Problem batu ginjal Penyebab utama batu ginjal belum diketahui Bentuk utama batu : Calcium, Calcium, struvite, struvite, asam urat, asam urat, cystine. - презентация

1 Problem batu ginjal Penyebab utama batu ginjal belum diketahui Bentuk utama batu : Calcium, Calcium, struvite, struvite, asam urat, asam urat, cystine cystine

2 The prevalence of kidney stones is three times higher in men than women, and is higher among Caucasians than Asians or African Americans, for reasons that are not clear. The prevalence of kidney stones is three times higher in men than women, and is higher among Caucasians than Asians or African Americans, for reasons that are not clear. They are especially likely to strike between the ages of 40 and 60. They are especially likely to strike between the ages of 40 and 60. Nutritional steps are important in preventing stones and can also help prevent recurrences, which is important given that percent of people diagnosed with a renal stone have a recurrence within five years. Nutritional steps are important in preventing stones and can also help prevent recurrences, which is important given that percent of people diagnosed with a renal stone have a recurrence within five years. Preventing stones is like keeping a salt crystal from forming in a glass of salty water. You can either reduce the concentration of salt or add more water. Preventing stones is like keeping a salt crystal from forming in a glass of salty water. You can either reduce the concentration of salt or add more water. Epidemiologic studies have shown that certain parts of the diet help reduce the amount of calcium that filters into the urine. It is a simple matter to put these factors to work clinically. Epidemiologic studies have shown that certain parts of the diet help reduce the amount of calcium that filters into the urine. It is a simple matter to put these factors to work clinically.

3 Batu calcium 70%-80% tersusun dari calcium oksalat dengan atau tanpa fosfat 70%-80% tersusun dari calcium oksalat dengan atau tanpa fosfat Kelebihan calcium dalam urine dapat disebabkan oleh : Kelebihan calcium dalam urine dapat disebabkan oleh : 1. intake berlebihan makanan yang mengandung calcium tinggi 1. intake berlebihan makanan yang mengandung calcium tinggi 2. kelebihan vitamin D, absorbsi calcium 2. kelebihan vitamin D, absorbsi calcium 3. imobilisasi lama 3. imobilisasi lama 4. hiperparatiroidism ekskresi calcium 4. hiperparatiroidism ekskresi calcium

4 Batu struvite Terdiri dari MgNH 4 PO 4 Terdiri dari MgNH 4 PO 4 Sering disebut batu infeksi Sering disebut batu infeksi Tidak berhubungan dengan makanan spesifik Tidak berhubungan dengan makanan spesifik Tidak ada terapi diet spesifik Tidak ada terapi diet spesifik Biasanya berukuran besar perlu operasi Biasanya berukuran besar perlu operasi Angka kejadiannya : sering Angka kejadiannya : sering

5 Batu asam urat Kelebihan ekskresi asam urat, gangguan metabolisme purin. Kelebihan ekskresi asam urat, gangguan metabolisme purin. Terjadi pada penyakit gout, atau karena pemecahan jaringan yang cepat selama kelaparan Terjadi pada penyakit gout, atau karena pemecahan jaringan yang cepat selama kelaparan

6 Batu cystine Angka kejadiannya jarang Angka kejadiannya jarang Terjadi karena defect genetik pada metabolisme asam amino cystine, akan terjadi gangguan reabsorbsi asam amino cystine cystinuria Terjadi karena defect genetik pada metabolisme asam amino cystine, akan terjadi gangguan reabsorbsi asam amino cystine cystinuria Terjadi pada anak dengan riwayat penyakit genetik Terjadi pada anak dengan riwayat penyakit genetik

