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    SN Vs SNA

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    Chofi Qolbi
    This document discusses syndromes of nephrotic and acute nephritic. It describes the primary and secondary causes of nephrotic syndrome including minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy and others. It outlines the clinical features, investigations including urine analysis and kidney biopsy, and management with medications like steroids, cyclophosphamide and others. It also describes acute nephritic syndrome seen more in children which can be post-streptococcal and presents with edema, high blood pressure and hematuria, managed with antibiotics and diuretics.

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    SN Vs SNA

    Uploaded by

    Chofi Qolbi
    151 views26 pages
    This document discusses syndromes of nephrotic and acute nephritic. It describes the primary and secondary causes of nephrotic syndrome including minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy and others. It outlines the clinical features, investigations including urine analysis and kidney biopsy, and management with medications like steroids, cyclophosphamide and others. It also describes acute nephritic syndrome seen more in children which can be post-streptococcal and presents with edema, high blood pressure and hematuria, managed with antibiotics and diuretics.

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    SN vs SNA

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    This document discusses syndromes of nephrotic and acute nephritic. It describes the primary and secondary causes of nephrotic syndrome including minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy and others. It outlines the clinical features, investigations including urine analysis and kidney biopsy, and management with medications like steroids, cyclophosphamide and others. It also describes acute nephritic syndrome seen more in children which can be post-streptococcal and presents with edema, high blood pressure and hematuria, managed with antibiotics and diuretics.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    151 views26 pages

    SN Vs SNA

    Uploaded by

    Chofi Qolbi
    This document discusses syndromes of nephrotic and acute nephritic. It describes the primary and secondary causes of nephrotic syndrome including minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy and others. It outlines the clinical features, investigations including urine analysis and kidney biopsy, and management with medications like steroids, cyclophosphamide and others. It also describes acute nephritic syndrome seen more in children which can be post-streptococcal and presents with edema, high blood pressure and hematuria, managed with antibiotics and diuretics.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
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    of 26

    Sindrom Nefrotik

    Sindrom Nefritik Akut


    Nyimas Annissa MA, dr.

    SINDROMA NEFROTiK (SN)

    PRIMARY

    Minimal Change Nephropathy


    Focal Glomerulosclerosis
    Membranous Nephropathy
    Hereditary

    Etiology SN

    SECONDARY

    DM
    SLE
    Viral Infection
    Preeclampsia

    Anak2/dewasa
    Wajah bengkak
    Bengkak di seluruh tubuh
    Kencing berbusa
    Kencing keruh
    Kencing berdarah

    ANAMNESIS

    Pitting edema
    Edema anasarka
    Asites
    Efusi pleura
    Hipertensi

    Pemeriksaan fisik

    Darah rutin
    Urin rutin : proteinuria +3 (3 gram/L), eritrosit (+), Bence Jones protein (+)
    oval fat bodies (+)
    Profil lipid : LDL HDL TG Kol Tot
    Albumin serum
    Albumin Urin
    Elektrolit
    Biopsi renal

    Pemeriksaan penunjang

    Oval fat bodies urine

    Minimal change disease (MCD): is the most common cause of nephrotic syndrome in children. It owes its
    name to the fact that the nephrons appear normal when viewed with an optical microscope as the lesions are
    only visible using an electron microscope. Another symptom is a pronounced proteinuria.
    Focal segmental glomerulosclerosis (FSGS): is the most common cause of nephrotic syndrome in adults.[15] It
    is characterized by the appearance of tissue scarring in the glomeruli. The term focal is used as some of the
    glomeruli have scars, while others appear intact; the term segmental refers to the fact that only part of the
    glomerulus suffers the damage.
    Membranous glomerulonephritis (IMN): The inflammation of the glomerular membrane causes increased
    leaking in the kidney. It is not clear why this condition develops in most people, although an auto-immune
    mechanism is suspected.[15]
    Membranoproliferative glomerulonephritis (MPGN): is the inflammation of the glomeruli along with the
    deposit of antibodies in their membranes, which makes filtration difficult.
    Rapidly progressive glomerulonephritis (RPGN): (Usually presents as a nephritic syndrome) A patients
    glomeruli are present in a crescent moon shape. It is characterized clinically by a rapid decrease in the
    glomerular filtration rate (GFR) by at least 50% over a short period, usually from a few days to 3 months. [16]

