Prof. Syarifuddin Rauf (Sindrome Nefrotik, UTI, GNAPS)

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


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LOMERULONEFRITIS

AKUT ( NA)


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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,*


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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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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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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


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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


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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


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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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Prof. Syarifuddin Rauf (Sindrome Nefrotik, UTI, GNAPS)

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