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Sindrom Nefr otikSindrom Nefr itik Akut Nyimas Annissa MA, dr.

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SINDROMA NEFROTiK (SN)

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Etiology SN

Minimal Change Nephropathy

Focal Glomerulosclerosis Membranous Nephropathy Hereditary

DM

SL !iral "n#ection $reeclampsia

$%"MA%& SECONDARY

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ANAMNESIS

Ana'()de*asa +a ah beng'a' -eng'a' di seluruh tubuh encing berbusa encing 'eruh encing berdarah

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$itting edema dema anasar'a Asites #usi pleura Hipertensi

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Pemeriks n !enun" ng

Darah rutin /rin rutin 0 proteinuria 12 32 gram)L4, eritrosit 314, -ence 5ones protein 314 o6al #at bodies 314 $ro#il lipid 0 LDL HDL 7G ol 7ot Albumin serum Albumin /rin le'trolit

-iopsi renal

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O# l f t $odies urine

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%istology

Minimal change disease 3MCD40 is the most common cause o# nephrotic syndrome in children. "t o*es itsname to the #act that the nephrons appear normal *hen 6ie*ed *ith an optical microscope as the lesions areonly 6isible using an electron microscope. Another symptom is a pronounced proteinuria.

Focal segmental glomerulosclerosis 3FSGS40 is the most common cause o# nephrotic syndrome in adults.is characteriimmunemechanism is suspected. 89:;

Membranoproli#erati6e glomerulonephritis 3M$GN40 is the in#lammation o# the glomeruli along *ith thedeposit o# antibodies in their membranes, *hich ma'es #iltration di##icult.

%apidly progressi6e glomerulonephritis 3%$GN40 3/sually presents as a nephritic syndrome4 A patient?sglomeruli are present in a crescent moon shape. "t is characteri

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MINIMALCHANGEDISEASE

(MCD)

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Glomerulus terlu'a Si#atnya sclerosis Hanya beberapa segmental $aling banya' de*asa

Focal segmentalglomerulosclerosis

(FSGS)

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"n#lamasi di membran glmerulus Dinding 'apiler menebal

Mem!ranousglomerulone"#ritis

(IMN)

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"n#lamasi glomerulus Deposit antibody

Mem!rano"roli$erati%e glomerulone"#ritis

(M&GN)

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Glomerulus berbentu'cressent moon shape4

GF% turun drastis

Ra"i'l "rogressi%eglomerulone"#ritis

(R&GN)

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DD

SNA Gagal Gin al Gagal 5antung Diabetic Nephropathy

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Peneg kk n di gnosis

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T t l ks n

$rednisone 3E@mg)day4 sediaan :mg tappering dose Cyclophospamide 3(>2 mg)'g)day4 sediaan "! :@@mg 9( minggu Cyclosporine 3:>B mg)'g)day4 sediaan "! :@ mg %itu imab 32 : mg)m(4 sediaan "! 9@mg)ml Furosemide 39 mg)'gbb)day4 Spironola'ton 3(mg)'gbb)day4 Albumin 39 gram)'gbb)day4

Captopril

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RemiSION nd rel !s

proteinuria negati# atau trace 3proteinuria E mg)m( L$-) amhari berturut>turut dalam 9 minggu proteinuria I (1 3proteinuria I E@ mg)m( L$-) am4 2 hari

berturut>turut dalam 9 minggu 2 relaps ter adi 'urang dari ( 'ali dalam B bulan pertama setelah

respons a*al atau 'urang dari E 'ali per tahun pengamatan

3#reJuent relaps4 0 relaps ter adi I ( 'ali dalam B bulan pertamsetelah respons a*al atau I E 'ali dalam periode 9 tahun

relaps ter adi pada saat dosis steroid diturun'an atau dalam 9E setelah pengobatan dihenti'an, dan hal ini ter adi ( 'ali berturutturut

tida' ter adi remisi pada pengobatan prednison dosis penuh 3#

dose4 ( mg)'g--)hari selama E minggu.

REMISI

RELAPS

RELAPS

JARANG

RELAPS SERING

DEPENDEN

STEROID

RESISTEN

STEROID

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Sindrom nefritis kut

Infeksi &

GNA$S3Glomerulone#ritisA'ut $asca Streptococcus4

% Ag K Abimuncomple

Non Infeksi & !as'ulitis SL Cryoglobulinemia $olyartritis Nodusa Henoch Scholein purpura -erger disease

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An mnesis

La'i>la'i /sia (>9E tahun A*alnya beng'a' di mata,

'emudian *a ah -A ber*arna merah 'ehitaman -A sedi'it 3oliguri4 Demam malaise

Nyeri 'epala Mual Muntah Nyeri pinggang Nyeri sendi elainan 'ulit %i*ayat batu' pile' sa'it

tenggoro'an

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Pemeriks n fisik

/ lemah Hipertensi Dyspnea dema palpebra dan *a ah Mimisan 5!$ E$usi "leura Ras#* "allor* +elainan +ulit

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Pemeriks n !enun" ng

Darah rutin /rin rutin 0 > gross hematuri

> proteinuria > %-C > +-C > granullar cast > o6al #at bodies 3'ronis4

-/N 3blood urea nitrogen le'trolit $emeri'saan Complemen

serum AS7 314 -iopsi renal

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Stt ry sky imunofluores'en'e

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T t l ks n

"n . $enicilin G (:@ mg ) E@@.@@@ "/ )day $ . Cephale in E (:@ mg $ . ritromicin E E@@ mg selama 9@ hari "n . Furosemide "n . Nitroprusside $ . Ni#edipine 9 :mg

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