Kidney Stones

Nephrolitiasis

Nephrolithiasis =

Kidney Stones

Batu ginjal adalah massa

kristal padat yang
dibentuk di ginjal dan
melalui jalur kantung
kemih (Urinary Text)

Diniyah Kholidah
Nelms, Marcia, Sucher, Kathryn & Long, Sara. (2007). Nutrition Therapy and Pathophysiology. Belmont: Thomson.

Batu Ginjal

Batu ginjal berbentuk kecil dan keras, tersusun

atas mineral dan garam.
Nama lain :
Renal Lithiasis
Renal Calculi
Nephrolithiasis (Kidney Stone Disease)
Jenis batu diklasifikasikan berdasarkan pada
lokasi batu dalam sistem kemih dan komposisi
kristal batu.

Nephrolithiasis
Batu berkembang dalam ginjal.
Klasifikasi batu : oxalate, uric acid, cystine,
calcium phosphate, and magnesium
ammonium phosphate (struvite).

Chapter 19

Prevalence

Nephrolithiasis affects over 5% of adults in

the United States

Statistics

Incidence Rate:

12% men
6% women

50% of patients will have additional stones

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More than 1 million cases annually in US

1 in 272 or 3.6 per 1000 Americans develop
stones annually.

80% of stones under 2mm in size

90% of stones pass through the urinary
system spontaneously

Generally stone smaller than 6mm are passable

(National Institute of Diabetes and Digestive and Kidney Diseases; NIDDK)
(National Kidney and Urologic Disease Information Clearinghouse; NKUDIC)

Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110.
Worcester, Elaine M. & Coe, Fredric L. (2008). Nephrolithiasis. Prim Care; 35(2), 369vii. Retrieved September 9, 2009, from Pub Med database.

Formasi Batu Ginjal

Signs and Symptoms

Disebabkan :

Tingginya konsentrasi urin, urine stasis

Ketidakseimbangan pH urin

Asam : Uric and Crystine Stones

Basa : Calcium Stones

Gout
Hyperparathyroidism
Inflammatory Bowel Disease
UTI
Medications

Hematuria
Mual dan muntah
Terasa sakit saat
BAK
Sakit dibawah ulu hati

Lasix, Topamax, Crixivan

http://www.pilotfriend.com/aeromed/medical/images2/25.jpg
Nelms, Marcia, Sucher, Kathryn & Long, Sara. (2007). Nutrition Therapy and Pathophysiology. Belmont: Thomson.

Types of Stones

Signs and Symptoms

What are the key findings?

Additional S/S:

Severe flank pain

Abdominal pain
Nausea and vomiting
Fatigue
Elevated temperature, BP, and
respirations
UA positive for RBC
Objective Data: perspiration,
clutching of the abdomen,
doubled-over.
Steady Pain
Left flank tendernes

Presence of UTI
Fever or Chills
Pain in groin, labia or testicles
Cloudy or foul-smelling urine
Dysuria
Persistent urge to void

Calcium Oxalate

Insiden terbesar pada wanita dibandingkan pria.

Berhubungan dengan UTI.

Uric Acid

Paling sering

Calcium Phosphate
Struvite

Disebabkan karena diet tinggi protein dan purin.

Cystine

Jarang, berhubungan dengan penyakit bawaan

http://knol.google.com/k/-/-/27ifsyywko3wx/sqc1f9/kidneystonesymptoms.jpg

Assessment Information

Family history
Current medications
Frequency of urination
Do you experience pain while urinating?
What is your typical diet?

Risk Factors

http://erstories.net/wp-content/uploads/2008/10/kidneystone1a.jpg

Increased BMI
Increased waist circumference
Genetics
Hypertension
Hypercalciuria
Vitamin C
Diarrheal state

Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110.
Moe, Orson W., Abate, Nicola & Sakhaee, Khashayar. (2002). Pathophysiology of uric acid nephrolithiasis. Endocrinol Metab Clin N Am, 31, 895-914.
Worcester, Elaine M. & Coe, Fredric L. (2008). Nephrolithiasis. Prim Care; 35(2), 369vii. Retrieved September 9, 2009, from Pub Med database.
Worcester, Elaine M., Parks, Joan H., Evan, Andrew P. & Coe, Fredric L. (2006). Renal Function in Patients with Nephrolithiasis. Journal of Urology, 176, 600603.

Risk Factors

Abnormal Lab Values

Urinary Tract Infection
Catheterization
Bowel Disease
Environmental
Factors:

BUN
Creatinine

Heat exposure
Employment
Exercise

Urine Analysis

https://www.clevelandclinic.org/heartcenter/images/guide/tests/lab.gif

http://www.ganfyd.org/images/f/fb/Dipstick_bottle.jpg

Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110.
Moe, Orson W., Abate, Nicola & Sakhaee, Khashayar. (2002). Pathophysiology of uric acid nephrolithiasis. Endocrinol Metab Clin N Am, 31, 895-914.

Diagnostic Studies

Lithotripsy: used to break into smaller fragments

allowing it to pass through the urinary tract.

