Dr Dian-tractus Urinarius

8/19/2019 Dr Dian-tractus Urinarius

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TRACTUS URINARIUS

dr. Dian. Y. Lestari





Disorder of Kidney

• Congenital – Malformasi, ectopic, cysta, dysplasia

• Acquired – Glomeruli disease

– Tubulointersitial disease

– Renal calculi

– Neoplasma







• Primary – Acute diffuse post streptococcal

– Lipoid nephrosis or minimal change

– gA nephropathy

• Secondary – !L", Diabetes, #ypertension etc

• Immune, Toxic, metabolic



Cyst Disease of Kidney

• Simle cyst

• Adult olicystic !idney disease

• C"ild"ood olycystic !idney disease





Pat"ogenesis





Clinical Syndrome

• #efritic syndrome

• #efrotic syndrome

• Acute $enal %ailure &$P'#(• C"ronic $enal %ailure



#efritic Syndrome

Penya!it yang memacu reson eradanganroliferatif &sel endotel, sel mesangial)eitel(

• *ematuria &macros)micros(• +liguria a-otemia

• *iertensi



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



• 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



$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+





2acroscois

• 'in0al membesar, ucat

• Perdara"an tec"ie

• 'lomeruli necrosis focal, roliferasidifuse)focal, roliferasi mesangial



2icroscois

• 3ulan SA3IT &cresentic( ada glomeruli

o! roliferasi dari sel4sel eitel arietal

!asula bo5man infiltrasi monosit dan

macrofag



normal

!resnti!



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(



normal

inflamasi



Diffuse Proliferati1e '#.

• 9nlarged "yercellularglomeruli:

• *yerlasia of eit"elium endot"elium: Cell

S5elling:• Inflammatory cells:

• Collased caillaries:+bstruction to blood flo5:



#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



#9%$+TIC S;#D$+2

• ?ioid nefrosis• #efroati membranosa

• 'lomerulosis segmental focal

• 'lomerulonefritis Proliferasi membranosa&2P'#(

















Disease $enal intersitium tubulus

• #efritis intersitial tubulus &TI#( –yelonefritis

– a+ut

–croni+

• #e!rosis tubuler a!uta



$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+



macroscopis

• 'in0al # ) <<

• 3atas 0elas

• Ke!uningan

• microabcess

microscopis

• #ecrosis suuratif

• #ecrosis aila renalis

&necroti-ing yelonefritis(





microabces

Paila

necrosi

s





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



#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





ACBT9 TB3B?A$ #9C$+SIS

• Destru!si sel tubulus dan suresi a!ut fungsigin0al

• Penyebab A$%

• $e1ersible• 9tiologi . trauma berat, ancreatitis acut,

seti!emia

















TB2+$ 'I#@A?

• Ca sel gin0al

• ilms tumor

• Tumor calyces el1is



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



macroscois

• 3esar, massa bulat , diameter 8 – 6 cm• Irisan . !uning – abu4abu – uti"

• ?una!, !isti!

• Perdara"an &/(• 3atas 0elas





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 &/(





'e0ala !linis

• Trias. – #ematuria tanpa nyeri

– Demam lama

– Nyeri tumpul pinggang

• Kadang .

– $olisitemia

– #ipercalcemia, hipertensi, cushing syndroma,

feminisasi masculinisasi









I?2S TB2+$

• Kan!er !e48 ada ana! = 6> t"

• Penyebab utama !ematian ada ana!

• Isi . mesoderm



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+





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





'e0ala !linis

• 2assa tumor teraba di abdomen• Kadang . anas ) nyeri abdomen

Prognosis . H ysr F>G







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









'e0ala !linis

• *ematuria tana nyeri• ? . P J H . 6

• De!ade – II

• Predisosisi

– !igaret, +onta+ beta1naftilamin

– !istitis +ronis

– !+istosomiasis

– si+lofosfamid



• Prognosis . – 3 ysr 346

– n7asif & 3 ysr @ :5 6

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Dr Dian-tractus Urinarius