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Acute Glomerulonephritis (Agn)
Acute Glomerulonephritis (Agn)
( 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
3 - PROLIF. 1 LEBIH GLOMERULAR CELL TYPE:
1. ENDOTHELIAL
2. MESANGIAL
1 . I 2 3. EPITHELIAL
- GLOMERULAR SIZE
PMN
- MESANGIAL EDEMA MESANGIAL MATRIX
(FINE FIBRILAR TYPE)
JLH CAPILLARY LOOP YG TERBUKA BER(- )
- PADA INTERSTITIAL BISA INFILTR. PMN MN
PROLIF
KLINIS
LAB. MINIMAL SEVERE
PATH. ABN
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
M STREPT. SEROTYPE
PHARYNGITIS DERMATITIS
(URI) (PYODERMA)
ANTIGEN:
TERBANYAK 12 49
KURANG 1,3,4 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
1 2
AgAb AgAb C1 C4 C2 C3 PROPERDIN
CRP C5
(CYTOLYSIS) C9 C8 C7 C6
PADA GN ANTIGENNYA BISA BERASAL: