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ACUTE GLOMERULONEPHRITIS

( AGN )

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PRIMER GLOMERULUS YG DIKENAI DIIKUTI

GANGGUAN SISTEMIK ( RINGAN BERAT )

KLINIS DAN LAB:1. OLIGURIA (

240 ML / M2 / 24 JAM )

- BATAS MINIMAL PENGELUARAN SOLUTE / HASIL

METABOLISME: BILA LEBIH OLIGURIC R.

2. EDEMA SEDIKIT ( JARANG SEPERTI NS )

- PL. COLLOID OSMOTIC PRESS. TIDAK

- PL. PROTEIN LE!EL BIASA NORMAL

". HIPERTENSI ( SERING )

- DISANGKA: RENIN

# !ASOKONSTRIKSI PERIER

- PENTING: RETENSI AIR DAN NATRIUM

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4. CIRCULATORY CONGESTION ( BISA ADA )

- PULMONARY EDEMA

- CARDIAC O!ERLOAD:

- HEPATOMEGALY

- DISTENSI !. JUGULARIS E$T.

- GALLOP RYTHME

%. HEMATURIA:

GROSS HEMATURIA& DARK& RED& BRO'NISH URINE&

TEA COLORED URINE& COCA COLA URINE

- SEDIMENT URINE:

RBC ()

GRANULAR CAST

RBC CAST MI$ED

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. PROTEINURIA

"0 - 100 MG / DL 1000 MG / DL

ATAU * NEPHROTIC LE!EL

+. ANEMIA

BIASANYA NORMOCHROMIC

HB , - 11 G/DL OK HEMODILUSI

. AOTEMIAAKIBAT GR BUN

& SERUM CREATININE

&

SERUM PHOSPHATE

( / - )

SERUM URIC ACID

( / - )

PLASMA C LE!EL

SERUM PHOSPHATE

,. ELECTROLYTE # ACID BASE TERGANGGU

HIPERKALEMIA& HIPONATREMIA

ASIDOSIS DIPERKUAT OLEH HIPERKALEMIA

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PATHOLOGIC INDINGS TERGANTUNG DARI SPECIIC

DISEASES UMUMNYA SAMA:

- ADA INILTRASI PMN LEUKOSIT- PROLI. 1 LEBIH GLOMERULAR CELL TYPE:

1. ENDOTHELIAL

2. MESANGIAL

". EPITHELIAL

- GLOMERULAR SIE

- MESANGIAL EDEMA MESANGIAL MATRI$

(INE IBRILAR TYPE)

JLH CAPILLARY LOOP YG TERBUKA BER(- )

- PADA INTERSTITIAL BISA INILTR. PMN MN

. I

1 2

"

PMN

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PROLIF

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KLINIS

LAB.

PATH. ABN

PATHOLOGIC INDINGS:

1. ACUTE POST-STREPTOCOCCAL GN

2. NEPHRITIC O ANAPHYLACTIC PURPURA

". HEMOLYTIC-UREMIC SYNDROME4. RECURRENT MACROSC. HEMATURIA DGN OCAL GN

%. GN ASSOCIATED 'ITH SEPSIS& INECTED SHUNT O

HYDROCEPHALUS& OR SUB-ACUTE BACT. ENDOCARDITIS

TERBANYAK ACUTE POST-STREPTOCOCCAL GN:

YG TIMBUL 2-" MINGGU SSDH INEKSI PHARYN$ (URI)

CUTAN (DERMATITIS) OK GROUP A BETA-HEMOLYTICSTREPTOCOCCUS NEPHROGENIC STRAIN

MINIMAL SE!ERE

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GN INI TERMASUK IMMUNOLOGIC RENAL DISEASE:

NEPHRITOGENIC STRAIN DARI STREPTOCOCCUS

MEMPUNYAI ANTIGEN M DAN T

M STREPT. SEROTYPE

PHARYNGITIS DERMATITIS (URI) (PYODERMA)

ANTIGEN:TERBANYAK 12 4,

KURANG 1&"&4 2&%%&%+

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ANTIBODY RESPONSE:

