CASE REPORT

ACUTE KIDNEY INJURY

IN 7 YEARS OLD
Presented By :
Agnes Thasia Parhusip (110100284)
Cennikon Pakpahan (110100299)
Supervised by :
dr. Johannes Harlan Saing M.Ked (Ped) SpA
(K)
CHILD HEALTH DEPARTMENT
H.ADAM MALIK HOSPITAL
UNIVERSITY OF NORTH SUMATERA

ACUTE KIDNEY INJURY

Definition
has a uniqueness that is fast growing
characterized
has
a uniqueness
by athat
reversible
is fast growing
increase in the blood concentration of
Definition
characterized by a reversible increase in the blood concentration of

Pathophysiology
Depressed Renal Blood Flow
Acute Tubular Necrosis
Apoptosis and Inflamatory Process
Vasoconstriction
Isothenuria,Restoration and
Associated Complication

Clinical Manifestations
Skin :and Eyes
Ears
Cardiovascular
Abdomen
Pulmonary
: : Rales,Hemopthysis
: System
Keratitis,Iritis,Uveitis,Jaundice
: Irregular Rhytmhs, Murmur, VJ Distention

Differential Diagnosis

Dehydration
Gastrointestinal (GI) bleeding
Heart failure
Chronic renal failure
Urinary obstruction
Urinary tract infection
Diabetic ketoacidosis

Diagnostic

Treatment
Correction of fluid overload with furosemide
Correction of severe acidosis with bicarbonate
administration, which can be important as a bridge to
dialysis
Correction of hyperkalemia
Correction of hematologic abnormalities
Avoid Nephrotoxic agents
Dopamine infusion
Type of fluid administration
Fluid administration
Diuretics
Nutritional Support
Renal Replacement Therapy (RRT)

Prognosis
The prognosis for patients with AKI is directly
related to the cause of renal failure and, to a
great extent, to the presence or absence of
preexisting kidney disease (estimated GFR
[eGFR] < 60 mL/min), as well as to the
duration of renal dysfunction prior to
therapeutic intervention. In the past, AKI was
thought to be completely reversible, but
long-term follow-up of patients with this
condition has shown otherwise.

Case Review

Name
:N
Age
: 7 years
Sex
: Male
RM
: 00.63.82.74
Address
: Dusun IX Purwosari
Date of Admission : April,5 2015

History
Main Complaint

: Fever

It has happened for 10 days before admit to hospital. It is high Fever

and responds with Anti-Pyretic drug. He also had dyspnea since 10 days
before His Parents admit him to hospital and this dyspnea not related
with His Activities,Weather. Cyantoic Appereance is Rejected. Cough is
found for 1 week. Mucous wasnt found. Edema (+) in all of his Body
happen for 10 days. Edema started from palpebra and eyelid continue
to hand and foot. Edema could not seen when patient admit to hospital.
History of Gross Hematuria (+) happened at for one week. Dysuria (-).
History of Vomitting (+) happened for 3 days. Frequency 3-4 times for
one day. He vomitted what he ate and drunk with volume 62,5 cc.
He was referred from R.S Insana Stabat with Nefrotik Syndroma,
Glomerunephritis Post Streptococci Infection and Congestive Heart
Failure.
He was Given Lasix Injection, Ranitidine injection, and Ondansentron
Injection.

 History of Previous Illness

The patient previously went to RS Insani Stabat with same
complaints.
History of birth
Patient was born spontaneously and immediately cried. The birth
was helped by midwife. Birth weight 3600 grams. Family History
The age of patients father is 33 years old whereas the age of her
mother is 30 years old. Patient was the first child in his family.

Feeding History
The patient got exclusive breast milk until 4 months, continue with
MP-ASI (Promina) from 6 until 8 Months. From 8 Months-2 Years, He
Got Poured Rice.

