NEPHRITIC SYNDROME

1. Definition - Abrupt onset of one or more

o Hematuria

o Oliguria

o Edema

o Hypertension

2. Cause

- Post infection : Streptococcus, Malaria, Leptospira, etc

- Systemic Vasculitis : HSP

- IGA nephropathu

- SLE

 

3. POST STREP AGN

- commonest cause AGN

- Age 6-10 yo

 

4. Skin lesion - Usually pt present with AGN about 4 weeks later. 

- Strep infection - 2 weeks later.

5. Graph/diagram 

- Hematuria may persist up to 1 year

- Complement should normalize after 6 weeks, if C3 still low, maybe need consider something else as diagnosis, need to investigate

- ASOT will be decrease in 6 weeks time

 

6. Clinical Symptom

- Edema

- Hypetension

- Oliguria

 

7. Blood Ix

- UFEME : RBC (microscopic hematuria can persist up to 1 year)

- BUSE : urea creat high, hyponatremia, hyperkalemia

- Complement level : Low C3 but normalize by 6 weeks

- ASOT : initially high. If 1:200 or less (not significant) ,titre more than that ( maksudnye kena dilute dgn banyak to make it disappear)

8. MANAGEMENT 

1. Diet - Salt restriction

2. Diuretic - Frusemide 

- Moderate edema : 1-3mg/kg

- Pulmonary Edema : 2-4 mg/kg

3. Medication

A) 1st line - Lasix : to remove sodium and water

- Sbb patophysiology  nephritic adalah sodium and water retention

B) Hypertension 

- Mild : control salt and water intake
- Antihypertensive - Can give Niphedipine, if still not controlled, give Frusemide, then Beta Blocker and ACE Inhibitor (risk hyperkalemia)