In Indonesia, cases of stone disease found many channels urine. In Asian countries such as Indonesia, the Middle East, China and India as the literature mentioned in the countries with the number of cases of stone channel urine tinggi.1
Stone channel urine often occurs in urine is sterile. Estimated that the increased incidence of stone associated with low protein diet and vegetable phosphate. There is a change in the pattern of life to a modern style, which, among others, with a marked increase in animal protein komsumsi, incidence of stone channel urine tended to increase. Foods that affect the formation of stones is different foods that contain calcium, but contains little serat.1
Stone channel does not actually chew more than minerals in the water in the settling and condense. Dehydration due to weather, climate and tropical heat can make diarrhea keadaaan stones or kidney stones urine channel previously have occurred. Besides, the stone channel urine often have the nature of relapse so that a threat for life for penderitanya.1
In developing countries, many patients found a stone jar, while in developed countries found it more stones chew the top of the channel, because of the influence of nutritional status and activities of day-to-patient hari.2 kidney stones or nefrolithiasis attack around 4% of all population, with the ratio of male: female is 4: 1, and the disease nefrolithiasis accompanied by a large morbiditas because of soreness. 3
II. 1. Definition Nefrolithiasis
Nefrolithiasis or kidney stones are solid objects that occur in the kidney that through the process of oxygen-fisikokimiawi substances in the urine of water. Kidney stones form the endogen of the smallest elements, mikrolith-mikrolith and can grow to be large. Massa was originally software, for example jendalan blood, can also experience pembatuan (kalsifikasi) 4
II. 2. Etiology Nefrolithiasis
Terbentuknya on kidney stones related to alleged interference with the flow of urine, interference metabolik, channel urine infections, dehydration and other conditions that still have not been revealed (idiopatik) 2
The epidemiologis, there are several factors that facilitate the occurrence of kidney stones. These factors are 2:
1. Intrinsic factor
That is the situation that comes from someone's body. The intrinsic factors and generally difficult to idiopatik corrected, so have a tendency to kambuh5.
Intrinsic factors that include:
a. Hereditair and Ras
The disease is suspected nefrolithiasis derived from the fact tuanya2 and family members nefrolithiasis have more opportunities to suffer from the same disease in other people. For example, familial genetic factors in hipersistinuria, hiperkalsiuria primary and hiperoksaluria primer5. Stone channel urine also found more in Africa and Asia while in the United States and Europe rarely ditemukan.5
b. Age.
Nefrolithiasis disease most often obtained at the age of 30 to 50 years
c. Sex
The number of male patients three times more than the patient perempuan2 and the men found more stone and ureter jar while the women more often found stones or kidney stones trophies ginjal.5
2. Factors ekstrinsik
That is the influence coming from the surrounding environment. Ekstrinsik factors, if it can be taken steps to change the environmental factors or kebiasaaan daily occurrence so rekurensi can dicegah5. Ekstrinsik several factors, which are:
a. Geography
In some areas show a number of stone incidence is higher than other areas, so that the area known as the stone belt
b. Climate and temperature
Place the bersuhu summer, for example, in the tropics, in the engine room, causing a lot of sweat that will be issued to reduce production and facilitate the establishment of urin stone. While in the area of cold, will cause a lack of water in the Feed community.
c. Feed water
Feed the lack of water content of all substances in urin will increase and will facilitate the establishment and the high degree batu5 mineral calcium in the water can increase the dikomsumsi incidence batu2.
