CASE REPORT

ACUTE
GLOMERULONEPHRITIS
Background
 Acute Glomerulonephritis

Definition: an inflammatory mechanism

causing proliferation and inflammation of
glomerulus
INTRODUCING
Etiology

Bacteri

Acute
Protozoa glomerulo Virus
-nephritis

Ricketsia
 CLINICAL
MANIFESTATION

HYPERTENSION

PROTEINURIA
HEMATURIA
ACUTE
GLOMERLO
NEPHRITIS

RENAL
EDEMA
INSUFISIENSI
 THE PROGNOSIS OF ACUTE
GLOMERULONEPHRITIS

Acute glomerulonephritis heals perfectly within

1 to 2 weeks if there is no complication
References
 Definition

•Acute glomerulonephritis is an
imunology infection in renal caused y
bactery and virus
 Clinical Manifestation

• Hematuria
• Proteinuria
• Edema
• Oligouri
 Etiology
• 1. Bacteri :Streptokokus grup C,
Meningococcocus, Streptoccocus viridans,
Gonococcus, Leptospira, Mycoplasma
pneumoniae, Staphylococcus albus,
Salmonella typhi, dll
• Virus: Hepatitis B, varicella, echovirus,
parvovirus, influenza, parotitis epidemika
• Parasite: Malaria dan toksoplasma
 PATOPHYISIOLOGY
Some theory that explains about how acute
glomerulonephritis happens is7
1. An imun complex in circulation traps in renal
glomerular
2. Similarity of microorganism antigen molecular
and renal antigen
3. Imun complex forms and agains microorganism
and glomeruli antigen
4. Direct activation of complement
 DIAGNOSIS

Anamnesis Physical Laboratory Finding

• Edema Diagnosis • Leukosituria
• hematuri • Edema • Hematuria
• Hypertension • Hypertension • Proteinuria
• Oligouria • Oligouria • C3 Complemen↓
• Ur, Cr ↑
 Diferential Diagnosis
• APSGN (Acute Post Streptococal
Glomerulonefritis)
• HSP (Hanoch Shconlen Purpura)
• MPGN (Membranoproliferative
Glomerulonefritis)
• SLE (Systemic Lupus Erythematosus)
• ANCA (Antineutrophil Cytoplasmic Antibodies)
 Treatment

EDEMA
1. Restriction of sodium
intake HYPERTENSION
2. Oral or iv diuretic ANTIBIOTIC 1. Captopril 0,3-2
1. Amoxicillin mg/bw/day
3. IV albumine 50mg/bw/day in for 10 2. Furosemide
combined with diuretic days
3. Combination of these
PROTEINURIA 2. For patient with two
penicilin alergic history :
1. Decreasing of protein Eritromisin 30 mg/bw/day
intake (0,3-1 g/day)
2. Ace Inhibitor or ARB
 COMPLICATION
• Encephalopaty hypertension
• Acute kidney disease
• Pulmonal edema
CASE REPORT
 PATIENT’S IDENTITY
 Name : An. DA
 Age : 11 years
 Address : Pemudi street
 Addmision Date : 27th February 2018
Alloanamnesis was given by Patient’s mother

Chief
Complaint

Red color of urine since 1 day

before admission
 History of Present Illness
• Since 1 day before admission, patient’s mother told that
patient’s urine color is dark color, there is no disuria, but
decreasing of pee frequency, 2-3 times perday.

• Patient vomited 4 times perday, ±62,5 mL each vomit,

there is no fever, dispneu

• 14 days before admission, patien experienced edema in

whole body, happened sudenly, started at pretibial to
abdomen and ended at scrotum. Most happen in the
morning and decreases in evening. Edema without pain,
no decrease when lift the leg
History of Present Illness

• Patient bought to Eria Bunda Hospital,

got an medication, but the hematuri
getting worse, patient delivered to
hospital to get better examination and
another treatment
 • There is no tuberculosis drug consumption history
• There is no dysuria
• There is acute respiratory inflammation history
History of one month before admission
Last Illness

• There is no hypertension history in father and

mother
History of
family
History Pragnancy
• ANC was 4 times with SpOG, last USG,
baby with breech presentation

• No history of bleeding, febris, trauma,

hypertention or diabetic during
pregnancy

• Mother had history of leukore and no

treatment
 History of eat and drink
• 0-6 month : breast milk
• 7-12 month : breast milk + weaning
food
• 12 month - now : Adult food
 History of Pregnancy