    Histology

    MINIMAL
    CHANGE
    DISEASE
    (MCD)

    Focal segmental
    glomerulosclerosis
    (FSGS):

    Glomerulus terluka
    Sifatnya sclerosis
    Hanya beberapa segmental
    Paling banyak dewasa

    Membranous
    glomerulonephritis
    (IMN):
    Inflamasi di membran glmerulus
    Dinding kapiler menebal

    Membranoproliferativ
    e glomerulonephritis
    (MPGN):
    Inflamasi glomerulus
    Deposit antibody

    Rapidly progressive
    glomerulonephritis
    (RPGN):

    Glomerulus berbentuk
    cressent moon shape)
    GFR turun drastis

    SNA
    Gagal Ginjal
    Gagal Jantung
    Diabetic Nephropathy

    DD

    Penegakkan diagnosis

    Prednisone (40mg/day) sediaan 5mg tappering dose


    Cyclophospamide (2-3 mg/kg/day) sediaan IV 500mg 12 minggu
    Cyclosporine (5-6 mg/kg/day) sediaan IV 50 mg
    Rituximab (375 mg/m2) sediaan IV 10mg/ml
    Furosemide (1 mg/kgbb/day)
    Spironolakton (2mg/kgbb/day)
    Albumin (1 gram/kgbb/day)
    Captopril

    Tatalaksana

    REMISI

    RELAPS
    RELAPS
    JARANG
    RELAPS SERING
    DEPENDEN
    STEROID

    proteinuria negatif atau trace (proteinuria < 4 mg/m2 LPB/jam) 3


    hari berturut-turut dalam 1 minggu
    proteinuria 2+ (proteinuria 40 mg/m2 LPB/jam) 3 hari
    berturut-turut dalam 1 minggu 3
    relaps terjadi kurang dari 2 kali dalam 6 bulan pertama setelah
    respons awal atau kurang dari 4 kali per tahun pengamatan
    (frequent relaps) : relaps terjadi 2 kali dalam 6 bulan pertama
    setelah respons awal atau 4 kali dalam periode 1 tahun
    relaps terjadi pada saat dosis steroid diturunkan atau dalam 14 hari
    setelah pengobatan dihentikan, dan hal ini terjadi 2 kali berturutturut
    tidak terjadi remisi pada pengobatan prednison dosis penuh (full
    dose) 2 mg/kgBB/hari selama 4 minggu.

    RemiSION and relaps


    RESISTEN
    STEROID

    Infeksi :

    Non Infeksi :

    GNAPS
    (Glomerulonefritis
    Akut Pasca Streptococcus)
    Rx Ag Ab
    imuncomplex

    Vaskulitis
    SLE
    Cryoglobulinemia
    Polyartritis Nodusa
    Henoch Scholein purpura
    Berger disease

    Sindrom nefritis akut

    Laki-laki
    Usia 2-14 tahun
    Awalnya bengkak di mata,
    kemudian wajah
    BAK berwarna merah kehitaman
    BAK sedikit (oliguri)
    Demam
    malaise

    Anamnesis

    Nyeri kepala
    Mual
    Muntah
    Nyeri pinggang
    Nyeri sendi
    Kelainan kulit ?
    Riwayat batuk pilek sakit
    tenggorokan ??

    KU lemah
    Hipertensi
    Dyspnea
    Edema palpebra dan wajah
    Mimisan
    JVP
    Efusi pleura
    Rash, pallor, kelainan kulit

    Pemeriksaan fisik

    Darah rutin
    Urin rutin :
    - gross hematuri
    - proteinuria
    - RBC
    - WBC
    - granullar cast
    - oval fat bodies (kronis)

    BUN (blood urea nitrogen)


    Elektrolit
    Pemeriksaan Complement
    serum
    ASTO (+)
    Biopsi renal

    Pemeriksan penunjang

    Sttary sky imunofluorescence

    Inj. Penicilin G 250 mg / 400.000 IU /day


    PO. Cephalexin 4 x 250 mg
    PO. Eritromicin 4 x 400 mg selama 10 hari
    Inj. Furosemide
    Inj. Nitroprusside
    PO. Nifedipine 1x 5mg

    Tatalaksana

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