Post on 02-Mar-2018
7/26/2019 Prof. Syarifuddin Rauf (Sindrome Nefrotik, UTI, GNAPS)
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Prof. Dr. dr.Syarifuddin Rauf, SpAK
Bagian Ilmu Kesehatan Anak FK - UNHASBagian Ilmu Kesehatan Anak FK - UNHAS
RS Dr. Wahidin Sudirohusodo MakassarRS Dr. Wahidin Sudirohusodo Makassar
7/26/2019 Prof. Syarifuddin Rauf (Sindrome Nefrotik, UTI, GNAPS)
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LOMERULONEFRITIS
AKUT ( NA)
7/26/2019 Prof. Syarifuddin Rauf (Sindrome Nefrotik, UTI, GNAPS)
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Proliferasi dan inflamasi glomeruli
Sekunder oleh mekanisme imunologik
Antigen: bakteri, virus, parasit & zat lain.
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LOMERULONEFRITIS AKUT
LOMERULONEFRITIS AKUT
PASCA STREPTOKOKKUSASCA STREPTOKOKKUS
( NAPS)
NAPS)
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1. Angka kejadian1. Angka kejadian
Lebih sering umur !" thn, jarang # $ thn
Laki % laki perempuan '(:1)
1*! 1( + kasus infeksi strept. hemolitikus
grup A
aplan: -*+ kasus asimtomatik pd epidemi
/APS didahului 0SPA atau piodermi
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(. tiologi
Streptokokus hemolitikus grup A 'tipe 2)
/34056/0
3aringitis 'serotipe tersering 1(, lalu 1,$,7,,(-)
Piodermi 'serotipe tersering 78, lalu (,-$,--,
-,-",-9,*
7/26/2019 Prof. Syarifuddin Rauf (Sindrome Nefrotik, UTI, GNAPS)
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a. Periode latent: 1 % $ minggu
b. dema
. ;ematuri
d. ;ipertensi
e. 6ligouria
f. ejala!gejala lain: lelah, malaise, letargi
& anoreksia
g. elainan laboratorium
2A/03S5AS0 L0/0
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>A4A;:
5iter AS56 meningkat
2enurunn?a kadar @$
L> meninggi
;ipoproteinemi ringan
Pemeriksaan bakteriologik
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ila memenuhi 7 gejala berikut
;ematuri makroskopik atau mikroskopik
dema
;ipertensi
AS56 meningkat
@$ menurun
>iagnosis /APS
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SINDROM NEFROTIK (SN)
INDROM NEFROTIK (SN)
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1. dema 2asif
(. Proteinuri 2asif
$. ;ipoproteinemi '# (,- gBdl)
7. ;iperkolesterolemi
'(-* mgBdl)
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A/A CA>0A/A/A CA>0A/
Anak de=asa
Anak: 1 % $ tahun
- tahun
Dila Dir?a '188(): kasusB1**.*** penduduk
# 17 thnBthn
Cumlah kasus di 0ndonesia '(1* juta pend.) :
-*7* S/
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506L60506L60
5idak diketahui: S/ idiopatik
enetik : S/ kongenital
;LA!1(, ;LA 9
Penetus : 0nfeksi virusBbakteri
Alergi
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PA562A/0S2
Soluble antigen! antibod? ompleE
5eori elektrokemik
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7/26/2019 Prof. Syarifuddin Rauf (Sindrome Nefrotik, UTI, GNAPS)
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62PL0AS0 FA/ 54CA>0 PA>A62PL0AS0 FA/ 54CA>0 PA>A/APS >A/ S/:/APS >A/ S/:
1.;0P45/S0 /S3AL6PA50
(. >2A PA4 *0 mm/hour
&ncreased (P )> *0 u,/m!
