ACUTE GLOMERULONEPHRITIS

( AGN )

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.F
2. EDEMA SEDIKIT ( JARANG SEPERTI NS )
- PL. COLLOID OSMOTIC PRESS. TIDAK
- PL. PROTEIN LEVEL BIASA NORMAL
3. HIPERTENSI ( SERING )
- DISANGKA: RENIN & VASOKONSTRIKSI PERIFER
- PENTING: RETENSI AIR DAN NATRIUM

4. CIRCULATORY CONGESTION ( BISA ADA )

- PULMONARY EDEMA
- CARDIAC OVERLOAD:
- HEPATOMEGALY
- DISTENSI V. JUGULARIS EXT.
- GALLOP RYTHME
5. HEMATURIA:
GROSS HEMATURIA, DARK, RED, BROWNISH URINE,
TEA COLORED URINE, COCA COLA URINE
- SEDIMENT URINE:
RBC (+++)
GRANULAR CAST + MIXED
RBC CAST +

6. PROTEINURIA
30 - 100 MG / DL 1000 MG / DL
ATAU > NEPHROTIC LEVEL
7. ANEMIA
BIASANYA NORMOCHROMIC
HB 9 - 11 G/DL OK HEMODILUSI
8. AZOTEMIA
AKIBAT GFR BUN , SERUM CREATININE ,
SERUM PHOSPHATE ( + / - )
SERUM URIC ACID ( + / - )
PLASMA Ca++ LEVEL SERUM PHOSPHATE
9. ELECTROLYTE & ACID BASE TERGANGGU
HIPERKALEMIA, HIPONATREMIA
ASIDOSIS DIPERKUAT OLEH HIPERKALEMIA

PATHOLOGIC FINDINGS TERGANTUNG DARI SPECIFIC

DISEASES UMUMNYA SAMA:
- ADA INFILTRASI PMN LEUKOSIT
- PROLIF. 1 LEBIH GLOMERULAR CELL TYPE:

1. ENDOTHELIAL
2. MESANGIAL
1
. I 2
3. EPITHELIAL

PMN

- GLOMERULAR SIZE
- MESANGIAL EDEMA MESANGIAL MATRIX
(FINE FIBRILAR TYPE)
JLH CAPILLARY LOOP YG TERBUKA BER(- )
- PADA INTERSTITIAL BISA INFILTR. PMN MN

PROLIF

KLINIS
LAB.
PATH. ABN

MINIMAL SEVERE

PATHOLOGIC FINDINGS:
1. ACUTE POST-STREPTOCOCCAL GN
2. NEPHRITIC OF ANAPHYLACTIC PURPURA
3. HEMOLYTIC-UREMIC SYNDROME
4. RECURRENT MACROSC. HEMATURIA DGN FOCAL GN
5. GN ASSOCIATED WITH SEPSIS, INFECTED SHUNT OF
HYDROCEPHALUS, OR SUB-ACUTE BACT. ENDOCARDITIS
TERBANYAK ACUTE POST-STREPTOCOCCAL GN:
YG TIMBUL 2-3 MINGGU SSDH INFEKSI PHARYNX (URI)
CUTAN (DERMATITIS) OK GROUP A BETA-HEMOLYTIC
STREPTOCOCCUS NEPHROGENIC STRAIN

GN INI TERMASUK IMMUNOLOGIC RENAL DISEASE:

NEPHRITOGENIC STRAIN DARI STREPTOCOCCUS
MEMPUNYAI ANTIGEN M DAN T
M STREPT. SEROTYPE
PHARYNGITIS DERMATITIS
(URI)
(PYODERMA)
ANTIGEN:
TERBANYAK
KURANG

