I.

II.
III.

RENAL CALCULI
URINARY OBSTRUCTION
NEOPLASMA

BLOK XV UROGENITAL
dr. JB Soebroto, Sp.PA
29 April 2013 Jam: 13.30 15.30

Stone constituent: Ca, oxalates, uric acid, cystine, etc

Acidic urine facilitate precipitation of uric acid &
cystine
Alkaline phosphate, may combine with Mg and
NH4 (converted from urea by Proteus & other ureasplitting bacteria) staghorn calculi calices &
pelvis renis
The majority of stones contain Ca oxalate,
phosphate and hydoxyapatite
Large stone asymptomatic, hematuria
Small stone ureter colick
Bacteria & urine stasis predisposing factor

Predisposisi batu saluran urine

1. Faktor keturunan / bakat gangguan filtrasi,
resorbsi urin kongenital tersembunyi
2. Kurang minum
3. Kurang bergerak, banyak duduk
4. Konsumsi makan/minum mengandung
mineral (calon inti batu)
5. Kurang vitamin epitelisasi saluran urin
6. Radang / infeksi

Stone
Calcium oxalate / phosphate
Idopathic hypercalciuria (50%)
Hypercalcemia & hypercalciuria (10%)
Hyperoxaluria (5%)
Enteric (4.5%)
Primary (0.5%)
Hyperuricosuria (20%)
No known metabolic abnormality (15-20%)
Struvite (Mg, Nh3, Ca, PO4)
Renal infection
Uric acid
Associated with hyperuricemia
Associated with hyperuricosuria
Idopathic (50% of uric acid stones)
Cystine
Others or unknown

Percentage
75

10-15
6

1-2
+/-10

Etiology: stones, BPH, congenital defects, tumors,

functional disorders, pregnancy predisposing to
infection & stone formation hydronephrosis
progressive atrophy of the kidney
It may be unilateral or bilateral ( anuria)
Renal changes become irreversible after about 3
weeks (several months of partial obstruction)
Acute obstruction acute dilatation & stretching of
renal capsule pain
Gradual obstruction may be asymptomatic
Hypertension may ensue

Marked dilatation
of the pelvis and
calyces and
thinning of renal
parenchyma

Schematic
representation of
pathways of renal
infection

More common

CAUSES :
Most commonly infectious in origin: gram
negative bacteria (usually E. Coli) from patients
intestinal tract
Normal kidney is resistant to blood borne infection
Most common route of infection: bacterial
ascension from the urinary bladder

Acute disease often associated with:

Urinary obstruction
Instrumentation of the urinary tract
Vesicoureteral reflux
Pregnancy
Prior renal disease
diabetes
Histology:
Interstitial suppurative inflammation and tubular
necrosis
Abscesse often multiple rupture to tubules
collecting ducts complications: necrotizing
papillitis, pyonephrosis, perinephric abscess

The cortical surface is

studded with focal pale
abscesses
The lower pole is
relatively unaffected
Between the abscess
there is dark congestion
of the renal surface

Major cause of CRF

Common etiology reflux nephropathy, and less
common by chronic obstruction leading to
recurrent infections
Clinically may be insidious presenting as renal
insufficiency and hypertension, or as repeated
acute pyelonephritis
Tubular damage polyuria and nocturia
Grossly: kidney are small with broad irregular scar
and deformed blunted calyces
Mic: tubular atrophy and/or thyroidization with
chronic inflammation periglomerular fibrosis
glomerular sclerosis (late state)

Typical coarse scars

the scars are usually
polar and are
associated with with
underlying blunted
calices

Catatan: ingat infeksi

desendern sistemik:
immunologis >< focal
infection glomerulo
nefritis

Renal cell carcinoma (RCC)

- The most frequent renal cancer in adult
- It may have endocrine-like effect procuce
polycytemia, hypercalcemia, hypertension
(renin)Cushings syndrome, etc.
Wilms tumor
- More common tumor in childhood
Tansitional cell carcinoma
- 5-10% of adult cancer
- Prostat

NefromaMesoblastik
PA : - Jinak Kongenital
- Tumor fibrosa + focus tulang rawan
dysplastik dan mesenkim embrional +
glomerulus + tubulus
I.