7 Tanda-tanda klinis Tanda utama batu ginjal :Nyeri hebat, general weakness, kadang ada panas Tanda utama batu ginjal :Nyeri hebat, general weakness, kadang ada panas Pengelolaan : Pengelolaan : Intake cairan : banyak minum urine encer mencegah akumulasi material pembentuk batu Intake cairan : banyak minum urine encer mencegah akumulasi material pembentuk batu Membatasi diet sesuai dengan komposisi batu menghambat kekambuhan Membatasi diet sesuai dengan komposisi batu menghambat kekambuhan Mengatur pH urine Mengatur pH urine Binding agents : mis, sodium phytate untuk mengikat calcium, dan aluminium gel untuk mengikat fosfat, glisin untuk mengikat oksalat dalam usus menghambat absorbsi, dan mengeluarkan dari tubuh. Binding agents : mis, sodium phytate untuk mengikat calcium, dan aluminium gel untuk mengikat fosfat, glisin untuk mengikat oksalat dalam usus menghambat absorbsi, dan mengeluarkan dari tubuh.

8 Diit pada batu ginjal Memperlambat pertumbuhan batu ginjal atau membantu mencegah pembentukan batu ginjal Memperlambat pertumbuhan batu ginjal atau membantu mencegah pembentukan batu ginjal Perencanaan nutrisi dihubungkan dengan jenis batu. Perencanaan nutrisi dihubungkan dengan jenis batu. Mengurangi jenis makanan yang berperan dalam pembentukan batu. Mengurangi jenis makanan yang berperan dalam pembentukan batu.

9 Macam diit dan indikasi pemberian Diit rendah calcium tinggi sisa asam Diit rendah calcium tinggi sisa asam Diberikan pada penderita dengan batu Kalsium : Ca Fosfat, Ca carbonat, dan Ca oksalat. Diberikan pada penderita dengan batu Kalsium : Ca Fosfat, Ca carbonat, dan Ca oksalat. Makanan ini cukup kalori, protein, besi, vitaminA, thiamin dan vitamin C Makanan ini cukup kalori, protein, besi, vitaminA, thiamin dan vitamin C Syarat : banyak cairan ; 2500 ml/hari, Syarat : banyak cairan ; 2500 ml/hari, rendah calsium : 400mg/hari rendah calsium : 400mg/hari Makanan yang boleh diberikan : KH : beras, bulgur,roti,mie, makaroni, bihun, tepung- tepungan tepungan Protein hewani : telur, daging, unggas, ikan tanpa tulang tulang

10 Makanan yang boleh diberikan Protein nabati : tahu/tempe maks 50 g/hari, kacang- kacangan kering maks: 25 g/hari Protein nabati : tahu/tempe maks 50 g/hari, kacang- kacangan kering maks: 25 g/hari Lemak : minyak,mentega, margarin Lemak : minyak,mentega, margarin Sayuran : semua kecuali yang dilarang maks : 200 g/ hari Sayuran : semua kecuali yang dilarang maks : 200 g/ hari Buah : semua buah- buahan segar maks: 200 g/ hari Buah : semua buah- buahan segar maks: 200 g/ hari

11 Makanan yang tidak boleh diberikan KH : kentang, ubi,singkong, biskuit dan kue yang dibuat dengan susu KH : kentang, ubi,singkong, biskuit dan kue yang dibuat dengan susu Protein hewani : susu,keju, udang, kepiting, ikan teri, ikan asin, sardin, otak, ginjal, hati,jantung Protein hewani : susu,keju, udang, kepiting, ikan teri, ikan asin, sardin, otak, ginjal, hati,jantung Sayuran : bayam, daun mangkokan, daun melinjo, daun pepaya, daun lamtoro, daun singkong, daun talas, daun katuk, daun kelor, jantung pisang, buah melinjo, sawi, leunca. Sayuran : bayam, daun mangkokan, daun melinjo, daun pepaya, daun lamtoro, daun singkong, daun talas, daun katuk, daun kelor, jantung pisang, buah melinjo, sawi, leunca. Buah-buahan : semua buah-buahan yang dikeringkan Buah-buahan : semua buah-buahan yang dikeringkan Minuman : yang mengandung soda, coklat, soda kue, yeast Minuman : yang mengandung soda, coklat, soda kue, yeast