G3P2A0H2, birth pervaginam helped by midwife,

aterm, birth weigh 3500g, birth length 48 cm, crying
after delivery. There is no history of fever, hypertension
and diabetic melitus antepartum.
 Vactination

Patient’s mother forgot about

vactination history
 House and Enviroment Condition

• Semi permanent house

•Lighting and ventilation are good enough
•Fresh water from well
•Drinking water from gallon
 Parent’s Occupation

• Mother : Housewife
• Father : Entrepreneur
 Physical Examination
• General condition : Moderate illness
• Conciousness : alert

Vital Signs Nutrition

• BP : 120/70 • BW : 25 kg
• Temp : 36,60C • IBW : 34 kg
• Pulse: 84x/min • BS : 142 cm
• RR : 20 x/min • Nutrition status : gizi
kurang
EYES & EARS HEAD & HAIR
• Pale conjungtival (-/-) • Normocephal
• Sclera icteric (-/-)
• Pupil isokor
• Light reflex (+/+)
• None abnormality in
ears

THORAX
• Inspection: simmetrical
movement,retraction
ABDOMEN
(+) intercosta and
substernal • Inspection: normal
• Palpation: VF difficult • Palpation: hepar and
to defined spleen not palpable
• Percusion: sonor • Percusion: thympanic
• Auscultation: normal (+)
heart sound 1 & 2, • Auscultation: normal
vesicular (+/+) • Paten anus

GENITALIA:
Boys, no abnormality
 Laboratory Finding
• Routine Blood Test Diff Count :
• Hb : 13,6 g/dl Neutrofil : 77,9
Limfosit: 11,2
• Hematokrit : 40,7%
Monosit : 10,3
• Leukosit : 23.470 /ul Eosinofil : 0,3
• Eritrosit : 2,64 x 106/ul Basofil : 0,3
• Trombosit : 406.000 /ul Kesan : Shift to the left
• MCV : 78,1 fl
• MCH : 26,1 pg
• MCHC : 33,4 g/dL
Chemical • Glucose : -
blood(11/03/2018) • Bilirubin : -
• Ureum : 53 mg/dL • pH : 6,0
• Creatinin : 1,14 mg/dL • BJ : 1,030
• Albumin : 1,4 gr/dL • Blood : +3
• GFR : 68,5 • Keton :
Urine Examination(10/03/2018) Negative
Macroscopies • Microskopis
• Color : • Eritrosit 100-200/LPB
Kuning Kemerahan • Leukosit 7-10/LPB
• Kejernihan : Keruh • Epitel 3-4/LPK
• Chemical urine
• Protein : +2
 Working Diagnosis : Acute glomerulonephritis
 Nutrition diagnosis : malnutrition
 Differential diagnosis : Nephrotic syndrom
CURVE
 THERAPY
• Pharmacology :
- IVFD KAEN IIIB 6 tpm
- Furosemid 2 x 20 mg
- Spironolakton tab 2 x 25 mg
- Ceftriaxon 3 x 500 mg
- Sodium intake 1500 calory
• Nutrition : 1500 ccal
No Date Follow
Follow up up

1 Monday, 12/3/18 Reddis color urine, T: 36,8, RR: 22x/I HR:

92x/I TD 110/70 mm Hg.
Macroscopic hematuri, Protein ++, Blood
+++, Eritrosit 100-200/LPB, Leukosit 7-
10/LPB
Ureum : 53
Cr : 1,14
GFR: 68,5
Diuresis : 1,5
Treatment :
- IVFD KAEN IIIB 6 tpm
- Furosemid 2 x 20 mg
- Spironolakton tab 2 x 25 mg
- Ceftriaxon 3 x 500 mg
- Low sodium intake 1500 kalori
2. Tuesday BP: 120/70 mmHg, Leukosit 2-3/LPB,
(13/03/2018) Eritrosit
> 300/LPB. Continue the treatment

3. Wednesday BP: 120/70 Ureum : 77. Kreatinin : 2,46, GFR

(14/03/2018) :31,74.Albumin : 2,7, Diuresis: 1,6, continue the
treatment

4. Thursday BP: 110/70 mmHg, Eritrosit > 500/LPB, diuresis

(15/03/2018) : 1,9. Continue the treatment
5. Friday BP: 100/80 mmHg, Protein +++, Leukosit: 4-5/
(16/03/2018) LPB, Eritrosit >200/LPB, Diuresis: 1,7
Continue the treatment