d. Diet
Purin many diet, and calcium oksalat ease terbentuknya batu2. On the people who eat more animal protein, reduced the number morbiditas stone while in the community with low socio-economic conditions more often morbiditas increase. Population vegetarian meals that are less white eggs more often suffering from a stone jar and uretra and only a few were found suffering from kidney stones or stones trophies ginjal5
e. Job
Nefrolithiasis disease often found in people who sit or work more or less sedentary activity life2
f. Infection
Channel urine infection can cause kidney and nekrosis network will be the core of the formation of stones. Infection by bacteria that break ureum (urea splitting organism) and the form will change the pH Amonium urin into alkali and salt will precipitate-phosphate salt so that it will speed up the formation of stones that have been ada.5
g. Obstruksi and stasis urin
There is a channel obstruksi urine, for example, by tumor, striktur and hiperplasi prostat, will cause stasis urin while urin itself is the substance that contains a lot of bacteria so that the occurrence of infection and facilitate the formation of stones. 5
In addition to the factors on which there are other factors also influence, eg, metabolic disturbances. Metabolic disturbances are that can lead to increased value of the product can settle and become a stone. For example hiperkalsemia caused by hiperparatiroidisme, milk alkali syndrome, multiple mieloma, Ca metastase and sarkoidosis. Hiperurikemia and therapy with sitostatika or diuretika a long time, and hipersistinemia caused by renal Tubular acidosis
II. 3. Patofisiologi Nefrolithiasis
Theoretically, the stone can chew on all channels, especially in places that are often obstacles to the flow of urine (urine stasis), namely in the system kalises kidney or jar. There is a difference in the default pelvikalises (stenosis uretero pelvis), divertikulum, obstruksi intravesika chronic as in the hiperplasi prostat benigna, striktura and jar neurogenik are conditions that facilitate the establishment of a batu.2
Kidney stones form in the kidney tubuli, and in the kidney kaliks, pielum, infundibulum, renal pelvis, and can even fill the pelvis and the entire kidney kaliks. Stone fill pielum and more than two kaliks give you a kidney-like deer horn sehinggga called staghorn stones. Obstruksi aberration or the system pelvikalises kidney (constringency infundibulum and stenosis uteropelvik) will facilitate the occurrence of kidney stones. 2
The stone came from a run down the kidney and ureter, most probably be stuck in one of three locations, namely in connection uteropelvik, ureter intersect at the point iliaka vein, or in connection ureterovesika6. Stone is not too large, the system is driven by peristaltic pelvikalises and down to the ureter into ureter stones. Peristaltic ureter energy trying to remove the stones to go down to the jar. A small stone size (<> 250-300 mg/24 hours. There are 3 kinds of causes of the occurrence hiperkalsiuria, among others:
* Hiperkalsiuria absorbtif: hiperkalsiuria absorbtif situation occurred because of the increased calcium through the gut absorbsi
* Hiperkalsiuri renal: hiperkalsiuria renal situation could occur because of interference ability reabsorbsi calcium through the kidneys tubulus
* Hiperkalsiuria resorptif: hiperkalsiuria resorptif situation occurred because of the increased calcium resorpsi bones. Many hiperparatiroidisme occurred in or on the primary tumor paratiroid.
b. Hiperoksaluri
Oksalat urine is ekskresi exceed 45 grams / day. Hiperoksaluria situation found in many patients with disturbances in the intestine after undergoing intestinal surgery and the patient a lot of mengkomsumsi will oksalat rich food such as tea, instant coffee, soft drink, kokoa, strawberry, orange, citric, and greens, especially spinach.
c. Hiperurikosuria
It is the acid content in muscle in urine than 850 mg/24 hours. Acid excessive muscle in urine, acts as the core of stone / nidus for stone terbentuknya calcium oksalat. Source acid in the blood vessel in the urine comes from the many purin food such as meat, fish, poultry and derived from the metabolism endogen.
d. Hipositraturia
Can occur in asidosis tubulus kidney, malabsorbsi syndrome, or the use of thiazide in diuretik long time
e. Hipomagnesiuria
The cause tersering hipomagnesiuria is inflamasi bowel disease
(Inflammatory bowel disease) followed malabsorbsi interference.
