MODUL 2 - URONEPHROLOGY

“DECREASE URIN PRODUCTION”

CREATED BY GROUP 4
Tutor : dr. Nur Aisyah

Muh. Akram Mu’fid 11020170085

Wa Ode Nur Fatimah Rifaat 11020170118
Vania Almira 11020170121
Nurul Azizah An’naajiyyah 11020170148
Nurlana Zamaun 11020170162
Noor Qadriyanti Ramadhani 11020160090
Muh. Muslim Purnomo Sukman 11020170012
Tebi 11020170020
Miftahul Janna 11020170042
Andi Ishmah Faza 11020170056
SCENARIO 2
A woman, 30 years old, was hospitalized with complaints of
reduced urine production since yesterday afternoon. Complaints
accompanied by low back pain. In addition, patients feel very
weak, vomiting often, and decreased appetite. History of taking
Ibuprofen for the past 1 week due to headaches. On physical
examination obtained TD 100/80 mmHg.
DIFFICULT WORD

-
 KEYWORDS
30-years-old woman

Urinary production has decreased since yesterday afternoon

.
Low back pain, weakness, frequent vomiting and decreased
appetite
History of taking Ibuprofen medicine for the past 1 week
And Heart Rate: 100/80 mmHg
QUESTIONS
1. Explain the anatomy, physiology and pathomechanism of decreased
urine production!
2. What are the factors that cause a decrease in urine production?
3. Explain the pathomechanism of weakness, vomiting, and decreased
appetite related to the scenario!
4. Explain the relation of the use of Ibuprofen drugs to patients based on
the scenario!
5. Explain diagnostic steps!
6. Explain the differential diagnosis related to the scenario!
7. Explain the initial management of the scenario!
8. Write down the perspective of Islam related to the scenario!
Anatomy of Kidney
PHYSIOLOGY OF KIDNEY
The Pathomechanism of Urine Production Decreases

Pre Renal
Intra Renal
Pasca Renal
 Factors causing the decrease in urine
production

1. Pre-renal
2. Intra renal
3. Pasca renal
 Pathomechanism of Weakness Relate to Scenario

DECREASE A
CELL PRODUCTION OF ATP

DECREASE OF WEAKNESS
OXYGEN SUPPLY
 Pathomechanism of Vomiting Relate to Scenario

Increase of creatinin and

BUN in serum Nausea and Vomiting

Stimulate the vomiting

Azotemia center (in MO-
Chemoreseptor Trigger
Zone)
 Pathomechanism of Decrease Appetite Relate to Scenario

hipothalamus Nucleus arcuatus

POMC/CART AgRP/NYP

Inhibition : Stiulation increase

decrease appetite appetite

Decrease Increased grelin

leptin
appetite leptin I blod
 The Relations of Ibuprofen Drug Use to
Patients Based on The Scenario

Ibuprofen Inhibition of prostaglandin Inhibition of COX2

Vasoconstriction a. renalis Decreased of GFR

Kidney injury Ischemic or necrosis glomerular/ tubulus

 HOW TO DIAGNOSIS?

Anam-
nesis
ANAMNESIS :
- Patient’s identity
PHYSICAL - Main complaint
EXAMINA-
TION - Another complaint
SUPPORTING - Medical history, family’s health history,
EXAMINATION
environment, habitual history
Physical Examination
-Inspection
-Palpation
-Percussion
-Auscultation

Laboratory Examination
-Urinalisis
-Blood test
-Urine culture
-Kidney function test
-HistoPA

Supporting Examination
-Radiology examnination
DIFFERENTIAL DIAGNOSIS
Disease DefinItion Epidemiologi Clinical Diagnosis Treatment Prevention
and Etiologi Manisfestation

Acute a rapid AKI is also a history of swelling, Anamnesis, no specific The best
kidney decrease (in medical history of urinary physical therapy for prevention of AKI
injury hours to complication in stones, oligouria is treatment, establishing is to pay attention
weeks) that developing a specific indicator laboratory intrinsic renal to the
the GFR is countries, for acute kidney examination, AKI due to hemodynamic
generally especially failure urinalysis, ischemia or status of a
reversible, patients with a histology and nephrotoxicit patient, maintain
followed by background of pathology Management fluid balance and
kidney diarrheal anatomy must focus on prevent the use of
failure to diseases, eliminating nephrotoxic
excrete infectious hemodynamic substances or
nitrogen diseases such as abnormalities drugs that can
residual malaria, of causes or interfere with
metabolism, leptospirosis toxins, kidney
with / avoiding compensation in
without additional someone with
impaired symptoms impaired kidney
fluid and function
electrolyte
balance.
Disease Definition and Epidemiologi Clinical Diagnosis Treatment Prevention
Etiologi manifestation

Urolythiasi Urinary stones Up to 10% of achy and colic in Anamnesis, Endoscopic Keep the fluid
s are hard masses caucasian men will the physical surgery, intake and
that develop from have urinary tract costovertebral examination, Conservative output in
crystals that stones by the age angle laboratory, therapy with balance,
separate from the of 70. Within 1 year (costovertebra blood and diuretic because The
urine while in the calcium oxalate will angle = CVA kidney administratio bigger the
urinary tract. form, 10% of men be fever, chills function tests. n can only be stone the
Normally, urine will form another and apathy. In the done on worse the
contains calcium oxalate Symptoms of examination ureteral prognosis.
chemicals to stone, and 50% will digestive tract of urinalysis, stones <5mm Location of
prevent or inhibit form another type such as nausea, BNO IVP, CT in diameter stones that
the formation of of stone in 10 vomiting, and scan with mild can cause
these crystals. years. urinary tract abdominal hydronephro obstruction
However, the stone disease is distension can sis whose can facilitate
block does not determined by occur due to colic pain has infection
work on individual intrinsic paralytic ileus. been treated.
everyone, so on factors (sex, age, Hematuria can
those people the heredity) and occur micro
stone is still extrinsic factors
formed
Disease Definition and Epidemiologi Clinical Diagnosis Treatment Prevention
Etiologi manifestation

Chronic Chronic kidney The number of low blood Anamnesis, Dialysis is Maintain ideal
kidney failure is kidney patients with pressure, dry physical needed if body weight,
failure damage that chronic or mouth, lost skin examination, these steps, stop smoking,
occurs for more asymptomatic tone, lethargy, laboratory combined with avoid
than 3 months, chronic renal fatigue, nausea examination, dietary consuming
based on failure makes it and finally kidney function restrictions, NSAIDs which
pathological difficult to know confusion. Urine test, urinalysis, are not enough can worsen the
abnormalities the exact output decreases to prevent or kidney
or markers of prevalence of and affects the control condition.
kidney damage chronic kidney chemical hyperkalemia,
such as failure. A more composition. fluid saturation,
proteinuria. The precise number high blood symptomatic
diagnosis of is the number of pressure, heart uremia
chronic kidney patients with rate becomes (drowsiness,
disease is chronic kidney irregular, swelling nausea,
when the failure who enter of congestive vomiting and
glomerular the terminal heart failure. tremor), or a
filtration rate phase because Decreased rapid rise in
(LFG) is less they require or appetite, nausea, BUN and
than 60ml / min are undergoing vomitinh creatinine
/ 1.73m². dialysis. levels.
Prompt treatment related to the scenario

1. The fluid intake must be balanced with the output during oligouri
2. Electrolytes: concerned are Na and K intakes
3. If hyponatremia occurs, 3% NaCl / hypertonic can be given
4. If hyperkalemi arises, given:
5. Ca gluconate 10%: 0.5 ml / kg body weight / day
6. NaHCO3 7.5%: 3 ml / kgBB / day
7. Kayexalate: 1 gr / kgBB / day (K exchange resin)
8. Protein: protein restriction must be as soon as possible.
ISLAMIC PERSPECTIVE

It means: "It was narrated from Sa'ad bin Abi Waqas from his father, from
the Messenger of Allah. : Verily, Allah SWT is holy who likes holy things,
He is Clean, He likes cleanliness, He is Mahamulia who likes glory, He is
Beautiful and loves beauty, therefore clean your places "(Narrated by
Tirmizi).
Thank You