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1. Eradicate acute inection
. etection %reention 2 treatment
recurrent inection
*. etection 2 sur,ica! correction
a"norma!ity o anatomica! structure
MANAGEMENTMANAGEMENT
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7/26/2019 Prof. Syarifuddin Rauf (Sindrome Nefrotik, UTI, GNAPS)
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Sudden loss or dereased of kidne?sSudden loss or dereased of kidne?s
funtionfuntion
0mbalane of =ater & eletrol?te blood0mbalane of =ater & eletrol?te blood
0nreased of =aste produts '
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A. Prerenal: >erased blood flo=
>iarrhea deh?dration
;emorrhage
urns
Septi shok
ETIOLO Y:
TIOLO Y:
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. 4enal:
Aute 5ubular /erosis
Aute /ephriti S?ndrome
/ephroti s?ndrome
Aute P?elonephritis
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@. Postrenal:
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1. Prerenal:1. Prerenal:Perinatal hemorrhage 'birth trauma, plaenta
abruption)
/eonatal hemorrhage 'severe intraventriular
hemorrhage, adrenal hemorrhage)
Perinatal asph?Eia
;?aline membrane disease
tiolog? of A43 in /e=born:tiolog? of A43 in /e=born:
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(. 4enal :(. 4enal :
Aute 5ubular /erosis 'perinatal asph?Eia)
2aternal!fetal transfer:
Antibodies
0nfetions: s?philis, @?tomegalovirus
$. Postrenal :$. Postrenal :@ongenital malformations of urinar?
olleting s?stem
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CLINICAL MANIFESTATIONS:
LINICAL MANIFESTATIONS:
1. >ereased urine volume '6ligouria Anuria)(. eneralized s=elling
$. @hanges in mental status:
eliriumBonfusion
@oma
7. Seizures-. /ausea, vomiting
. Anemia
". usmaul respiration
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DIA NOSIS
IA NOSIS
@linial 2anifestations@linial 2anifestations
Lab. Eamination:Lab. Eamination:
Serum
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TREATMENT
REATMENT
1. 5he goal of the treatment is to identif? & treat
reversible auses like prerenal auses
'diarrhea deh?dration) & post renal auses
'e.g. obstrutive uropath? b? surgeonproedure)
(. 2edial drugs:
Antibiotis: 5o prevent infetion
>iuretis: to treat oligouria or anuria
>iazepam: 5o handle onvulsion
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$. mergen? ondition:
;?perkalemia:
@a lukonas
Potassium eEhange resin
'a?eEalate) 6ralBretal
2etaboli aidosis: iarbonate /atrius
7/26/2019 Prof. Syarifuddin Rauf (Sindrome Nefrotik, UTI, GNAPS)
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7/26/2019 Prof. Syarifuddin Rauf (Sindrome Nefrotik, UTI, GNAPS)
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4enal funtion progresses to derease4enal funtion progresses to derease
slo=l?slo=l?
0mbalane of =ater & eletrol?te0mbalane of =ater & eletrol?te
0nreased of =aste produts 'lood0nreased of =aste produts 'lood
ureum & reatinin)ureum & reatinin)
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# - ?ears old:
;?poplasia B >?splasia kidne?
@ongenital struture of urinar? trat
Gesioureteral refluE
@ongenital /ephroti S?ndrome
ETIOLO Y:
TIOLO Y:
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- % 1- ?ears old :
;ereditar? diseases: AlportOs s?ndrome,
sistinuri
Primar? glomerulonephritis: /ephriti
S?ndrome
Seondar? glomerulonephritis : SL,S;S
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TREATMENT
REATMENT
1. @onservative 5reatment:
5he aims of this treatment:
Preparing the hild & famil? for the
treatment of @43
Slo=l? progression to nd Stage 43
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(. 4eplaement therap?:
5he aims is to replae the funtion of the
unfuntion kidne? b?:
>ial?sis:
Peritoneal dial?sis 'P>)
;emodial?sis
5ransplantation
7/26/2019 Prof. Syarifuddin Rauf (Sindrome Nefrotik, UTI, GNAPS)
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@ompliation of SL
>amage to glomerulus
Progressive loss of kidne? funtion
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1.1.
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$. /ongeneti fator:
Longterm treatment of ertain drugs
' months) h?dralazine
SeE hormone: estrogen SL 'K)
Giral infetion
SFS520@ L
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SFS520@ L
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PA5;6/S0SPA5;6/S0S
Autoimune proessM
Antinulear Antibod? 'A/A)Q >s!>/A 'Antigen)
MSoluble Ag!Ab @ompleEM
2
M>eposition of: A/A Q >s!>/A Q @$
M4enal s?mptoms
/4AL SF2P562S/4AL SF2P562S
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/4AL SF2P562S/4AL SF2P562S
3ever
2alar rash: A rash shaped like butterfl?
