Presentasi Referat Gna

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  • 8/19/2019 Presentasi Referat Gna



    Preceptor :

    dr. Pulung M.Silalahi, Sp.A

    Presentant :

     Fatmawati (07120110091)

    Department of Pediatrics Rumah Sakit Bhayangkara Tk.1 R.S Sukanto-Jakarta

    Facuty of !edicine" Peita#ara an $ni%ersit

  • 8/19/2019 Presentasi Referat Gna



    • Glomerulonephriti i a term ued !or "idne# dieae with an in$ammation and proli!eration o! glomerular %ell.

    • Glomerulonephriti (G&) i generall# %ategoried into either proli!eratie or non*proli!eratie .

    • +iagnoing the pattern o! G& i important e%aue out%ome - treatment depend on the t#pe.

    • A%ute pot trepto%o%%al glomerulonephriti i the mot %ommon %aue glomerulonephriti in %hildren.

    • A%ute glomerulonephriti uuall# re%ognie aed on

    %lini%al appearan%e u%h a gro hematuria, $uid oerload that mani!eted a edema and h#pertenion, and ome nding o! inu/%ien%# "idne# !un%tion li"e in%reaing o! & and %reatinine.

  • 8/19/2019 Presentasi Referat Gna


  • 8/19/2019 Presentasi Referat Gna


    1. ANATOMY

  • 8/19/2019 Presentasi Referat Gna


    Renal artery 

    Segmental Arteries

    Interlobar Arteries

     Arcuata arteries

    Interlobular Arteries

     Afferent arterioles

    Glomerular cappilaries

    Efferent arterioles

    Peritubular capillaries

    Interlobular veins

     Arcuate veins

    Interlobar veins

    Renal vein

    BLOOD SPPL! O" #$E %ID&E! 

  • 8/19/2019 Presentasi Referat Gna


    THE NEPHRON 'onsist of t(o parts ) *+ Renal corpuscle

      , glomerulus

      , glomerular - Bo(man.s/ caps

    0+ Renal tubule

      , pro1imal convulute2 tubule

      , loop of 3enle

      , 2istal convulute2 tubule

  • 8/19/2019 Presentasi Referat Gna


    *. P#,S/0, 

    #3e 4i2ney 2o ma5or (or4 of t3e urinary system+ #3e ot3er parts of t3e system

    mainly passagea(ays an2 storage areas+ "unction of 4i2ney inclu2e )

    •  Regulation of bloo2 ionic composition+

    • Regulation of bloo2 p$+

    • Regulation of bloo2 volume+

    • Regulation of bloo2 pressure+

    • 6aintenence of bloo2 osmolarity+

    • Pro2uction of 3ormones+

    • Regulation of bloo2 glucose level+

    • E1cretion of (astes an2 foreign substances+ By forming urine7 4i2neys 3elp

    e1crete (aste+

  • 8/19/2019 Presentasi Referat Gna


    *+ Glomerular filtration ) (ater an2 most

    solutes in bloo2 plasma move across t3e (all of glomelural capillaries into t3e glomerular

    capsule t3en into renal tubule+

    0. Tubular reabsorbtion )(ater an2 solutes

    return to t3e bloo2 as it flo(s t3roug3

    peritubular capillaries an2 vasa recta+

    3. Tubular secretion+ ) flui2 flo(s along t3e

    renal tubule an2 t3roug3 t3e collecting 2uct7

    t3e tubule an2 2uct cells secrete ot3er materials7

    suc3 as (astes7 2rugs7an2 e1cess ions7 into t3e


    RI&E "OR6A#IO&

  • 8/19/2019 Presentasi Referat Gna


    G3M45A5 F65A63&

    • Glomerular capillaries are relatively

    impermeable to proteins+

    • #3e flui2 t3at enters t3e capsular space is

    calle2 glomerular filtrate+ • 6ore t3an 889 of glomerular filtrate

    return to t3e bloo2 stream via tubular

    reabsorbtion7 so only *,0 liters is e1crete2

    in to urine+

  • 8/19/2019 Presentasi Referat Gna


    •  he glomerular %apilla# wall i the ltration unit and

    %onit o! the !ollowing tru%ture 81. 4ndothelial %ell

    2.Glomerular aement memrane (GM)

    . Podo%#te

  • 8/19/2019 Presentasi Referat Gna


  • 8/19/2019 Presentasi Referat Gna


    • 6at3ematically7 t3e G"R e:uals t3e pro2uct of %f an2 t3e net filtration pressure) G"R ; %f < &et filtration pressure

    #3e net filtration pressure representst3e sum of t3e 3y2rostatic an2 colloi2 osmotic forces t3at eit3er favor or oppose filtration across t3e glomerular capillaries+

    • #3e G"R can t3erefore be e1presse2 as G"R ; %f < -PG = PB = pG > pB/

  • 8/19/2019 Presentasi Referat Gna



    • Glomerulonephritis is an inflammatory process affecting primarily the part of kidney that filters blood called

    glomerulus, with infiltration and proliferation of acute

    inflammatory cells.

