Simpo 9 Sisipan- Early Detection and Management in Aggression and Attempt to Suicide - Dr Carla SpKJ
GNAPS Online Simpo Rev 2
description
Transcript of GNAPS Online Simpo Rev 2
Introduction
Inflammation and proliferation of glomerulus caused by imunological
process, with history of prior streptococcal infection
Management mainly supportive Prognosis was excellent in most cases,
but remains an important causes of AKI in developing countries
APSGN
Iturbe BR, Mezzano S. Acute post infectious glomerulonephritis . Pediatric Nephrology. 2008Eison M. T, Ault H.B. Post-streptococcal acute glomerulonephritis in children : clinical feature and pathogenesis.
Pediatr Nephrol. 2011Rauf S, Albar H, Aras J. Konsensus glomerulonefritis akut pasca streptokokus.IDAI. 2012
Most common form of acute nefritic syndrome
ETIOLOGYStreptokokus β-
hemolitikus grup A (SBHGA) nefritogenic
strain
Serotipe associated with URI : M types
1,3,4,12,49
Serotipe associated with pyodermitis :
M types 2,49,55,57,60
.•Pardede SO. Struktur sel streptokokus dan patogenesis glomerulonefritis akut pascastreptokokus. Sari Pediatri. 2009. h 56-65.
•Rodriguez B, Musser J. J Am Soc Nephrol 2008.
CLINICAL MANIFESTATION
ANS
Hematuria
Edema
HypertensionProteinuria
Decreased GFR
Eison M. T, Ault H.B. Post-streptococcal acute glomerulonephritis in children : clinical feature and pathogenesis. Pediatr Nephrol. 2011;26:165-80.
Gross Hematuria in Children
APSGN
•Abdominal pain, joint pains, rash, arthralgia
Henoch Schonlein Purpura
•Recurrent, painless gross hematuria
IgA Nephropathy
•Fever, weight loss, fatigue, arthritis
SLE
•Family history of renal disease that led to ESRD
Alport Syndrom
Welch TR. An approach to the child with acute glomerulonephritis, review article. Int J Pediatr. 2012;3:1-3.
CLINICAL MANIFESTATION
.
3 Phases
Latent phase
Acute phase
Recovery phase
Eison M. T, Ault H.B. Post-streptococcal acute glomerulonephritis in children : clinical feature and pathogenesis. Pediatr Nephrol. 2011;26:165-80.
1-2 weeks in upper respiratory infection3-6 weeks in skin infection (pioderma) 6-8 weeks
After resolution of overload, along with n BP, resolution of proteinuria, and gross hematuria
CLINICAL MANIFESTATION
. Eison M. T, Ault H.B. Post-streptococcal acute glomerulonephritis in children : clinical feature and pathogenesis. Pediatr Nephrol. 2011;26:165-80.
DIAGNOSIS
•History of antecendent upper respiratory tract or skin infectionHistory
•Acute nephritic syndromeClinical
manifestations
•RBCs, frequently in asscociation with RBC casts, proteinuria, leukosituriaUrinalysis
•ASO ↑, antihialurodinase
•C3 ↓ and normal C4
•Pharyngeal swab culture Laboratorium
•Usually not indicatedBiopsy
Behrman RE, Kliegman R. Acute postreptococal glomerulonephritis. Dalam : Nelson’s Essentials of Pediatrics. Philadelpia : WBSaunders and company; 2004. hal 1740-1.
MANAGEMENT
•Treat the acute effect of renal insufficiency and hypertension
Goals Supportive
Salt restictionand loop diuretic
Antihypertension Antibiotic
Behrman RE, Kliegman R. Acute postreptococal glomerulonephritis. Dalam : Nelson’s Essentials of Pediatrics. Philadelpia : WB Saunders and company; 2004. hal 1740-1.
COMPLICATIONS
• hypertensive encephalopathy
• acute lung edema
• acute renal failure
Albar H, Rauf S. The profile of acute glomerulonephritis among Indonesian Children. Paediatr
Indones. 2005;45:264–9.
Management of hypertensive crisis
Nifedipine
• 0.1-0.5 mg/kg sublingual, with a maximum total dose of 10 mg
• Can be repeated every30 minutes
• Onset within 1-5 minutes
• Side effect: precipitous fall of BP
The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents, Pediatrics 2004
Management of hypertensive crisis
Clonidine
• 0.002 mg/kg/dose IV slow – 4 times a day
Can be increased up to 0.006 mg/kg/dose
• Onset: 5 minutes
• Duration: few hours
• Side effect: rebound hypertension
• 5-10 mcg/kg/day oralThe Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents, Pediatrics 2004
Management of hypertensive crisis
Nicardipine
• 1-5 mcg/kg/min as a continuous infusion
• Very rapid onset of action, within few minutes
• Short duration of action, half-life 40 minutes
The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents, Pediatrics 2004
Management of hypertensive crisis
Sodium nitoprusside
• 0.5-10 mcg/kg/min IV drip
• Onset within 2 minutes
• Duration < 10 minutes
The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents, Pediatrics 2004
• Excellent
• Survival rate up to 95% in APSGN cases
• Only 1% will become RPGN
• Low recurrent rate but might happen ec other nephrogenic strain of Streptococcus
PROGNOSIS
Kasahara T, Hayakawa H, Okubo S. Okugawa T. Kabuki N. Tomizawa S, dkk. Prognosis of acute poststreptococcalglomerulonephritis is excellent in children, when adequately diagnosed. Pediatr Int. 2001;43:364-67.
TAKE HOME MESSAGES
• Exclude diseases other than glomerulonephritis.
• The presence of a post- infectious process is suggested by a clinical history of infection, laboratory evidence of recent infection, and the presence of transiently decreased activation of complement via the alternative pathway.
• If the diagnosis remains inconclusive, biopsy can aid the final inference.