3rd

POMR

SEPSIS IN ACUTE
GROMERULO
NEPHRITIS PATIENT
Monika Evelyn Hanjoyo
Moderator: Dr. dr. Hani Susianti Sp.PK(K)
◦ Boy. R/ 13yo
◦ Chief complaint : Decrease of consciousness
◦ Patient was referred from RS Grati because of
decreasing consciousness.
◦ He has gotten cough and sore throat from a week
before admission, followed with intermitten fever and
headache 5 days before admission.
◦ 4 days ago, his family noticed swelling on his face
and palpebrae which spread to his arms and legs.
◦ His urine has become redish brown like coca cola
since a day before.
◦ His family denied he had swelling joint, seizure, and
skin lesion.
◦ During the illness, he vomited 4 times, not projectile,
2
½ glass everytime he vomit.
◦ Histrory of Past Ilness:
History of prolonged cough and fever were
denied
◦ History of Family Diseases:
No family had severe illness.
◦ History of social life:
Patient is a boarding school (Pesantren) student
◦ Developmental history:
◦ First born from 1st pregnancy, from a 26 yo mother and
a 32 yo father
◦ Delivery by midwife, aterm, weight 3400g/length 50cm
◦ History of immunization was complete
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Physical Examination
General Severely ill, GCS : 3-3-5
status Weight :53 kg Height : 153 cm
BMI can not be evaluated
Vital sign BP : 120/80 mmHg HR : 70 bpm
RR : 20 tpm Tax : 38,3°C
Head & Anemic conjunctiva -/-, Icteric sclera -/-, palpebrae
Neck edema +/+
Thorax Pulmo : symetrical, vesiculer sound +/+, Rh-/-, Wh -/-
Cardiac : ictus at 5th ICS left MCL, single S1/S2,
murmur (–), gallop (-)
Abdomen Distended, soepel, BS (+), Liver & lien can not be
evaluated, shifting dullness (+)
Extremities warm, parese -/-, legs edema +/+ 4
 LABORATORY RESULT
Hematology Result Reference
Hemoglobin 13,50 13,4 – 17,7 g/dl
Erythrocyte 4,68 4,0 – 5,5.106/µl
Hematocrite 38 40 – 47 %
MCV 81,20 80 – 93 fl
MCH 28,80 27 – 31 pg
MCHC 35,50 32 – 36 g/dL
RDW 12,30 11,5 – 14,5 %
Leukocyte 26,47 4,3 – 10,3 x 103/µl
Thrombocyte 215 142 – 424 x 103/µl
Diff. count 0/0/0/92/4/4 1-5/0-1/3-6/25-60/25- 5
Coagulation Test Result Reference
PPT patient 10,5 9,4 – 11,3
control 11,0
INR 1,01 <1,5
APTT patient 28,80 24,6 – 30,6
control 24,8
Conclusion Normal PPT and APTT

Serum Electrolyte Result Reference

Natrium 132 132 – 141 mmol/L

Kalium 3,64 3,3 – 4,6 mmol/L
Chloride 97 97 – 107 mmol/L

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Blood Chemistry Result Reference
Liver Function
AST/ SGOT 48 <33 U/L
ALT/SGPT 36 <26 U/L
Albumin 2,78 3,8 – 4,5 g/dL

Renal Function
Ureum 112,10 18 - 45 mg/dL
Creatinine 2,19 < 0,87 mg/dL
Uric Acid 10,3 3,1 – 7,0 mg/dL

Carbohydrate Metabolism
RBS 100 < 200 mg/dL

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Blood Chemistry Result Reference
Fat
Total Cholesterol 117 91 – 204 mg/dl
Triglyseride 133 <150 mg/dl
HDL Cholesterol 24 >55 mg/dl
LDL Cholesterol 53 <100 mg/dl