    • The inflammation happens because of an immunologic process that makes pathologic abnormality of glomerulus

    • There can be both acute glomerulonephritis and chronic glomerulonephritis

  • 8/19/2019 Presentasi Referat Gna


     Acute Glomerulnephritis • Acute glomerulonephritis is a disease

    characterized by sudden appearance of :

    1. Edema

    2. ematuria

    !. ypertension

    ". #liguria

    • This due to the immunologic response which triggers inflammation and proliferation of

    glomerular tissue that result in damage to the

    glomerular layer.

    Nephritic Syndrome

  • 8/19/2019 Presentasi Referat Gna



    • $%A&' can happened either sproradically or epidemically

    • Epidemic outbreaks ha(e taken place in communities with

    densely populated dwellings that ha(e poor hygienic conditions.

    • %poradic A$%&' following upper respiratory tract infection is more common in winter and spring in temperate areas, whereas

    skin infections are commonly found to precede A$%&' in the

    more tropical and subtropical areas.

    • )n de(eloping countries A$%&', usually occurs in children, predominately males, most cases occur in patients aged *+1*


  • 8/19/2019 Presentasi Referat Gna


    &O& I&"E'#IOS

    Primary renal 2isease

    Systemic 2isease


    *+ Ba4teri )

    most common )

    streptococcal species+

    0+ ?irus

    @+ "ungal

    + Parasites

    *+ 6PG&

    0+ IgA nep3ropat3y 

    @+ 6embranous


    + 6inimal c3ange


    *+ Lupus nep3riti2

    0+ Diabetic


    @+ $enoc3,Sc3nlein


    + Goo2pasture


  • 8/19/2019 Presentasi Referat Gna



    • Glomerular lesion in acute G& result in glomerular 2eposition of immune comple1es+

    • On gross appearance t3e

    4i2neys appear symmetrically enlarge2+

    • Immunoflueressence microscopy reveals a pattern of Clumpy,bumpy+

    • On electron microscopy7

    electrone 2ense 2eposurs or C3umps are observe2 on epit3elial si2e of GB6+

  • 8/19/2019 Presentasi Referat Gna



    • Glomerular in:ur# ma# e reult o! 8 geneti%, immunologi% , per!uion, or %oagulation diorder.

    • 6mmunologi% in:ur# to the glomerulu reult in

    glomerulonephriti .• 4iden%e that glomerulonephriti i %aued # immunologi% in:ur# in%lude morphologi% and immunopathologi% imilaritie to e;perimental immune* mediated glomerulonephriti< the demontration o!

    immune rea%tant (immunogloulin, %omplement) in glomeruli< anormalitie in erum %omplement< and the nding o! autoantiodie (anti*GM) in ome o! thee dieae .

  • 8/19/2019 Presentasi Referat Gna



    • #(o ma5or mec3anism of immunologic associate2 in5ury 3ave been establis3e2 )

    *+ in5ury resulting from 2eposition of soluble

    circulating antigen,antibo2y comple1es in t3eglomerulus+

    0+ In5ury by antibo2ies reacting in situ (it3in glomerulus

  • 8/19/2019 Presentasi Referat Gna



    -*/ glomerular trapping of circulating immune comple1es an2

    -0/ in situ immune antigen,antibo2y comple1 formation resulting from antibo2ies reacting  (it3 eit3er streptococcal  components 2eposite2

    in t3e glomerulus or (it3 components of t3eglomerulus itself+

  • 8/19/2019 Presentasi Referat Gna


    • $ost factor

    • Streptococcus factor , &ep3ritogenic strains of group A

     beta,3emolytic streptococci+

    , 6 Protein in bacterial (all -6

    protein serotypes ie7 *7 07 7 *07 *7

    0F7 87 FF7 F7 an2 H/

    , &ep3ritogenic antigen ) &ep3ritis

    associate2 streptococcal plasmin

    receptor -&APLr/ an2 pyogenic

    e1oto1in - SPEB/

  • 8/19/2019 Presentasi Referat Gna


    Clinical Manifestation

    #ypical presentations Atypical presentation

    1. =ematuria8 the %lai% de%ription o! tea* or %ola*%olored urine

    o%%ur in appro;imatel# 2>?@0 o