12 Diit tinggi sisa basa Diberikan pada penderita dengan batu cystine dan asam urat, makanan ini cukup kalori, mineral, dan vitamin Diberikan pada penderita dengan batu cystine dan asam urat, makanan ini cukup kalori, mineral, dan vitamin Syarat : banyak cairan : 2500 ml/hari, rendah asam amino yang mengandung sulfur Syarat : banyak cairan : 2500 ml/hari, rendah asam amino yang mengandung sulfur Makanan yang bpleh diberikan : Makanan yang bpleh diberikan : KH : nasi maks: ½ gelas/ hari, roti 4 potong, kentang ubi,singkong, kue-kue yang dibuat dari tepung maezena, hunkwee, tapioka, agar- agar, sirop. Protein hewani : daging 50 g, atau telor: 1 bt/ hari, susu. Protein hewani : daging 50 g, atau telor: 1 bt/ hari, susu. Lemak : minyak, mentega, margarin Lemak : minyak, mentega, margarin Protein nabati : kacang-kacangan kering :25g/hari atau tahu, tempe,oncom : 50 g/hari Protein nabati : kacang-kacangan kering :25g/hari atau tahu, tempe,oncom : 50 g/hari sayuran : semua sayuran paling sedikit 300 g/hari sayuran : semua sayuran paling sedikit 300 g/hari buah-buahan : semua buah-buahan paling sedikit 300 g/hari buah-buahan : semua buah-buahan paling sedikit 300 g/hari minuman : sari buah, teh, kopi, coklat minuman : sari buah, teh, kopi, coklat

13 Diit rendah purin Tujuan : Tujuan : Mengurangi pembentukan asam urat Mengurangi pembentukan asam urat Menurunkan berat badan bila pasien gemuk, dan mempertahankan BB dalam batas normal Menurunkan berat badan bila pasien gemuk, dan mempertahankan BB dalam batas normal Syarat : Rendah purin : mg/hari, normal : mg/hari Cukup kalori, protein, mineral, dan vitamin Tinggi hidrat arang, untuk membantu pengeluaran asam urat Lemak sedang : cenderung menghambat pengeluaran asam urat Banyak cairan ; membantu mengeluarkan kelebihan asam urat

14 Bahan makan yang boleh diberikan : KH : semua KH : semua Protein hewani : daging, ayam, ikan tongkol, ikan tenggiri, bawal, bandeng: 50 g/hari, telor, susu, keju Protein hewani : daging, ayam, ikan tongkol, ikan tenggiri, bawal, bandeng: 50 g/hari, telor, susu, keju Sumber protein nabati : kacang-kacangan kering :25g/hari atau tahu, tempe, oncom : 50 g/hari Sumber protein nabati : kacang-kacangan kering :25g/hari atau tahu, tempe, oncom : 50 g/hari Lemak : minyak dalam jumlah terbatas Lemak : minyak dalam jumlah terbatas Sayuran : semua sayuran, kecuali asparagus, kacang polong, kacang buncis, kembang kol, bayam, jamur maksimum : 50 g/ hari Sayuran : semua sayuran, kecuali asparagus, kacang polong, kacang buncis, kembang kol, bayam, jamur maksimum : 50 g/ hari Buah-buahan : semua macam buah Buah-buahan : semua macam buah Minuman : teh, kopi, minuman yang mengandung soda Minuman : teh, kopi, minuman yang mengandung soda Bumbu : semua macam bumbu Bumbu : semua macam bumbu

15 Makanan yang tidak boleh diberikan Sumber protein hewani : sardin, kerang, jantung, hati, usus,limpa,paru,paru,otak, ekstraks daging/kaldu, bebek, angsa, burung Sumber protein hewani : sardin, kerang, jantung, hati, usus,limpa,paru,paru,otak, ekstraks daging/kaldu, bebek, angsa, burung Minuman : alkohol Minuman : alkohol Bumbu : ragi Bumbu : ragi

16 Protective Foods Water. Water. Water dilutes the urine and keeps calcium, oxalates, and uric acid in solution. Water dilutes the urine and keeps calcium, oxalates, and uric acid in solution. In research studies, those subjects whose total fluid intake (from all sources) over 24 hours was roughly 2.5 liters, the risk of a stone was about one-third less than that of subjects drinking only half that much. (They do not need to drink 2.5 liters of water per day; rather this is the total fluid consumption, including juices, soups, etc.) In research studies, those subjects whose total fluid intake (from all sources) over 24 hours was roughly 2.5 liters, the risk of a stone was about one-third less than that of subjects drinking only half that much. (They do not need to drink 2.5 liters of water per day; rather this is the total fluid consumption, including juices, soups, etc.)

