OVORAN NEFROLOGI

Rabu, 13 April 2022

3A. Pangkey Jonathan/L/17thn 9 bln
BB: 52kg TB: 163 cm BSA 1,75 (1,54) DPJP 3A. Livino Timothy Koroh/L /14 Tahun 9 Bulan
BB : 51,5 kg TB : 160 cm BSA 1,51
DPJP
MRS: 10/4/22
Alamat: Minut
RM: 00725556
Hp :082290777804
AU MRS : 19/3/2022 Alamat : Tomohon AU
No RM : 542669 Telp : 082143668085
Lab (12/04/22):
Dx : Sindrom Nefrotik Relaps + Hipertensi Hb : 10.7 Dx : Sindrom Nefrotik Relaps + Hipertensi terkontrol + Hasil Lab RSUP
Kandou 10/4/22
terkontrol + AKI Stadium Risk (LFG 57.75 ) + HCT : 30 Hipoalbuminemia (2,81) + Hiperkolesterolemia + Hb 19
Leukosit : 12.700
Hiperurisemia (9.1) + Hipoalbuminemia (1.37) Hiperurisemia (11.5) Ht 52,1
Trombosit : 373.000
Leu 13.400
OT/PT: 9/10
Tc 518.000
Bengkak pada kedua kelopak mata dan kedua Ur/Cr: 101/2 PERAWATAN H-3 CRP <6
LFG 57.75
kaki berkurang. E: 139/4.8/108/7.24
Alb 2,81

Buang air kecil berbusa masih ada (+) Mg/F 2.39/5.8 TD : 110/80 mmHg Glob 2,33
Prot total 5,14
Albumin 1.37 Bengkak pada mata (-), bengkak pada tungkai (-)
TD: 120/70 mmHg Kolestrol total 585
OT/PT 28/53
Ur/cr 31/0,6
LDL 466
HDL 42
Tx : E
PERAWATAN H-4 Furosemide 2 x 20 mg PO (dosis 1 mg/kg/x) 135/4,8/96/8,59
Trigliserida 384
Asam Urat 9.1 Captopril 3 x 18,75 mg PO (dosis 0,3 mg/kg/x) UL: protein +3
Tx : Simvastatin 1 x 20 mg PO
UL (12/04/22) :
INT Kuning jernih Prednison 2 x 8 tab PO (5) Rontgen thoraks:
Normal
Inj. Furosemide 2x50mg (do 1 mg/kg/kali) Eirtrosit 1-3/+1 Alopurinol 1 x 200 mg PO
Prednison 2x8tab (do 40 mg/BSA) PO Full dose Leukosit 0-1/negatif Diet rendah protein 0,5 - 1g/kg/hari Swab antigen
Epitel 4-6
(39) Bakteri negatif
Diet rendah garam 0,5 - 1g/kg/hari Sars-Cov-2 RS
Minum 1500ml / 24 jam Bethesda
Candesartan 1x8mg (do 0,1 mg/kg/kali) Protein +4
Tomohon
Glukosa +2 PL/24 jam 10/4/22: Negatif
Spironolactone 2x25 mg PO Keton negatif TH : UL (13/4/22)
Allopurinol 1x100 mg PO Bilirubin negatif
Silinder negatif
Diet rendah garam 0,5 - 1 gr/hari Kristal negatif
Hasil Lab RS
Bethesda
Diet rendah protein 0,5 - 1 gr/kg/hari B: -1786 TD: 110/70 mmHg LP: 74 cm (T 74 cm) Tomohon 7/4/22
UL 11/04 (I) D: 2,1 UB: +3 BB : 49,3 kg
PL/24 jam Kuning keruh
Hb 16,2
Hct 44,7
Minum 1000 cc Eirtrosit 2-4 (1+)
Leu 9,53
Pro transfusi albumin 25% 165cc CEK Leukosit 0-1 (neg)
Eri 5,62
Epitel 2-3
TH : UL ke III (13/4) Tc 404.000
Bakteri neg Persentil Hipertensi :
Cr 0,7
Post tranfusi albumin 25% 100 cc (12/4/22) Protein/glukosa 4+/3+ Grade 1 : 130/80-139/89 mmHg Kol Total 827
Keton –
Bilirubin – Grade 1 : 140/90 mmHg HDL 71
LDL 708
Silinder –
Trigliserid 243
B: -810 TD: 120/70 mmHg LP: 73 cm (T 76,5 cm) Kristal -
Protein Total 4,5
D: 0,87 UB: +4 BB : 51,2 kg Alb 2,4
UL 09/04
Glo 2,1
Kuning keruh
Na 133
Eirtrosit 12-15(3+)
K 3,8
Leukosit 0-1 (neg)
Cl 101
Persentil Hipertensi : Epitel 3-4
Neu 81.7
Bakteri +
Grade 1 : 130/80-139/89 mmHg Protein/glukosa 4+/4+
Lim 12
Mono 6.2
Grade 1 : 140/90 mmHg Keton –
Eos 0
Bilirubin -
Baso 0.1
MCV 79,5
Lab 09/04:
MCH 28,8
Hb: 12,5
MCHC 36,2
Ht: 34.1
LED 18
L: 11500T: 418000
OT/PT: 13/9
Hasil Lab Prodia
Ur/Cr: 69/2.2
4/4/22
E: 136/4.8/104
Urin
Protein Total
LFG 51,8
4.916
Foto torax: tak ada
Hasil Lab RS
kelainan
Bethesda
Tomohon
31/3/22
As. Urat 11,5
Kol Total 699
HDL 60
LDL 607
Trigliserid 156
Protein Total 3,7
Alb 1,8
Glo 1,9
 OVORAN NEFROLOGI
Rabu, 13 April 2022