12
1,3,4

49
2,55,57

ANTIBODY RESPONSE:
A. PHARYNGITIS
1. ANTIBODIES (ANTI N.A.D-ASE) DR STREPTOCOCCUS
= NICOTINAMIDE ADENINE DINUCLEOTIDASE
= D.P.N ASE (DIPHOSPHO PYRIDINE NUCLEOTIDASE)
2. ASTO, ANTI D.N-ASE B
( STREPTOC. DEOXYRIBONECLEASE B )
B. PYODERMA / SKIN ( IMPETIGO )
1. ANTI D.N ASE B ATAU HYALURUNIDASE RESPONSE
2. ASTO IRREGULER / WEAK
JADI BILA:
PHARYNGITIS: ANTI N.A.D-ASE
(ANTI D.P.N-ASE)
DERMATITIS : ANTI D.N-ASE B

DIINJEKSI KUMAN
SERUM DAPAT MEMBUNUH
KUMAN ( KILLING ) - IN VITRO

KALAU SERUM DIPANASKAN 56C 30 MENIT, DAYA

MEMBUNUH INI HILANG WALAU DI DALAMNYA MASIH ADA
ANTIBODI THD KUMAN TSB
ZAT ITU: COMPLEMENT
(COMPLEMENTARY THD ANTIBODI UTK BACTERIOLYSIS)
(IgG,IgA,IgM,IgD,IgE)

COMPLEMENT SYSTEM:
UNTUK AKTIVASINYA: 1. CLASSICAL PATHWAYS
2. ALTERNATE PATHWAYS
( PROPERDIN PATHWAYS )
COMPLEMENT TERDIRI DARI KOMPONEN:
C1, C4, C2, C3, C5, C6, C7, C8, C9

1
2
AgAb AgAb C1 C4 C2 C3 PROPERDIN

CRP
C5

(CYTOLYSIS) C9 C8 C7 C6

PADA GN ANTIGENNYA BISA BERASAL:

1. EXOGENOUS Ag:

- BACTERIAL
- VIRAL
- FUNGAL
- PARACITIC

2. ENDOGENOUS Ag:
- DNA
- IgA (IgA NEPHROPATHY) + IgG
- NEOPLASTIC
- THYROGLOBULIN
- GLOMERULAR CONSTITUENT
( GLOM. BASEMENT MEMBRANE = GBM )

A. AgAb COMPLEX BISA TRAPPING (TERPERANGKAP)

1. INTRAMEMBRANEOUS
2. SUBENDOTHELIAL
3. MESANGIAL
4. SUBEPITHEL
5. TUB. BASEMENT MEMBRANE
6. TUB. CAPILLARY WALL
7. INTERSTITIUM
AgAb COMPLEX MENGGANGGU DI
TEMPAT TRAPPING PROLIFERASI

B. TRAPPING MACROMOLECULE
(NON - IMMUNOLOGIC ORIGIN ) DAMAGED GLOM.
FIBRIN, C3, IgM, IgG

TREATMENT AGN:
- ACUTE PHASE 1 - 2 MINGGU
- TIME REQUIRED RECOVER SPONTANEOUSLY
- HARUS DI RS: DI AWASI
1. ACUTE RENAL INSUFFICIENCY:
FLUID
ELECTROLYTE
ABNORMALITIES
ACID BASE
2. ACUTE HYPERTENSION (SALT & WATER RETENSION)
HYPERTENSIVE ENCEPHALOPATHY
3. OLIGURIA / ANURIA CIRCULATORY CONGESTIVE
PULMONARY EDEMA

TREATMENT ARI ( ACUTE RENAL INSUFF. )

1. FLUID RESTRICTION, HANYA UNTUK INSENSIBLE W.L
( 400 ML / M2/ DAY ) + URINARY OUT PUT
2. CUKUP CALORI ( 400 CAL / M2 / DAY ) DALAM BENTUK
CARBOHYDRATE
CEGAH ENDOGENOUS TISSUE CATABOLISM
3. KALAU MUNTAH-MUNTAH / TIDAK BISA MAKAN:
IVFD 10 - 20% GLUCOSE IN WATER
4. METABOLIC ACIDOSIS:
KOREKSI DENGAN PARENTERAL BIC. NATRICUS
5. PREVENTION OR CORRECTION:
ELECTROLYTE AND FLUID DISTURBANCES

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