GUS-K12_AGN_3
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Transcript of GUS-K12_AGN_3
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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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