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

69 Batu Ginjal

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  • Problem batu ginjalPenyebab utama batu ginjal belum diketahuiBentuk utama batu : Calcium,struvite,asam urat,cystine

  • 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.Nutritional steps are important in preventing stones and can also help prevent recurrences, which is important given that 30-50 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. 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.

  • Batu calcium70%-80% tersusun dari calcium oksalat dengan atau tanpa fosfatKelebihan calcium dalam urine dapat disebabkan oleh :1. intake berlebihan makanan yang mengandung calcium tinggi2. kelebihan vitamin D,absorbsi calcium 3. imobilisasi lama4. hiperparatiroidism ekskresi calcium

  • Batu struviteTerdiri dari MgNH4PO4 Sering disebut batu infeksiTidak berhubungan dengan makanan spesifikTidak ada terapi diet spesifikBiasanya berukuran besar perlu operasiAngka kejadiannya : sering

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

  • Batu cystineAngka kejadiannya jarangTerjadi karena defect genetik pada metabolisme asam amino cystine, akan terjadi gangguan reabsorbsi asam amino cystine cystinuriaTerjadi pada anak dengan riwayat penyakit genetik

  • Tanda-tanda klinisTanda utama batu ginjal :Nyeri hebat, general weakness, kadang ada panasPengelolaan : Intake cairan : banyak minum urine encer mencegah akumulasi material pembentuk batuMembatasi diet sesuai dengan komposisi batumenghambat kekambuhanMengatur pH urineBinding 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.

  • Diit pada batu ginjalMemperlambat pertumbuhan batu ginjal atau membantu mencegah pembentukan batu ginjalPerencanaan nutrisi dihubungkan dengan jenis batu.Mengurangi jenis makanan yang berperan dalam pembentukan batu.

  • Macam diit dan indikasi pemberianDiit rendah calcium tinggi sisa asamDiberikan pada penderita dengan batu Kalsium : Ca Fosfat, Ca carbonat, dan Ca oksalat.Makanan ini cukup kalori, protein, besi, vitaminA, thiamin dan vitamin CSyarat : banyak cairan ; 2500 ml/hari, rendah calsium : 400mg/hariMakanan yang boleh diberikan :KH : beras, bulgur,roti,mie, makaroni, bihun, tepung- tepunganProtein hewani : telur, daging, unggas, ikan tanpa tulang

  • Makanan yang boleh diberikanProtein nabati : tahu/tempe maks 50 g/hari, kacang-kacangan kering maks: 25 g/hariLemak : minyak,mentega, margarinSayuran : semua kecuali yang dilarang maks : 200 g/ hariBuah : semua buah- buahan segar maks: 200 g/ hari

  • Makanan yang tidak boleh diberikanKH : kentang, ubi,singkong, biskuit dan kue yang dibuat dengan susuProtein hewani : susu,keju, udang, kepiting, ikan teri, ikan asin, sardin, otak, ginjal, hati,jantungSayuran : 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 dikeringkanMinuman : yang mengandung soda, coklat, soda kue, yeast

  • Diit tinggi sisa basaDiberikan pada penderita dengan batu cystine dan asam urat, makanan ini cukup kalori, mineral, dan vitaminSyarat : banyak cairan : 2500 ml/hari, rendah asam amino yang mengandung sulfurMakanan yang bpleh diberikan : KH : nasi maks: 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. Lemak : minyak, mentega, margarin Protein nabati : kacang-kacangan kering :25g/hari atau tahu, tempe,oncom : 50 g/hari sayuran : semua sayuran paling sedikit 300 g/hari buah-buahan : semua buah-buahan paling sedikit 300 g/hari minuman : sari buah, teh, kopi, coklat

  • Diit rendah purinTujuan :Mengurangi pembentukan asam uratMenurunkan berat badan bila pasien gemuk, dan mempertahankan BB dalam batas normalSyarat :Rendah purin : 120-150 mg/hari, normal : 600-1000 mg/hariCukup kalori, protein, mineral, dan vitaminTinggi hidrat arang, untuk membantu pengeluaran asam uratLemak sedang : cenderung menghambat pengeluaran asam uratBanyak cairan ; membantu mengeluarkan kelebihan asam urat

  • Bahan makan yang boleh diberikan :KH : semuaProtein hewani : daging, ayam, ikan tongkol, ikan tenggiri, bawal, bandeng: 50 g/hari, telor, susu, kejuSumber protein nabati : kacang-kacangan kering :25g/hari atau tahu, tempe, oncom : 50 g/hariLemak : minyak dalam jumlah terbatasSayuran : semua sayuran, kecuali asparagus, kacang polong, kacang buncis, kembang kol, bayam, jamur maksimum : 50 g/ hariBuah-buahan : semua macam buahMinuman : teh, kopi, minuman yang mengandung sodaBumbu : semua macam bumbu

  • Makanan yang tidak boleh diberikan Sumber protein hewani : sardin, kerang, jantung, hati, usus,limpa,paru,paru,otak, ekstraks daging/kaldu, bebek, angsa, burungMinuman : alkoholBumbu : ragi

  • Protective FoodsWater.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.)

  • 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.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.

  • 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.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.

  • 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. 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.

  • 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.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 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.

    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.

  • 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.

    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.

  • 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.

  • Sugar. 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.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

  • 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. 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. Encourage patients to avoid animal products. Their proteins and sodium content increase the risk of stones. Patients should keep salt and sugar use modest.