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@L0/0@AL 2A/03S5A506/S:@L0/0@AL 2A/03S5A506/S:4/AL SF2562PS4/AL SF2562PS
1. P4650/462
>0A/6S0S>0A/6S0S
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>0A/6S0S>0A/6S0S
@linial 2anifestations
Lab. Eamination:
lood: Anti /ulear Antibod? 'Q)
L ell 'Q)
>s!>/A 'Q)
@$M & @7M
@ S @ 6 S 6 6 6 @
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@LAS030@A506/ ;0S56PA5;6L60@@LAS030@A506/ ;0S56PA5;6L60@
0. /ormal histopathologi feature
00. 2esangial lomerulonephritis
000. 3oal Segmental Proliferative lomerulonephritis
0G. >iffuse Proliferative lomerulonephritis
G. 2embranous lomerulonephritis
54A52/554A52/5
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54A52/554A52/5
@lass 0 & 00 : S?mptomati treatment
/o speifi treatment
@lass 000,0G&G: S?mptomati treatment
Speifi treatment
@ortiosteroid
0mmunosuppressive
7/26/2019 Prof. Syarifuddin Rauf (Sindrome Nefrotik, UTI, GNAPS)
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0>/F0>/F
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0>/F :0>/F :1.1. A/S0SA/S0S: 0LA54AL 4/AL A/S0S
R PotterOs S?ndrome
6ligoh?dramnion
Pulmonar? h?poplasia
Lo=!set ears
(.(. 4/AL ;FP6PLAS0A :4/AL ;FP6PLAS0A : 5he kidne? is small
/ormal nephron
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$.$. ;orseshoe kidne?;orseshoe kidne? :
3usion of the renal parenh?ma
Coined at the lo=er pole
7.7. Pol??sti kidne? :Pol??sti kidne? :
a. 0nfantile Pol??sti idne? '0P@)
b. Adults Pol??sti idne? 'AP@)
0 P @ 0 P @
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0 P @ 0 P @
Autosomal 4eessive Pol??sti idne?
nlargement of distal tubulus & olligents
dutus
lomerulus & proEimal tubulus normal
Liver enlargement
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GS0@6
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LA>>4 'GS0@A >4 'GS0@A
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S;S : S?stemi disease
Gasulitis on :
Skin )ur)ura
Coint arthritis
>igestive trat abdominal pain
idne? glomerulonephritis
0/@0>/@0/@0>/@
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Age inidene :
All ages
"-+ of ases : (!11 ?ears
SeE inidene : K : R ( : 1
-*+ of ases : preeded b? upper respirator?
infetion group A streptooi
0/@0>/@0/@0>/@
@L0/0@AL 2A/03S5A506/S
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1. P
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(. astrointestinal S?mptoms:
Abdominal pain : $-!9-+ of ases
astrointestinal bleeding: melena,
hematemesis, blood? stool
0nvagination, intestinal perforation
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$. Coint S?mptoms:
Arthritis
Arthralgia
Ankles & knees: most ommonl?
affeted
5he three signs: @lassi triad of S;S
4/AL 0/G6LG2/5 'S;S /P;4050S)
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;aematuria assoiated =ith proteinuria
Aute /ephriti S?ndrome
/ephroti S?ndrome
4enal 3ailure
4/AL 0/G6LG2/5 'S;S /P;4050S)
PA5;6P;FS06L6F
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0/@050/ 3A@564 '
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1. Self Limiting >isease
(. Supportive & s?mptomati 5reatment:
3luid intake
Antih?pertensive ;?pertensive patient
>iureti 6ligouria
Antibioti 0nfetion
Analgesis Arthralgia
2A/A2/5
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$. Speifi treatment:
@ortiosteroid 'Prednison 1!( mgBkgD)Severe Abdominal pain
0 bleeding
4enal treatment
4B Aute /ephriti s?ndrome
/ephroti S?ndrome
4enal 3ailure
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