17 High-Potassium Foods. High-Potassium Foods. A study of 46,000 men conducted by Harvard University researchers found that a high potassium intake can cut the risk of kidney stones in half. A study of 46,000 men conducted by Harvard University researchers found that a high potassium intake can cut the risk of kidney stones in half. Potassium helps the kidneys retain calcium, rather than sending it out into the urine. Potassium supplements are not generally necessary. Rather, a diet including regular servings of fruits, vegetables, and beans supplies plenty of potassium. Potassium helps the kidneys retain calcium, rather than sending it out into the urine. Potassium supplements are not generally necessary. Rather, a diet including regular servings of fruits, vegetables, and beans supplies plenty of potassium.

18 Calcium. Calcium. Although most stones contain calcium, the calcium in foods does not necessarily contribute to stones. Calcium supplements taken between meals may increase the risk of stones, because about 8 percent of any extra dietary calcium passes into the urine. Although most stones contain calcium, the calcium in foods does not necessarily contribute to stones. Calcium supplements taken between meals may increase the risk of stones, because about 8 percent of any extra dietary calcium passes into the urine. On the other hand, calcium consumed with meals has the opposite effect, reducing the risk of stones. The reason, apparently, is that calcium binds to oxalates in foods and holds them in the digestive tract, rather than allowing them to be absorbed. On the other hand, calcium consumed with meals has the opposite effect, reducing the risk of stones. The reason, apparently, is that calcium binds to oxalates in foods and holds them in the digestive tract, rather than allowing them to be absorbed.

19 Caffeine. Caffeine. Caffeinated beverages reduce the risk of stones. Caffeines diuretic effect causes the loss of both water and calcium, but the water loss is apparently the predominant effect. Caffeinated beverages reduce the risk of stones. Caffeines diuretic effect causes the loss of both water and calcium, but the water loss is apparently the predominant effect. alcoholic beverages are associated with a reduced risk of kidney stones, again presumably due to a diuretic effect. This is not a compelling reason to drink either coffee or alcohol, but their diuretic actions do present this advantage. alcoholic beverages are associated with a reduced risk of kidney stones, again presumably due to a diuretic effect. This is not a compelling reason to drink either coffee or alcohol, but their diuretic actions do present this advantage.

20 Problem Foods Animal proteins cause calcium to be leached from the bones and excreted in the urine where it can form stones. Diets rich in animal proteins also increase uric acid excretion. In a controlled research study, published in the American Journal of Clinical Nutrition, research subjects on a diet eliminating animal protein had less than half the calcium loss that they had on their baseline diet. Diets rich in animal proteins also increase uric acid excretion. In a controlled research study, published in the American Journal of Clinical Nutrition, research subjects on a diet eliminating animal protein had less than half the calcium loss that they had on their baseline diet. The Harvard study mentioned earlier found that even a modest increase in animal protein, from less than 50 grams to 77 grams per day, was associated with a 33 percent increased risk of stones in men. The same is true for women. The Harvard study mentioned earlier found that even a modest increase in animal protein, from less than 50 grams to 77 grams per day, was associated with a 33 percent increased risk of stones in men. The same is true for women.

21 The association between animal proteins and stones probably relates both to the amount of protein they contain and to their content of the sulfur-containing amino acids The association between animal proteins and stones probably relates both to the amount of protein they contain and to their content of the sulfur-containing amino acids Sulfur in cystine and methionine is converted to sulfate, which tends to acidify the blood. As a part of the process of neutralizing this acid, bone is dissolved, and bone calcium ends up in the urine. Meats and eggs contain two to five times more of these sulfur- containing amino acids than are found in grains and beans. Sulfur in cystine and methionine is converted to sulfate, which tends to acidify the blood. As a part of the process of neutralizing this acid, bone is dissolved, and bone calcium ends up in the urine. Meats and eggs contain two to five times more of these sulfur- containing amino acids than are found in grains and beans. Between 1958 and the late 1960s, there was a sharp increase in the incidence of kidney stones in Great Britain. During that period, there was no substantial change in the amount of calcium or oxalate- containing foods consumed. However, the consumption of vegetables decreased, and the use of poultry, fish, and red meat increased. Statistical analyses showed a strong relationship between the incidence of stones and animal protein consumption. Between 1958 and the late 1960s, there was a sharp increase in the incidence of kidney stones in Great Britain. During that period, there was no substantial change in the amount of calcium or oxalate- containing foods consumed. However, the consumption of vegetables decreased, and the use of poultry, fish, and red meat increased. Statistical analyses showed a strong relationship between the incidence of stones and animal protein consumption.

22 Sodium. Sodium. Sodium increases the passage of calcium through the kidney and increases the risk of stones. When people cut their salt (sodium chloride) intake in half, they reduce their daily need for calcium by about 160 milligrams. Sodium increases the passage of calcium through the kidney and increases the risk of stones. When people cut their salt (sodium chloride) intake in half, they reduce their daily need for calcium by about 160 milligrams. Plants of any kindgrains, vegetables, legumes, and fruitscontain almost no sodium at all unless it is added during canning or other processing. Dairy products and meats contain more salt than plant products, and table salt, frozen meals, and canned and snack foods are the highest-sodium food products. Plants of any kindgrains, vegetables, legumes, and fruitscontain almost no sodium at all unless it is added during canning or other processing. Dairy products and meats contain more salt than plant products, and table salt, frozen meals, and canned and snack foods are the highest-sodium food products.

23 Surprisingly, Surprisingly, oxalate-rich foods, such as chocolate, nuts, tea, and spinach, are not associated with a higher risk of renal stones, nor is vitamin C, even though it can be converted to oxalate. A large study of men taking vitamin C supplements found that they had no more kidney stones than men who do not take them. oxalate-rich foods, such as chocolate, nuts, tea, and spinach, are not associated with a higher risk of renal stones, nor is vitamin C, even though it can be converted to oxalate. A large study of men taking vitamin C supplements found that they had no more kidney stones than men who do not take them.

24 Sugar. Sugar accelerates calcium losses through the kidney. Sugar accelerates calcium losses through the kidney. In the Nurses Health Study, those who consumed, on average, 60 grams or more of sugar (sucrose) per day had a 50 percent higher risk of stones than those who consumed only about 20 grams. In the Nurses Health Study, those who consumed, on average, 60 grams or more of sugar (sucrose) per day had a 50 percent higher risk of stones than those who consumed only about 20 grams. Climate. Kidney stones are also more common in warm climates, presumably because perspiration leads to dehydration and a more concentrated urine, and because sunlight increases the production of vitamin D in the skin which, in turn, increases calcium absorption from the digestive tract.17

25 Here are simple steps to help your patients avoid kidney stones. Encourage patients to drink plenty of water or other fluids, staying ahead of their thirst. Encourage patients to drink plenty of water or other fluids, staying ahead of their thirst. Diets including generous amounts of vegetables, fruits, and beans are rich in potassium and very low in sodium. Diets including generous amounts of vegetables, fruits, and beans are rich in potassium and very low in sodium. If you prescribe calcium supplements, encourage patients to take them with meals, rather than between meals. If you prescribe calcium supplements, encourage patients to take them with meals, rather than between meals. Encourage patients to avoid animal products. Their proteins and sodium content increase the risk of stones. Encourage patients to avoid animal products. Their proteins and sodium content increase the risk of stones. Patients should keep salt and sugar use modest. Patients should keep salt and sugar use modest.