Immunoserology Result Reference

ASTO Positive Negative if <200
400 IU/mL
Autoimmune Result Reference

ANA Test 0,3 (Neg) Neg <1

Pos <1,2
Anti-dsDNA IgM 6 (Neg) Neg <20 IU/mL
Anti-dsDNA IgG 12,8 (Neg) Pos ≥20 IU/mL
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Immunoserology Result Reference
Procalcitonin 50,28 ng/mL <0,5 Low risk for
septic shock
>0,5 High risk for
septic shock

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 Blood Gas Analysis Result Reference
pH 7,30 7,35 – 7,45
pCO2 29,6 35 – 45 mmHg
pO2 41,8 80 – 100 mmHg
Bikarbonat (HCO3) 14,5 21 – 28 mmol/L
Base excess(BE) -12,2 (-3) – (+3)
O2 sat 78,2% > 95%

Acidosis Metabolic
Mixed vein?

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Urinalysis Result Reference
Turbidity-color Turbid- brown
pH 6,5 4,5-8,0
SG 1,020 1,005-1,030
Glucosa Negative Negative
Protein 3+ Negative
Keton Negative Negative
Bilirubin Negative Negative
Urobilinogen 16µmol/L <17 µmol/L
Nitrit Negative Negative
Leucocyte 2+ Negative
Blood 3+ Negative
10x Epithel 7 ≤1/lpf
Cast Negative
Erytrocyte 255,1 Eumorfic ≤3/hpf
25%
Leucocyte 87,5 Dismorfic≤5/hpf
75%
40X
Bacteria 9,5x103 ≤23x103 /ml 11
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PCCL PL IDx PDx
1. Boy 13 yo Acute Acute IgA serum
Gromerul Gromerulonephri
Laboratory onephritis tis Monitoring :
- Proteinuria 3+ dt. - Urinalisis
- Leukocyturia 2 + DD/: - Ureum
- Hematuria 3+ - post - Creatinin
- Erytrocyte dismorfic streptococcal - Albumin
75% Infection - ASTO
- ASTO + - IgA
- Hipoalbuminemia Nephropathy
- Azotemia
- Hiperuricemia

Physical Examination
Severely ill
Febris
Palpebra & Legs Edema
Acites

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PCCL PL IDx PDx
Cont…. Acute Acute IgA serum
Gromerul Gromerulonephri
1. Boy 13 yo onephritis tis Monitoring :
dt. - Urinalisis
Anamnesis DD/: - Ureum
- Cough and sore throat - post - Creatinin
 a week before streptococcal - Albumin
- Fever and headache  Infection - ASTO
5 days before - IgA
- Swelling face, palpebra, Nephropathy
spread to arms and legs
 4 days before
- His urine has become
redish brown like coca
cola since a day before.

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PCCL PL IDx PDx
2. Boy 13 yo Sepsis Sepsis ec - Blood culture
susp. - Throat swab
Laboratory
- PELOD score 12 Respiratory culture
- Leukocytosis infection - Thorax X-Ray
- Neutrofilia - Lactate serum
- Procalcitonin ↑ - Total protein
- SGOT & SGPT slightly ↑ - Globulin
- Azotemia - Bilirubin T,D,I
- Hipoalbuminemia - ALP, GGT
- ASTO
- Acidosis Monitoring:
- CBC
Physical Examination - BGA
- Severely ill - Serum electrolyte
- GCS 3-4-5 - Procalcitonin
- Febris
Anamnesis
- DOC
- Cough and sore throat
- Fever
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PCCL PL IDx PDx
3. Boy 13 yo Renal Renal Monitoring :
insufficie insufficiency - Urinalisis
Laboratory ncy dt. - Ureum, creatinine
- Azotemia - PCCL no 1 - Urine output
- Proteinuria 3+ - PCCL no 2 - Serum Electrolyte
- Leukocyturia 2 +
- Hematuria 3+
- PELOD score 12
- Leukocytosis
- Neutrofilia
- Procalcitonin ↑
- ASTO +
Physical Examination
- Severely ill
- GCS 3-4-5
- Febris
Anamnesis
- DOC
- Cough and sore throat
- Fever
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THANK
YOU
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