2. Stone struvit
Referred to as infection stones, because terbentuknya stone struvit caused by infection of the urine channel. Bacteria infection is the cause of the breaker urea bacteria that can produce the enzyme urease and the urine becomes bersuasana basa through urea hydrolysis into Ammonia. The atmosphere of ease basa salt-magnesium salt, Amonium, phosphate and form carbonic rock phosphate and magnesium Amonium carbonic apatit. Because of 3 kation, known as triple phosphate rock. Germs that breaker including urea are Proteus spp, Klebsiella, Serratia, Enterobacter, Pseudomonas, and Stafilokokus 2
3. Stone acid Urat
Is 5-10% of all stones channel urine. Most of the acid rock of pure muscle, the rest is a mixture of calcium oksalat. Acid rock muscle disease suffered by many patients the disease gout, mieloproliferatif, patients with the therapy antikanker, and many use obet urikosurik, among others sulfinpirazole, thiazide, and salisilat. Obesity, alcohol drinker, high-protein diet and a big get this disease. Stone sour nerves rounded shape and smooth out so often spontan.2
Source acids derived from dietary fiber containing purin and endogen metabolism in the body. Purin in the body didegradasi by inosinat acid, was changed into hipoxanthin,. With the help of enzyme xanthin oksidase, hipoxanthin was changed into xanthin which eventually was changed into acid fiber. In the men, because they do not have the enzyme urikase, the acid diekskresikan to nerves in the urine in the form of acid-free grain and grain of salt. Salt nerves more often berikatan with natrium form natrium muscle, the more easily soluble in water than acid-free fiber. Acid-free fiber relatively late in the urine, so that in some cases easy to form acid crystals form nerves and muscle acid stone. Some of the factors that affect the nerves terbentuknya stone sour adalah2:
* Urine that is too acid (pH urine <> 7)
Sediments
- Increased blood cell (90%), infection in white blood cells will increase.
- Of the crystals, such as crystal oksalat
- Urin culture to see the type of microorganisms cause infection in the urine channel
2. Blood
- Hemoglobin, the interruption of chronic kidney function can occur anemia
- Leukosit, urine infection channels caused by the stones leukositosis
- Ureum kreatinin, this parameter is used to view the kidney function
- Calcium, acid and fiber.
clip_image001 [1] Radiologik:
1. Photo plain abdomen
Aims to see the possibility of stone radioopak in the urine channel. Stone oksalat type of calcium phosphate and calcium radioopak and are most often found, while the grain is stone sour radiolusen.2
2. Pielografi Intra Vena
Aims to assess the anatomy and function of kidneys. It also can detect the existence of stone semi Opak or non Opak stone that can not be seen by the images of plain stomach. If pielografi intra vena (hereinafter called PIV) can not explain the channel system due to a decrease in urine kidney function, instead pielografi examination is retrograde.2
3. Ultrasonografi
Done when the patient does not undergo the examination may PIV, namely the situation in contrast to the reaction, kidney function and the decline in women who are pregnant. Ultrasonografi examination can assess the stones in the kidney or in the jar (as shown echoic shadow), hidronefrosis, pionefrosis, or the pengkerutan ginjal.2
II. 6. Penatalaksanaan Nefrolithiasis
Destination management of stones in the kidney is to remove obstruksi, treat infections, severe pain, prevent the occurrence of renal failure and reduce the possibility of a rekurensi3. To achieve this, steps can be taken are as follows 5:
* Diagnosis of the right of the stone, the location and size of the stone
* Setting the stone as a result of the pain, obstruksi with the changes in the kidneys, the infection and renal disfunction
* Eliminate obstruksi, infection and pain
* Analysis of stone
* Search for the background of a stone
* Take the prevention of a rekurensi
Penatalaksanaan actions that can be done is 2:
1. Medikamentosa
Terapi medikamentosa intended to rock the size of less than 5 mm, because the stone can be expected to come out spontaneously. Therapy was given more simtomatis, which aims to reduce the pain, expedite the flow of urine through diuretikum, and drink a lot of stone that can encourage exit
2. ESWL (Extracorporeal Shockwave Lithotripsy)
Tools ESWL kidney stones may break through the action without invasif and without anesthesia. The stone fragments into smaller fragments so-easily removed through the urine channel. Not infrequently, bills, bills, rock-out that are cause painful feelings kolik and cause hematuria.
3. Endourologi
Endourologi action is minimal invasif action to remove the stones, the action consists of split stone, and then remove it from the urine through the instrument channel is entered directly into the urine channel. The tool is inserted through uretra or through small insisi on the skin (perkutan). The process of breaking the stone can be either mechanical, using hidroulik energy, energy sound waves, or with laser energy. Endourologi some action to remove the stones in the kidney are:
a. PNL (Percutaneous Nephro Litholapaxy)
Namely removing the stones in the kidney in the channel with the endoscopy equipment to enter the system through kalises kidney insisi on the skin. Stone then issued or to be parsed first fragment-small fragments.
b. Uretero or Uretero-renoskopi
Which include equipment ureteroskopi per uretram to see kedaan ureter or kidney pielokaliks system. With a certain energy, which is located a stone in the ureter and pelvikalises system can be parsed through ureterorenoskopi guidance.
4. Open Surgery
In the clinics that do not have sufficient facilities for actions endourologi, laparaskopi and ESWL, the stone is still done through open surgery. Surgery that are pielolitotomi or nefrolitotomi to kidney stones in the channel. Not infrequently the patient must undergo nefrektomi action because their kidneys are not working and there has been pionefrosis, korteksnya have very thin or pengkerutan due to a stone obstruksi and cause chronic infections that
II. 7. Prevention Nefrolithiasis
Further action is no less important after the stone is the attempt to avoid the emergence kekambuhan. Prevention is made based on the actual elements of the sort of stone obtained from the analysis batu3. In general, prevention is the form of 5:
* Avoid dehydration by drinking enough and arranged the production of urine 2-3 L / day
* Sufficient daily activity
* Diet to reduce the oxygen level-forming substances component stone
Stone Type
Factors predisposisi
Preventive treatment for urine pH ynag needed
Urine acid (pH <> 6)
Calcium oksalat
Acid crystal fiber
Hiperkalsiuria
Chemotherapy gout
Vegetables, milk, fruit (except plum, dried plum, Cranberry)
Natrium bicarbonate or citric
Triple phosphate
Calcium phosphate
Urine basa
Channel urine infection
Hiperkalsiuria, long immobility
Urine acid
Meat, bread, food berprotein, Cranberry juice, plum, dried plum
mandelanin
II. 8. Prognosis Nefrolithiasis
Prognosis stones at the channel urine and kidney, especially depending on the size of the stone, stone setting, the infection and the obstruksi. The size of a large stone, the ugly prognosisnya. Location of stone that can cause obstruksi can facilitate the occurrence of infection. The greater the damage the network and the infection because of factors obstruksi will be a decline in kidney function, so the prognosis becomes jelek.5
II. 9. Complications Nefrolithiasis
Obstruksi ureter can cause hidroureter and hidronefrosis. Pielum in stone can cause hidronefrosis, stone in kaliks can cause major kaliekstasis on kaliks concerned. If accompanied by secondary infection, can cause pionefrosis, urosepsis, abses kidney, abses perinefrik, or pielonefritis. In the case information, kidney damage can occur, and if the both sides can lead to kidney failure permanen.2
REFERENCES
1. Ashadi T., 1998, Diagnostic Benefit Radiografi Channel chew on Stone, 24 (8), p.; 544 - 9, Medika
2. Ismadi M., 1976, Research In Urolithiasis About Attention With Nature Biokimiawi urine, Faculty of Medicine, Gadjah Mada University, Yogyakarta
