTAR PUSTA&A

1. P"na%"ita

In'on%ia.

$. P%"atan A4li P%na+it Dalam In'on%ia. B+ Aja" Ilm P%na+it Dalam

Jili' I. E'ii I/. Ja+a"ta Balai P%n%"3it FKUI.

#0


31/33

REFERAT

P$m+im+in 9

D#. Hami :ul"ili A++a! S*.PD; MH.&$!

D#. Siann$ A.


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&EPANITERAAN &LINI& PEN>A&IT DALAM

RSUD ARJA


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Documents

126185919 Referat Sindrom Nefrotik