3A2. Montong Felichia Kimberly /P/10thn 3 4A2. Siwih Christabella Fiorentina/P/6 thn 1 bln
bln
DPJP BB : 19 kg TB : 105 cm
DP
BB : 27 kg TB : 127 cm AU MRS : 19/3/2022
No RM : 751797
Alamat : Lolah I, Tombariri
Telp : 081343980533
AU
MRS : 8/4/2022 Alamat : Kombi Jaga II
No RM : 759069 Telp : 085756419705
Dx : Hipertensi Gr. I Lab 09/04: Dx : AKI stadium failure (LFG 18) + Hipertensi terkontrol + Lab (12/4/2
Hb 8,6
Hb: 13.8 mild hidronefrosis bilateral + Anemia ec penyakit kronik Ht 24,0
Ht: 39.3 (8,6) + Trombositopenia (28.000) + Riwayat miopati bilateral Leu 18.500
TD : 120/80 mmHg L: 6700 + Hematoma orbita Tc 29.000
OT/PT 246/3
Nyeri kepala (-), pandangan kabur (-) T: 336000 Ur/Cr 166/3
DC: 1/0/0/72/23/4 PERAWATAN H-25 LFG 18
LED: 22 E 140/5,1/10
PERAWATAN H-6 Asam urat: 4.6 CRP 12
Asam urat 5
Kolestrol: 150 TD : 90/60 mmHg
HDL: 49 Bengkak & kebiruan pada kelopak mata (+)
Tx : FL (12/4/22)
LDL: 90
- Captopril 3x15 mg (do 0.5 mg/kgbb/kali) Trigliserida: 57
warna hijau
Tx : bau busuk
- Nifedipin 2x 7 mg (do 0,25 mg/kgbb/kali) CRP: <6 INT benzidin tes