3. Palmer PES, 1995, Reading Images To Help Doctors General, Publisher EGC, Jakarta.
4. S. Price A., L. Wilson M., 1995. Kidney stones in the urine and channels Patofisiologi, the concept of clinical disease processes, ed 4, p.; 797 - 8, EGC, Jakarta
5. B. Purnomo, 2003, kidney stones and Ureter in Basics Urologi, p.; 57 - 68, Sagung Seto, Yogyakarta
6. Raharjo J. P., 1996, Stone in the ureter Diseases In Science, ed 3, p.; 337 - 40, Faculty of Medicine, University of Indonesia, Jakarta
7. C. Sabiston D. Jr., MD., 1997, kidney stones and Ureter in Ajar Bedah Book 2, p.; 472 - 3, EGC, Jakarta
8. Sjahriar et al, 2000, Nefrolitiasis, Diagnostic Radiology, the Medical Faculty of Radiology, University of Indonesia, Jakarta
9. Stuart J., Nefrolithiasis, www.eMedicine.com, 2005
10. Tisher C. Craig., C. Wilcox, 1997, kidney stone disease in the Book Saku Nefrologi, ha1; 86 - 99, EGC, Jakarta
Stone channel urine often occurs in urine is sterile. Estimated that the increased incidence of stone associated with low protein diet and vegetable phosphate. There is a change in the pattern of life to a modern style, which, among others, with a marked increase in animal protein komsumsi, incidence of stone channel urine tended to increase. Foods that affect the formation of stones is different foods that contain calcium, but contains little serat.1
Stone channel does not actually chew more than minerals in the water in the settling and condense. Dehydration due to weather, climate and tropical heat can make diarrhea keadaaan stones or kidney stones urine channel previously have occurred. Besides, the stone channel urine often have the nature of relapse so that a threat for life for penderitanya.1
In developing countries, many patients found a stone jar, while in developed countries found it more stones chew the top of the channel, because of the influence of nutritional status and activities of day-to-patient hari.2 kidney stones or nefrolithiasis attack around 4% of all population, with the ratio of male: female is 4: 1, and the disease nefrolithiasis accompanied by a large morbiditas because of soreness. 3
II. 1. Definition Nefrolithiasis
Nefrolithiasis or kidney stones are solid objects that occur in the kidney that through the process of oxygen-fisikokimiawi substances in the urine of water. Kidney stones form the endogen of the smallest elements, mikrolith-mikrolith and can grow to be large. Massa was originally software, for example jendalan blood, can also experience pembatuan (kalsifikasi) 4
II. 2. Etiology Nefrolithiasis
Terbentuknya on kidney stones related to alleged interference with the flow of urine, interference metabolik, channel urine infections, dehydration and other conditions that still have not been revealed (idiopatik) 2
The epidemiologis, there are several factors that facilitate the occurrence of kidney stones. These factors are 2:
1. Intrinsic factor
That is the situation that comes from someone's body. The intrinsic factors and generally difficult to idiopatik corrected, so have a tendency to kambuh5.
Intrinsic factors that include:
a. Hereditair and Ras
The disease is suspected nefrolithiasis derived from the fact tuanya2 and family members nefrolithiasis have more opportunities to suffer from the same disease in other people. For example, familial genetic factors in hipersistinuria, hiperkalsiuria primary and hiperoksaluria primer5. Stone channel urine also found more in Africa and Asia while in the United States and Europe rarely ditemukan.5
b. Age.
Nefrolithiasis disease most often obtained at the age of 30 to 50 years
c. Sex
The number of male patients three times more than the patient perempuan2 and the men found more stone and ureter jar while the women more often found stones or kidney stones trophies ginjal.5
2. Factors ekstrinsik
That is the influence coming from the surrounding environment. Ekstrinsik factors, if it can be taken steps to change the environmental factors or kebiasaaan daily occurrence so rekurensi can dicegah5. Ekstrinsik several factors, which are:
a. Geography
In some areas show a number of stone incidence is higher than other areas, so that the area known as the stone belt
b. Climate and temperature
Place the bersuhu summer, for example, in the tropics, in the engine room, causing a lot of sweat that will be issued to reduce production and facilitate the establishment of urin stone. While in the area of cold, will cause a lack of water in the Feed community.
c. Feed water
Feed the lack of water content of all substances in urin will increase and will facilitate the establishment and the high degree batu5 mineral calcium in the water can increase the dikomsumsi incidence batu2.