II. Nefroblastoma (Tumor Wilms)

- Faktor Genetik Trisomi 18 delesi Chr 8
- Ganas :
Elemen nefroblastik primitif
(blastenal)

Tubulus glomerulus

mesenchymal

Variatif
variatif
( Karsino Sarkoma )

PA : - berasal sel tubulus

- Klasik
clear cell Ad. Ca
sel-sel jernih seperti kelenjar Adrenal
(Supra Renalis) - Hipernefroma
Sitologi Urine +
Klinis - Trias (Hematuri, Nyeri, Massa)
- Para Neoplastic

Typical crosssection of
yellowish,
spherical
neoplasm in one
pole of the kidney
Note the tumor in
the dilated,
thrombosed renal
vain

IV. Tumor Pyelum Pelvis Renis

Ureter
PA : Urotel : Transisional Ca
V. Tumor Vesika Urinaria
- Fraktur Resiko = - zat warna Anilin
- Benzidin
- 2 Alpha Naphthylamin
- Sakarin, Siklamat
- Merokok
- Obat Analgesik
- Schistosomiasis

PA = - 95 % Urotelial = Papilloma
- Transisional Carcinoma
- Metaplasi Skuamosa
- Adeno Karsinoma
( Sistitis metaplastik glandular Brunn )
- Stadium P.TNM
PTIs = Insitu PT3b=Tembus
PT4b = dinding pelvis

Pertumbuhan : Lahir : Kel immatur pubertas

(Androgen) balans estrogen
- zone Anterior = stroma fibromusculer
- zone Perifer (post lat) = kelenjar
- zone Sentral (medial) campur
- zone Transisi Periuretral
Fisiologi : - Cairan semen eyakulat
- Asam Fosfatus, vital nutritien / cairan
medial sel sperma
- Prostatic Spesific Antigen (PSA)
marker

Faktor

Hormonal : Testosteron
Estrogen
Potensi endogen jaringan ikat
~ Proses menua Fisiologis
Zone transisi / peri uretral
Hiperplasi fibromusculer acinus kel

dysuri retensi urin

- Klinis : Prostat hypertrofi
BPH (Benign Prostat Hypertrofi)
MPH = Karsinoma Prostat

The symptom of the BPH patients are :

Getting up at night to urinate
Urinating frequently during daytime
Standing a long time before the urinary
stream starts
Lots of dribbling at the end of stream
A sense of urgency to rush to the bathroom
Leakage of urine
Straining to empty the urine
Returning to the bathroom to urinating
again just a few minutes after urinating

Karsinoma prostat
zone Perifer Sub Capsuler = Kelenjar >< Orchidectomi
Peka Androgen
Gangguan BAB Colok Dubur / rectal toucher (+)
lanjut baru
sumbatan urin
Campuran BPH

MPH

Hemo spermia

TURP
Tetap
5% Prostatectomi klinis BPH
PA : Adenocarcinoma
Occult Carcinoma
metastase : Col.Vert, Pelvis,
Tulang panjang, Paru
PA : Adeno Ca (Acinus, Kribriform, Solid, tubuler)
WHO = grade 1,2,3
Gleason : Skor deferensiasi(baik, sedang, buruk)2 - 10

Salah Urat/otot, Sprain, terkilir, Kesleo

- Syaraf
- Tulang
- Saluran cerna
- Saluran kencing - Nyeri Tumpul
- Nyeri Tajam
Nyeri Tumpul
: - Pasien tidak dapat menunjukkan
dengan ujung jari Luas
(Regio)
- Pembengkakan ginjal
Tambah Berat Peregangan Kapsul ginjal
-

Adaptasi-Syaraf < < berkurang

Nyeri tajam (colix) : ureter Posisi Tubuh
Nyeri kram kumat-kumatan, sakit sekali, keringat
dingin; menjalar sesuai alur saraf sampai testis / penis