- Bed rest ASTO < 200 Furosemid 1x10 mg IV (do 0,5 mg/kgbb/kali)
- Diet rendah garam 0.5 - 1 gr/kg/hari OT/PT: 28/10 Ceftriaxone 1x1 gram IV (8) DL 6/4
Hb: 5,4
Ur/Cr: 17/0,3 Captopril 1x6,25mg PO (do 0.3 mg/kgbb/kali)
- Diet rendah protein 0.5 - 1 gr/kg/hari E: 144/5/103/9.48
Ht: 15,1
Allopurinol 1x200 mg Po (do 10mg/kgbb/kali) Leuko: 17.00
- Minum IWL + UO 1000 ml (HS 1600ml) Mg/P: 2.51/4.4 Parasetamol syrup 3 x 1/2 cth (jika demam) Trombo: 39.
DC: 3/0/0/15
- PL/24jam Supplemen Fe 1x1 tab (2x seminggu)  selasa dan sabtu Asam urat: 1
- TH USG abdomen (13/4/22) EKG 09/04: Diet rendah garam 1-2 gr/hari Alb: 4,06
Diet rendah protein 0,5-1 gr/hari Ur/Cr: 166/3
Sinus rythm LFG: 15,6
Minum 1000 cc (IWL+UO = HS 1400 cc) OT/PT: 93/7
B: +467 TD: 100/60 mmHg LP: 55 cm (61cm) PL/24 jam E: 140/4,8/1
D: 1 UB: negatif BB : 24,4 kg UL 8/4/22 : Raber bedah anak CRP: 24
Warna kuning jernih
Leukosit 0-2 DL 29/3

Nitrit negatif Post Cefixime 8 hari s/d 6/4 Hb 9,9

Hct 27,5

Persentil Hipertensi : Protein negatif Post Albendazole 30/3 Leuko 6800

Trombo 59.000

P50 : 96/58 mmHg Glukosa negatif OT/PT 80/48

Ur/cr 87/1,8

Keton +2 Post transfusi PRC 230 ml (6/4 selesai jam 10.00 PCV 27%,
LFG 32,08

P90 : 109/72 mmHg E 133/4.8/92

Ca 8.92
6/4 mulai jam 22.30, PCV 30%). LDH 569
P95 : 113/75 mmHg Post transfusi PRC 200 ml (20/3,21/3 36%
Alb 4,44
As. Urat 11

P95+12 : 125/87 mmHg BT/BD 0,77/0,26

Malaria negatif

KH: 180/120 mmHg B: -26 TD: 90/60 mmHg LP: 53 cm (T

FL (29/3)
57 cm) Cacing +
Larva cacing +

USG Abdomen RS Tondano 2022: D: 2,37 UB: negatif BB : 17,5 kg Epitel 1-2

Sugestif Chronic Kidney Disease deisertai DL 26/3

peripherally calcified parenchymal kidney Hb 11.5

Hct 32.3

bilateral Konsul bedah anak (4/4/22): Leuko 6100

Trombo 74.000

Raber Ferritin 340,20

SI 157

Px CT Scan Urologi atau BNO IVP  TUNDA TIBC 284

Transferin 55

Konsul mata (09/04): Retikulosit 1,1

OT/PT 51/19

Tidak ada penambahan penanganan khusus

Ur/cr 82/1,4
Konsul Divisi Hemato-Onkologi: E 133/4.8/91
Ca 8.80
Diagnosis: Suspek Hemolytic Uremic Syndrome CRP <6

Anjuran: BT, BD, LDH, Coombs test, PT/APTT, Fibrinogen,

Malaria UL 25/3
Leuko 1-3/neg
Eritro 0-1/neg
Epitel 0-3
Kristal as.Urat neg
USG Ginjal (29/3) Bakteri +

Mild Hydronephrosis bilateral

24/3
Hb 12,2
Ht 34,7
Bloodsmear (19/3) L 6.700
Tc 94.000
Kesan : susp. Anemia defisiensi besi dapat juga anemia pada DC 2/0/1/42/48/7
E 130/4,7/95/8,93
penyakit kronik. Dengan trombositopenia. OT/PT 35/17
Ur/Cr 84/1,4
LFG 41,25
CRP 48

Persentil Hipertensi :
P50: 92/54 mmHg UL 19/3
Leuko 0-1/neg
P90: 106/67 mmHg Eritro 0-1/neg
Epitel 2-3
P95: 109/70 mmHg Kristal as. Urat 15-

P95+12: 121/83 mmHg

KH: 180/120 mmHg 19/3
Hb 6,6
Ht 19,4
Leuko 5.000
Trombo 135.000
EMG 29-12-2021: Sesuai dengan lesi miogenik DC 1/0/2/43/46/8
E 135/4,7/94
OVORAN NEFROLOGI
Rabu, 13 April 2022
OT/PT 49/27
Ur/Cr 71/1,3
LFG 44,4
CRP 12

Foto thorax: Norm