d. Diet
Purin many diet, and calcium oksalat ease terbentuknya batu2. On the people who eat more animal protein, reduced the number morbiditas stone while in the community with low socio-economic conditions more often morbiditas increase. Population vegetarian meals that are less white eggs more often suffering from a stone jar and uretra and only a few were found suffering from kidney stones or stones trophies ginjal5
e. Job
Nefrolithiasis disease often found in people who sit or work more or less sedentary activity life2
f. Infection
Channel urine infection can cause kidney and nekrosis network will be the core of the formation of stones. Infection by bacteria that break ureum (urea splitting organism) and the form will change the pH Amonium urin into alkali and salt will precipitate-phosphate salt so that it will speed up the formation of stones that have been ada.5
g. Obstruksi and stasis urin
There is a channel obstruksi urine, for example, by tumor, striktur and hiperplasi prostat, will cause stasis urin while urin itself is the substance that contains a lot of bacteria so that the occurrence of infection and facilitate the formation of stones. 5
In addition to the factors on which there are other factors also influence, eg, metabolic disturbances. Metabolic disturbances are that can lead to increased value of the product can settle and become a stone. For example hiperkalsemia caused by hiperparatiroidisme, milk alkali syndrome, multiple mieloma, Ca metastase and sarkoidosis. Hiperurikemia and therapy with sitostatika or diuretika a long time, and hipersistinemia caused by renal Tubular acidosis
II. 3. Patofisiologi Nefrolithiasis
Theoretically, the stone can chew on all channels, especially in places that are often obstacles to the flow of urine (urine stasis), namely in the system kalises kidney or jar. There is a difference in the default pelvikalises (stenosis uretero pelvis), divertikulum, obstruksi intravesika chronic as in the hiperplasi prostat benigna, striktura and jar neurogenik are conditions that facilitate the establishment of a batu.2
Kidney stones form in the kidney tubuli, and in the kidney kaliks, pielum, infundibulum, renal pelvis, and can even fill the pelvis and the entire kidney kaliks. Stone fill pielum and more than two kaliks give you a kidney-like deer horn sehinggga called staghorn stones. Obstruksi aberration or the system pelvikalises kidney (constringency infundibulum and stenosis uteropelvik) will facilitate the occurrence of kidney stones. 2
The stone came from a run down the kidney and ureter, most probably be stuck in one of three locations, namely in connection uteropelvik, ureter intersect at the point iliaka vein, or in connection ureterovesika6. Stone is not too large, the system is driven by peristaltic pelvikalises and down to the ureter into ureter stones. Peristaltic ureter energy trying to remove the stones to go down to the jar. A small stone size (<> 250-300 mg/24 hours. There are 3 kinds of causes of the occurrence hiperkalsiuria, among others:
* Hiperkalsiuria absorbtif: hiperkalsiuria absorbtif situation occurred because of the increased calcium through the gut absorbsi
* Hiperkalsiuri renal: hiperkalsiuria renal situation could occur because of interference ability reabsorbsi calcium through the kidneys tubulus
* Hiperkalsiuria resorptif: hiperkalsiuria resorptif situation occurred because of the increased calcium resorpsi bones. Many hiperparatiroidisme occurred in or on the primary tumor paratiroid.
b. Hiperoksaluri
Oksalat urine is ekskresi exceed 45 grams / day. Hiperoksaluria situation found in many patients with disturbances in the intestine after undergoing intestinal surgery and the patient a lot of mengkomsumsi will oksalat rich food such as tea, instant coffee, soft drink, kokoa, strawberry, orange, citric, and greens, especially spinach.
c. Hiperurikosuria
It is the acid content in muscle in urine than 850 mg/24 hours. Acid excessive muscle in urine, acts as the core of stone / nidus for stone terbentuknya calcium oksalat. Source acid in the blood vessel in the urine comes from the many purin food such as meat, fish, poultry and derived from the metabolism endogen.
d. Hipositraturia
Can occur in asidosis tubulus kidney, malabsorbsi syndrome, or the use of thiazide in diuretik long time
e. Hipomagnesiuria
The cause tersering hipomagnesiuria is inflamasi bowel disease
(Inflammatory bowel disease) followed malabsorbsi interference.