History of Immunization
The patient immunization was completed

Physical Examination
Generalized status
Body weight : 17 kg
Body length : 122 cm
Body weight in 50th percentile according to age : 24 kg
Body length in 50th percentile according to age : 123cm
Body weight in 50th percentile according to
body length : 24 kg
BW/Age : 17/24 = 70%
BL/Age : 122/123 = 99%
BB/TB : 17/24 = 70 %

Presence Status
Sensorium: Compos Mentis, HR =
120 bpm, RR= 40 x/min,
temperature: 38,5oC. Anemic (+),
dyspnea (+), cyanotic (-), edema (-),
icteric (-). Body weight (BW): 17 kg.
Body length (BL): 122 cm. CDC:
BW/Age = 70 %%, BL/Age = 99%,
BW/BL = 70%

Localized Status
Head : Eye: light reflex (+/+), isochoric pupil, pale inferior
conjunctiva palpebra (+/+). Ear/ Nose/ Mouth: within normal limit/
O2 nasal canule / within normal limit.
Neck : Lymph NodeEnlrgement (-)
Thorax :Symmetric fusiform, retraction (+) Epigastric Retraction,
HR: 120 bpm, regular, murmur (+),gallop,RR: 40 x/minute,
regular, ronchi (-/-)
Abdomen : Ascites (+), Smily Umbilical (-), peristaltic (+) normal.
Liver : not palpable
Spleen : not palpable
Extremities : Pulse 120 bpm, regular, adequate pressure/volume,
Warm Extremity, CRT < 3, TD : 110/80 mmHg
Genitalia: Male, within normal limit.

Lab Report
Hb/Ht/Leukosit/Trom : 10,7/37,8/10.390/171.000
Peripheral Blood Gas,
Ph/PCO2/PO2/PHCO3/TCO2/BE/SaO2 :
7,417/25.7/128,7/16,2/16,9/-7,3/98,9 %
Albumin : 2,9 mg/dl
Blood Glucose : 145 mg/dl
Ureum/Creatine : 58,6/0,91
GFR :73,7
Ca/Na/K/Cl : 7,9/134/3,3/105
PCT : 133,47 mg/ml

Differential Diagnostic
Acute Glomerunephritis
Congestive Heart Failue e.c Acyanotic
CHD
Nephrotic Syndrome
Working Diagnosis
Acute Glomerunephritis + CHF e.c
Acyanotic CHD

Therapi

O2 Nasal Canule -1 l/min

IVFD D5% NaCl 0,45 % 15 gtt/min, Macro
Cefoperazone inj 800 mg/12 Hours/ IV
Furosemide oral 3 x 20 mg
Spirinolactone 2 x 12,5 mg
Fluid Balance / 6 Hours
Diet MB RD 1350 kkal with 17 gr Protein
Plan : Urinalisa, Echocardiography

FOLLOW-UP

 Asto : 200
CRP Kualitatif : positif
PCT : Menyusul

Discussion
Theory

Observation in Report

marked decline in renal function with

azotemia and reduced glomerular
filtration rate

In this patient there is a decrease of

0.25% filtration rate and urine output
<0.5 ml / kg / h for 8 hours

The Classification based pRIFLE

The Clinist use Prifle to Clasify

caused by factors such as pre-renal,

renal and post-renal

cause of acute kidney injury is

suspected Glomerunephritis Post
Sterptococci

can be found symptoms such as

hypertension, edema, prutitus, it
could be an increase in heart rate

patients suspected failure Congestive

herat, on arrival at the first sound
Gallop suspected as a sign of good
circulation of fluid in the body. But
signs such as hypertension, edama,
pruritus is not clearly visible.

Treatment based symptomatic

Patients also get a combination of
etiology and also depend on the
both the administration and
cause. Congestive heart failure due to Sprinolacton Furosemide.
acute kidney injury are given
furosemide as a diuretic and can be

Giving Antibiotics can be

performed in patients with
suspected AKI caused by
Glomerunephritis with
ampicillin as antibiotic
selection option

antibiotics are given no

antibiotics group peniciline
group.

Giving dopamine and said fluid is

not recommended to be given to
patients with Acute Kidney Injury
as well as dopamine

patients are not given as a

treatment fluid.

Nutrition must be tightened first

protein nutrition

In these patients the granting of

nutrients is limited based on the
calculation of proteins according
to RDA

Treatment developed at this time

leads to renal replacement
therapy.

patients is not done it could be

due to the patient's renal function
can still be restored to normal
function.

monitor the amount of liquid

or fluid balanc

It this patients, it is done

Complications of Acute Kidney

Injury can be Congestive Heart
Failure.
Prognosis depends disease stage

In these patients Congestive

Heart Failure has occurred.
Glomeruly Filtration rate can
return to normal in

Summary
This patient was diagnosed with Acute
Kidney Injury caused Glomerunephritis
post streptococci. Diagnosis is by
history taking, clinical symptoms, and
laboratory tests. Patients were treated
according etiologic cause, in this case
the cause is GNPs. Symptomatic
treatment also depends symptoms
appear.