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Immune complex disease and

complement
Ag substance from outside Ag kompleks imun dr MBG send
the glomerulus
Ab spesifik

Imune complex Ag-Ab Formed Ab invade the


basement membrane(anti-
Masuk sirkulasi GBM antibody)
darah
Stuck in the Molekul adhesi
glomerulus settle
kemokin

TROMBOSIT
Sel2 inflamasi ACTIVATED
(PMN&makrofa
INFLAMATION
g)

PATOGENESIS DAMAGE GLOMERULUS


GLOM. FILT. MEM:
1. Endothelium

Pathogenesis of GN: 2. GBM


3. Podocyte Slit
membrane

Endothelium Blood
GBM

Podocyte
- Cells
fam
n
I Glob
Sy ria
c
iti ligu
.
r
eph o Alb.
N

Glom.Filt
ACUTE
GLOMERULONEPHRITIS
PATOFISIO
LOGI
Resistance vasa afferent and inflamation Kalor FEBRI
efferent S

Renal Plasma Flow , but


large filtration pressure Complemen Macrophages and sel T
activated mesangial cell activated
(C5A, C5B-9) proliferation
GFR

Epithelial Cell Damage


Removing Renin glomerulus

Loss of selectivity permeable


Angiotensin & aldosteron

PROTEINURIA, Anemia
Na and
ALBUMINURIA, HEMATURIA
waterretention Hypoalbumine
AZOTEMIA, EDEMA, PYURIA
mia HEPATOME
GALI
HYPERTE OLIGURIA
NSI Aldosteron & ADH Na and water CARDIOMEG
retention ALI
DIAGNOSIS

HYPERTENSION

HYPERTENSI CRISIS

HYPERTENSIVE
ENSEFALOPHATY
Clinical and laboratories
findings
Diagnosis

Full blown case 1.

ASTO C3 2.

culture positive for haemolytic 3.


streptococcus group A
PEMERIKSAAN PENUNJANG
Urinalisis
Pemeriksaan Penunjang
bacteriological examination
PENATALAKSANAAN
Break 3-4 weeks

Atibiotic
Penicillin - 10 days

Amoxicillin can be combined with 50 mg / kg


divided into 3 doses for 10 days If allergic replace
with Erythromycin 30 mg / kg / day divided into 3
doses
Penatalaksanaan

Food
Low protein 0,5- 1 g / kg / day
Low salt 0,5- 1 g / day
fluid intake
Comparable to insensible water loss
(20 to 25 ml / m2 body surface area /
day) plus a half or less of urine to leak
Penatalaksanaan
Hypertension
captopril (0.3-2 mg / kg / day) or
furosemide, or a combination of
both
Penatalaksanaan
Hypertensi Crisis

- Nifedipine dose of 0.1 mg / kg increased 0.1 mg / kg


/ x every 15 minutes at 1 hour intervals thereafter
30 minutes, with a maximum dose of 10 mg / times.
- -Furosemide dose of 1 mg / kg / times, 2 times a day
orally or IV
- Captopril initial dose of 0.3 mg / kg / time, 2-3 times
daily maximum dose of 2 mg / kg / day..
Cont..
hypertensive encephalopathy

- Sublingual or oral Nifedipine (0.25


in - 0.5 mg / kg / dose
- Captopril (0.3 - 2 mg / kg / day)
Penatalaksanaan
Diuretic
IV furosemide 2 mg / kg / time, 1-2
times / day
PROGNOSIS
95% healed
completely, generally
spontaneous
resolution.
5% have a
deteriorating course
of the disease.

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