Patofisiologi dan Pencegahan

Batu Saluran Kemih

Dr.dr. Nur Rasyid, SpU

Department of Urology, Cipto Mangunkusumo Hospital
Division of Urology, Department of Surgery
Faculty of Medicine University of Indonesia

Epidemiology
Life time prevalence : 1-15%1
1 to 5% in Asia, 5 to 9% in Europe, 13% in
North America, and 20% in Saudi Arabia. 2
Stone formation is affected by1
Gender
- Age
Race
- Ocupation
Body Mass Index
- Climate Geographic
location
Male : Female = 2-3:11
1.Pearle MS & Lotan Y; Campbell Walsh Urology 2007
2. Ramello A et al; J Nephrol 2000

URINARY STONE CHARACTERISTICS OF PATIENTS TREATED WITH EXTRACORPOREAL SHOCK

WAVE LITHOTRIPSY (ESWL) IN CIPTO MANGUNKUSUMO HOSPITAL JAKARTA, 2008-2013: A
GENDER ANALYSIS

Graphic 1. Urinary stone patient sort by gender

Graphic 3. Location of stone

Graphic 2. Numbers of urinary stone patients sort by gender and age

Graphic 4. Stone opacity

Stone Formation & Growth

Unstable
supersatura2on




Metastable
Supersatura2on





Undersaturated
Zone


1.Pearle MS & Lotan Y; Campbell Walsh Urology; 2007

Stone Formation & Growth

n Nephrolithiasis

starts with urinary super-

saturation.
n Concentration products exceeding
solubility product crystallization does
not necessarily occur ~ Presence of
inhibitors and other molecules
n High urine flow rates (more than 2 liters in
24 hours) will reduce supersaturation and
might prevent calculi formation

Physiopathology And Etiology Of Stone

Formation In The Kidney And The Urinary Tract

Physiopathology And Etiology Of Stone Formation In The Kidney And

The Urinary Tract

Types of Urinary Stones

n Calcium

stones ( 75%)

n Struvite

stones (10- 15%)

n Uric

acid stones (10- 15%)

n Cystine

stones (< 1%)

Stone Formation & Growth

Calcium Stones
n Comprised

of calcium oxalate stones,

hydroxiapatite stones, and brushite stones
n Several conditions lead to the formation of
the stone:
Hypercalciuria
Hyperoxaluria
Hyperuricosuria
Hypocytraturia

Uric Acid Stones

n Low

pH causes uric acid precipitation

n Other factors affect the formation:
Hyperuricosuria
Low urine volume

Infection stones
n Mainly

composed of MgNH4PO4.6H2O
(struvite)
n Related to the infection caused by bacteria
that splits urea (urease producing
bacteria)
Proteus mirabilis
Klebsiella Sp.
Pseudomonas Sp.
Staphylococcus Sp.

PREVENTION

Type of prevention
n General

prevention

Recommended for all individuals with a

history of urinary stones
n Spesific

prevention

Recommended for all individuals with a high

risk condition for recurrent stones

EAU GUIDELINES FOR UROLITHIASIS 2014

General Prevention

Source: EAU Guideline Urolithiasis 2014

Specific Prevention

Source: EAU Guideline Urolithiasis 2014