Test and Diagnostics:

Surgical Procedures

Blood Analysis
Urine Analysis
CT Scan
Abdominal x-ray
Ultrasound
Retrograde Pyelogram
Cystoscopy
Intravenous pyelography (IVP)
http://knol.google.com/k/-/-/PYwIQr_i/GXb8Fg/Stone%20CT.jpg

Extracorporeal Shock-Wave (ESWL)

Percutaneous Ultrasonic
Electrohydraulic
Laser

Surgical Therapy

Nephrolithotomy (Kidney)
Pyelolithotomy (Renal Pelvis)
Ureterolithotomy (Ureter)

Basket Extraction
http://www.svhm.org.au/Department_Index/Lithotripsy/images/Kidney-Stones.gif

Pencegahan

Edukasi

Minum 3 liter air/hari (14 gelas)

Air minum mineral
Lemonade (sitrat mengurangi pembentukan batu)

Diet

Hidrasi

Calcium Oxalate Stones

Rendah garam
Batasi oxalate
Rendah protein

Aktifitas fisik

Obat-obatan
Chapter 19

http://3.bp.blogspot.com/_-gcaht5yp_0/SdINrCVuqdI/AAAAAAAAAGw/xeEk4-F3z_I/s320/foods+rich+in+oxalate+2.gif

Rendah kalsium, mengurangi

resiko batu Ca Oxalate
In fact, higher dietary calcium
intake may decrease the
incidence of renal stones for
most people.
Memilih bahan makanan rendah
oksalat (beets, wheat bran,
chocolate, tea, strawberries,
spinach).

Copyright 2003 Delmar Learning, a Thomson

Learning company

18

Uric Acid Stones

Cystine Stones

Rendah purin.

Purines are the end products of nucleoprotein

metabolism.

Cystine adalah salah satu asam amino.

Batu Cystine dibentuk dari batu konsentrasi
tinggi ok. Kelebihan urin dalam sal. Kemih.
Meningkatkan cairan dan menganjurkan diet
sisa basa.

Ditemukan dalam ikan, daging, unggas,

ikan, jerohan, teri, sardines, kaldu
Berhubungan dengan penyakit Gout,
penyakit GIT karena diare, pnyakit
malignant diease.

Chapter 19

Copyright 2003 Delmar Learning, a Thomson

Learning company

19

Struvite Stones

Copyright 2003 Delmar Learning, a Thomson

Learning company

21

Medical Nutrition Therapy

Decrease sodium to 100 mmol/day

To prevent Uric acid and calcium stones

> 1 g/kg should be avoided
Recommendation 1 g/kg
.6 g/kg for diabetic patients

Tujuan diet untuk Nephrolithiasis :

mencegah terbentuknya batu baru dan
mencegah perkembangan batu

Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110.
Worcester, Elaine M., Parks, Joan H., Evan, Andrew P. & Coe, Fredric L. (2006). Renal Function in Patients with Nephrolithiasis. Journal of Urology, 176, 600603.

Medical Nutrition Therapy

To prevent Calcium containing stones

Decrease excessive animal protein

20

Medical Nutrition Therapy

Tersusun atas of magnesium ammonium

phosphate.
Kadang disebut infeksi batu karena berangkat
dari (UTI urinary tract infections).
Diet rendah P.

Chapter 19

Copyright 2003 Delmar Learning, a Thomson

Learning company

Increase calcium intake to 1000 -1200 mg/day

***
Increase fluids with at least 50% WATER
2.5-3 L/day
Urine volume should be 2 L/day
< 50 mg/day dietary oxalate

Avoid grapefruit juice, beets, cola,

chocolate, coffee, tea, berries,
spinach, and rhubarb
Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110.
Nelms, Marcia, Sucher, Kathryn & Long, Sara. (2007). Nutrition Therapy and Pathophysiology. Belmont: Thomson.
Vergili, Joyce M. (2009). Diabetic Kidney Diesase: What RDs need to know. Todays Dietitian, 11, 8-48.
Worcester, Elaine M. & Coe, Fredric L. (2008). Nephrolithiasis. Prim Care; 35(2), 369vii. Retrieved September 9, 2009, from Pub Med database.

To prevent Calcium Oxalate stones

Increase fruits and vegetables

Increase insoluble fiber
Weight loss
Low fat, low calorie
Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110.
Goldfarb, David S. (2009). Prospects for Dietary Therapy of Recurrent Nephrolithiasis. Advances in Chronic Kidney Disease, 16, 21-29.

General Dietary Principles:

Kidney Stones

Mosby items and derived items

2006 by Mosby, Inc.

Diet Sisa Asam

Meningkatkan keasaman urin (dengan

menggunakan chloride, phosphorus, and
sulfur)
Ditekankan pada golongan daging, keju dan
serealia
Membatasi sayur dan buah (kecuali jagung,
kacang-kacangan,, cranberries, plums,
prunes)

Slide 25

Diet Sisa Basa

Meningkatkan ph Basa urin (berisi sodium,

potassium, calcium, and magnesium)
Ditekankan pada golongan sayur dan buah
(kecuali jagung, lentils, cranberries, plums,
prunes)
Membatasi garam dan serealia