2. Stone struvit
Referred to as infection stones, because terbentuknya stone struvit caused by infection of the urine channel. Bacteria infection is the cause of the breaker urea bacteria that can produce the enzyme urease and the urine becomes bersuasana basa through urea hydrolysis into Ammonia. The atmosphere of ease basa salt-magnesium salt, Amonium, phosphate and form carbonic rock phosphate and magnesium Amonium carbonic apatit. Because of 3 kation, known as triple phosphate rock. Germs that breaker including urea are Proteus spp, Klebsiella, Serratia, Enterobacter, Pseudomonas, and Stafilokokus 2
3. Stone acid Urat
Is 5-10% of all stones channel urine. Most of the acid rock of pure muscle, the rest is a mixture of calcium oksalat. Acid rock muscle disease suffered by many patients the disease gout, mieloproliferatif, patients with the therapy antikanker, and many use obet urikosurik, among others sulfinpirazole, thiazide, and salisilat. Obesity, alcohol drinker, high-protein diet and a big get this disease. Stone sour nerves rounded shape and smooth out so often spontan.2
Source acids derived from dietary fiber containing purin and endogen metabolism in the body. Purin in the body didegradasi by inosinat acid, was changed into hipoxanthin,. With the help of enzyme xanthin oksidase, hipoxanthin was changed into xanthin which eventually was changed into acid fiber. In the men, because they do not have the enzyme urikase, the acid diekskresikan to nerves in the urine in the form of acid-free grain and grain of salt. Salt nerves more often berikatan with natrium form natrium muscle, the more easily soluble in water than acid-free fiber. Acid-free fiber relatively late in the urine, so that in some cases easy to form acid crystals form nerves and muscle acid stone. Some of the factors that affect the nerves terbentuknya stone sour adalah2:
* Urine that is too acid (pH urine <> 7)
Sediments
- Increased blood cell (90%), infection in white blood cells will increase.
- Of the crystals, such as crystal oksalat
- Urin culture to see the type of microorganisms cause infection in the urine channel
2. Blood
- Hemoglobin, the interruption of chronic kidney function can occur anemia
- Leukosit, urine infection channels caused by the stones leukositosis
- Ureum kreatinin, this parameter is used to view the kidney function
- Calcium, acid and fiber.
clip_image001 [1] Radiologik:
1. Photo plain abdomen
Aims to see the possibility of stone radioopak in the urine channel. Stone oksalat type of calcium phosphate and calcium radioopak and are most often found, while the grain is stone sour radiolusen.2
2. Pielografi Intra Vena
Aims to assess the anatomy and function of kidneys. It also can detect the existence of stone semi Opak or non Opak stone that can not be seen by the images of plain stomach. If pielografi intra vena (hereinafter called PIV) can not explain the channel system due to a decrease in urine kidney function, instead pielografi examination is retrograde.2
3. Ultrasonografi
Done when the patient does not undergo the examination may PIV, namely the situation in contrast to the reaction, kidney function and the decline in women who are pregnant. Ultrasonografi examination can assess the stones in the kidney or in the jar (as shown echoic shadow), hidronefrosis, pionefrosis, or the pengkerutan ginjal.2
II. 6. Penatalaksanaan Nefrolithiasis
Destination management of stones in the kidney is to remove obstruksi, treat infections, severe pain, prevent the occurrence of renal failure and reduce the possibility of a rekurensi3. To achieve this, steps can be taken are as follows 5:
* Diagnosis of the right of the stone, the location and size of the stone
* Setting the stone as a result of the pain, obstruksi with the changes in the kidneys, the infection and renal disfunction
* Eliminate obstruksi, infection and pain
* Analysis of stone
* Search for the background of a stone
* Take the prevention of a rekurensi
Penatalaksanaan actions that can be done is 2:
1. Medikamentosa
Terapi medikamentosa intended to rock the size of less than 5 mm, because the stone can be expected to come out spontaneously. Therapy was given more simtomatis, which aims to reduce the pain, expedite the flow of urine through diuretikum, and drink a lot of stone that can encourage exit
2. ESWL (Extracorporeal Shockwave Lithotripsy)
Tools ESWL kidney stones may break through the action without invasif and without anesthesia. The stone fragments into smaller fragments so-easily removed through the urine channel. Not infrequently, bills, bills, rock-out that are cause painful feelings kolik and cause hematuria.
3. Endourologi
Endourologi action is minimal invasif action to remove the stones, the action consists of split stone, and then remove it from the urine through the instrument channel is entered directly into the urine channel. The tool is inserted through uretra or through small insisi on the skin (perkutan). The process of breaking the stone can be either mechanical, using hidroulik energy, energy sound waves, or with laser energy. Endourologi some action to remove the stones in the kidney are:
a. PNL (Percutaneous Nephro Litholapaxy)
Namely removing the stones in the kidney in the channel with the endoscopy equipment to enter the system through kalises kidney insisi on the skin. Stone then issued or to be parsed first fragment-small fragments.
b. Uretero or Uretero-renoskopi
Which include equipment ureteroskopi per uretram to see kedaan ureter or kidney pielokaliks system. With a certain energy, which is located a stone in the ureter and pelvikalises system can be parsed through ureterorenoskopi guidance.