A. PHARYNGITIS

1. ANTIBODIES (ANTI N.A.D-ASE) DR STREPTOCOCCUS

3 NICOTINAMIDE ADENINE DINUCLEOTIDASE3 D.P.N ASE (DIPHOSPHO PYRIDINE NUCLEOTIDASE)

2. ASTO& ANTI D.N-ASE B

( STREPTOC. DEO$YRIBONECLEASE B )

B. PYODERMA / SKIN ( IMPETIGO )

1. ANTI D.N ASE B ATAU HYALURUNIDASE RESPONSE

2. ASTO IRREGULER / 'EAK

JADI BILA:

PHARYNGITIS: ANTI N.A.D-ASE

(ANTI D.P.N-ASE)

DERMATITIS : ANTI D.N-ASE B

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DIINJEKSI KUMAN

SERUM DAPAT MEMBUNUH

KUMAN ( KILLING ) - IN !ITRO

KALAU SERUM DIPANASKAN %C "0 MENIT& DAYA

MEMBUNUH INI HILANG 'ALAU DI DALAMNYA MASIH ADA

ANTIBODI THD KUMAN TSB

AT ITU: COMPLEMENT(COMPLEMENTARY THD ANTIBODI UTK BACTERIOLYSIS)

(I5G&I5A&I5M&I5D&I5E)

.

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COMPLEMENT SYSTEM:

UNTUK AKTI!ASINYA: 1. CLASSICAL PATH'AYS

2. ALTERNATE PATH'AYS

( PROPERDIN PATH'AYS )

COMPLEMENT TERDIRI DARI KOMPONEN:

C1& C4& C2& C"& C%& C& C+& C& C,

1 2

A5A6

A5A6 C1

C4 C2 C"

PROPERDIN

CRP C%

(CYTOLYSIS) C,

C

C+

C

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PADA GN ANTIGENNYA BISA BERASAL:

1. E$OGENOUS A5: - BACTERIAL

- !IRAL

- UNGAL

- PARACITIC

2. ENDOGENOUS A5:- DNA

- I5A (I5A NEPHROPATHY) I5G

- NEOPLASTIC

- THYROGLOBULIN

- GLOMERULAR CONSTITUENT

( GLOM. BASEMENT MEMBRANE 3 GBM )

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A. A5A6 COMPLE$ BISA TRAPPING (TERPERANGKAP)

1. INTRAMEMBRANEOUS

2. SUBENDOTHELIAL

". MESANGIAL

4. SUBEPITHEL

%. TUB. BASEMENT MEMBRANE. TUB. CAPILLARY 'ALL

+. INTERSTITIUM

A5A6 COMPLE$ MENGGANGGU DI

TEMPAT TRAPPING PROLIERASI

B. TRAPPING MACROMOLECULE

(NON - IMMUNOLOGIC ORIGIN ) DAMAGED GLOM.

IBRIN& C"& I5M& I5G

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TREATMENT AGN:

- ACUTE PHASE 1 - 2 MINGGU

- TIME RE7UIRED RECO!ER SPONTANEOUSLY

- HARUS DI RS: DI A'ASI

1. ACUTE RENAL INSUICIENCY:

LUID

ELECTROLYTE ABNORMALITIES

ACID BASE

2. ACUTE HYPERTENSION (SALT # 'ATER RETENSION)

HYPERTENSI!E ENCEPHALOPATHY

". OLIGURIA / ANURIA CIRCULATORY CONGESTI!E

PULMONARY EDEMA

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TREATMENT ARI ( ACUTE RENAL INSU. )

1. LUID RESTRICTION& HANYA UNTUK INSENSIBLE '.L

( 400 ML / M2/ DAY ) URINARY OUT PUT2. CUKUP CALORI( 400 CAL / M2 / DAY ) DALAM BENTUK

CARBOHYDRATE

CEGAH ENDOGENOUS TISSUE CATABOLISM". KALAU MUNTAH-MUNTAH / TIDAK BISA MAKAN:

I!D 10 - 208 GLUCOSE IN 'ATER

4. METABOLIC ACIDOSIS:KOREKSI DENGAN PARENTERAL BIC. NATRICUS

%. PRE!ENTION OR CORRECTION:

ELECTROLYTE AND LUID DISTURBANCES

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