6. Saturday BP: 100/80 mmHg T: 38, BP: 110/70 mmHg,

(17/03/208) Protein ++, Diuresis: 1,64. Continue the
treatment
7. Sunday BP: 100/80 mmHg T: 37,8 Leukosit: 2-4/LPB,
(18/03/2018) diuresis: 1,97. Continue the treatment

8. Monday BP: 110/80 mmHg, Eritrosit > 500/LPB, diuresis

(19/03/2018) 2,5. Continue the treatment
9. Tuesday (20/03/2018) BP: 110/80 mmHg. Febris, T : 38,2 flebitis,
Eritrosit > 200/LPB, diuresis: 2,07. Ureum:147,
Cr : 4,15, GFR : 18,8,
Albumin : 2,8, CRP : Reactive 192 mg/L, ASTO
: Non reactive< 200 IU/ml. Add Paracetamol
syr, continue another treatment
10. Wednesday BP: 110/80 mmHg T: 38 Yellow urine,
(21/03/2018) TD:110/80 mmHg, Colesterol : 246, LDL :
169,4, HDL : 30, TGL : 233.
Continue the treatment

11. Thursday (22/03/2018) BP: 100/70mmHg, diuresis: 2,3. Continue the

treatment
12. Friday BP: 110/70 mmHg, T: 38,1, Ureum:122, Cr : 3,13
(23/03/2018) GFR : 24,9, Diuresis: 1,86. Continue the treatment

13. Saturday BP: 110/70 mmHg Febris↓, T: 37,2, Eritrosit: 50-55/LPB,

(24/03/2018) diuresis: 2,5. Continue the treatment
14. Sunday BP: 100/70mmHg, Eritrosit:>200/LPB, Ureum:118
(25/03/2018) Cr : 2,19, GFR : 35,6, diuresis: 2,3.
15. Monday BP: 100/70mmHg. Diuresis: 1,8. Patient unhospitalized.
(26/03/2018) Treatment :
Stop antibiotic
Spironolakton 2 x 25 mg
Captopril 2 x ½ tab
Multivitamin 2 x 1 cth
16. Friday BP: 110/70 mmHg, T: 36,4, RR: 24x/I, HR: 88x/i, Protein +,
(06/04/2018) Eritrosit >100/LPB, Ureum : 89, Cr : 1,07, GFR :72,99.
Policlinic Treatment:
Spironolakton tab 2 x 25 mg
Cefixim 2 x 100 mg
17 Friday Yellow color urine, BP: 100/70 mmHg,
. (13/04/2018) Protein ++, Eritrosit > 200/LPB,
Ureum : 40, Cr : 0,68, GFR :114,85.
Treatment
Spironolakton tab 2 x 25 mg
Cefixim 2 x 100 mg
DISCUSSION
 Patient comes with hematuri as his
chief complain. The color becomes
yellow within 10 days. Macroscopic
hematuria in acute
glomerulonephritis gone in weeks
after onset.

Rauf S, Albar H, Aras J. Konsensus glomerulonefritis akut pasca streptokokus. Jakarta. 2012.
 Edema caused by sodium retension,
appears as a first sign and disapear
within the first week after onset

Rauf S, Albar H, Aras J. Konsensus glomerulonefritis akut pasca streptokokus. Jakarta. 2012.
 Grade I hypertensian experienced by
patient is gone 39 days after onset.
Hypertension in acute
glomerulonephritis doesn’t need any
medication, the treatment is enough
with diet control and bed rest.

Rauf S, Albar H, Aras J. Konsensus glomerulonefritis akut pasca streptokokus. Jakarta. 2012.
 No satisfying result for proteinuria in
this case. The proteinuria disapears in
6 month after onset

Rauf S, Albar H, Aras J. Konsensus glomerulonefritis akut pasca streptokokus. Jakarta. 2012.
 Microscopic hematuri still found in
this patient, the hematuri stays in 6
month, need an renal biopsy if
hematuri stays longer than 6 month

Rauf S, Albar H, Aras J. Konsensus glomerulonefritis akut pasca streptokokus. Jakarta. 2012.
The decreasing of glomerulo filtration
rate happens in 12 days of
hospitalization, it happens because of
the infection still destructs the
glomerulus
The prognostic of AGN is good as
long as no complication happens
THANK YOU