4. Open Surgery
In the clinics that do not have sufficient facilities for actions endourologi, laparaskopi and ESWL, the stone is still done through open surgery. Surgery that are pielolitotomi or nefrolitotomi to kidney stones in the channel. Not infrequently the patient must undergo nefrektomi action because their kidneys are not working and there has been pionefrosis, korteksnya have very thin or pengkerutan due to a stone obstruksi and cause chronic infections that
II. 7. Prevention Nefrolithiasis
Further action is no less important after the stone is the attempt to avoid the emergence kekambuhan. Prevention is made based on the actual elements of the sort of stone obtained from the analysis batu3. In general, prevention is the form of 5:
* Avoid dehydration by drinking enough and arranged the production of urine 2-3 L / day
* Sufficient daily activity
* Diet to reduce the oxygen level-forming substances component stone
Stone Type
Factors predisposisi
Preventive treatment for urine pH ynag needed
Urine acid (pH <> 6)
Calcium oksalat
Acid crystal fiber
Hiperkalsiuria
Chemotherapy gout
Vegetables, milk, fruit (except plum, dried plum, Cranberry)
Natrium bicarbonate or citric
Triple phosphate
Calcium phosphate
Urine basa
Channel urine infection
Hiperkalsiuria, long immobility
Urine acid
Meat, bread, food berprotein, Cranberry juice, plum, dried plum
mandelanin
II. 8. Prognosis Nefrolithiasis
Prognosis stones at the channel urine and kidney, especially depending on the size of the stone, stone setting, the infection and the obstruksi. The size of a large stone, the ugly prognosisnya. Location of stone that can cause obstruksi can facilitate the occurrence of infection. The greater the damage the network and the infection because of factors obstruksi will be a decline in kidney function, so the prognosis becomes jelek.5
II. 9. Complications Nefrolithiasis
Obstruksi ureter can cause hidroureter and hidronefrosis. Pielum in stone can cause hidronefrosis, stone in kaliks can cause major kaliekstasis on kaliks concerned. If accompanied by secondary infection, can cause pionefrosis, urosepsis, abses kidney, abses perinefrik, or pielonefritis. In the case information, kidney damage can occur, and if the both sides can lead to kidney failure permanen.2
REFERENCES
1. Ashadi T., 1998, Diagnostic Benefit Radiografi Channel chew on Stone, 24 (8), p.; 544 - 9, Medika
2. Ismadi M., 1976, Research In Urolithiasis About Attention With Nature Biokimiawi urine, Faculty of Medicine, Gadjah Mada University, Yogyakarta
3. Palmer PES, 1995, Reading Images To Help Doctors General, Publisher EGC, Jakarta.
4. S. Price A., L. Wilson M., 1995. Kidney stones in the urine and channels Patofisiologi, the concept of clinical disease processes, ed 4, p.; 797 - 8, EGC, Jakarta
5. B. Purnomo, 2003, kidney stones and Ureter in Basics Urologi, p.; 57 - 68, Sagung Seto, Yogyakarta
6. Raharjo J. P., 1996, Stone in the ureter Diseases In Science, ed 3, p.; 337 - 40, Faculty of Medicine, University of Indonesia, Jakarta
7. C. Sabiston D. Jr., MD., 1997, kidney stones and Ureter in Ajar Bedah Book 2, p.; 472 - 3, EGC, Jakarta
8. Sjahriar et al, 2000, Nefrolitiasis, Diagnostic Radiology, the Medical Faculty of Radiology, University of Indonesia, Jakarta
9. Stuart J., Nefrolithiasis, www.eMedicine.com, 2005
10. Tisher C. Craig., C. Wilcox, 1997, kidney stone disease in the Book Saku Nefrologi, ha1; 86 - 99, EGC, Jakarta
