Problem batu ginjal

Penyebab utama batu ginjal belum

diketahui
Bentuk 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 calcium

70%-80% tersusun dari calcium

oksalat dengan atau tanpa fosfat
Kelebihan calcium dalam urine dapat
disebabkan oleh :

1. intake berlebihan makanan yang

mengandung calcium tinggi
2. kelebihan vitamin D,absorbsi calcium
3. imobilisasi lama
4. hiperparatiroidism ekskresi calcium

Batu struvite

Terdiri dari MgNH4PO4

Sering disebut batu infeksi
Tidak berhubungan dengan makanan
spesifik
Tidak ada terapi diet spesifik
Biasanya berukuran besar perlu
operasi
Angka kejadiannya : sering

Batu asam urat

Kelebihan ekskresi asam urat,

gangguan metabolisme purin.
Terjadi pada penyakit gout, atau
karena pemecahan jaringan yang
cepat selama kelaparan

Batu cystine

Angka kejadiannya jarang

Terjadi karena defect genetik pada
metabolisme asam amino cystine,
akan terjadi gangguan reabsorbsi
asam amino cystine cystinuria
Terjadi pada anak dengan riwayat
penyakit genetik

Tanda-tanda klinis

Tanda utama batu ginjal :Nyeri hebat,

general weakness, kadang ada panas
Pengelolaan :

Intake cairan : banyak minum urine encer

mencegah akumulasi material pembentuk batu
Membatasi diet sesuai dengan komposisi
batumenghambat kekambuhan
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.

Diit pada batu ginjal

Memperlambat pertumbuhan batu

ginjal atau membantu mencegah
pembentukan batu ginjal
Perencanaan nutrisi dihubungkan
dengan jenis batu.
Mengurangi jenis makanan yang
berperan dalam pembentukan batu.

Macam diit dan indikasi pemberian

Diit rendah calcium tinggi sisa asam

Diberikan pada penderita dengan batu Kalsium :
Ca Fosfat, Ca carbonat, dan Ca oksalat.
Makanan ini cukup kalori, protein, besi, vitamin
A, thiamin dan vitamin C
Syarat : banyak cairan ; 2500 ml/hari,
rendah calsium : 400mg/hari
Makanan yang boleh diberikan :
KH : beras, bulgur,roti,mie, makaroni, bihun,
tepungtepungan
Protein hewani : telur, daging, unggas, ikan tanpa
tulang

Makanan yang boleh diberikan

Protein nabati : tahu/tempe maks 50 g/hari,

kacang-kacangan kering maks: 25 g/hari
Lemak : minyak,mentega, margarin
Sayuran : semua kecuali yang dilarang maks :
200 g/ hari
Buah : semua buah- buahan segar maks: 200 g/
hari

Makanan yang tidak boleh diberikan

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
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
Minuman : yang mengandung soda, coklat, soda
kue, yeast

Diit tinggi sisa basa

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
Makanan 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, the, kopi, coklat perlu dibatasi

Diit rendah purin

Tujuan :
Mengurangi pembentukan asam urat
Menurunkan berat badan bila pasien gemuk, dan
mempertahankan BB dalam batas normal
Syarat :
Rendah purin : 120-150 mg/hari, normal : 600-1000
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

Bahan makan yang boleh diberikan

KH
: semua
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
Lemak
: minyak dalam jumlah terbatas
Sayuran
: semua sayuran, kecuali asparagus,
kacang polong, kacang buncis, kembang kol,
bayam, jamur maksimum : 50 g/ hari
Buah-buahan : semua macam buah
Minuman
: teh, kopi, minuman yang
mengandung soda perlu dibatasi
Bumbu : 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, burung
Minuman : alkohol
Bumbu : ragi

Protective Foods

Water.
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.
Diet tinggi serat menurunkan absorbsi Ca diet

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.

Protein hewani

Menurunkan pH urine
Menurunkan reabsorbsi Ca ditubulus
distal
Meningkatkan oksalat
Meningkatkan asam urat
Menurunkan sitrat

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.

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.

Journal of the American Society

Nephrology (JASN), diet sehat
yang mencakup banyak
mengkonsumsi buah-buahan,
sayuran, kacang-kacangan, susu
rendah lemak dan biji-bijian;
membatasi asupan garam, daging
merah dan daging olahan, serta
mengurangi minuman yang manis
merupakan cara efektif untuk
mencegah terbentuknya batu
ginjal.