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Cedera Ginjal Akut akibat Glomerulonefritis Akut Pasca-Steptococcus pada KehamilanĀ  I Dewa Gede Agung Suta Ariwangsa; Nyoman Paramita Ayu
MEDICINUS Vol. 38 No. 11 (2025): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/kt004z43

Abstract

Acute post-Streptococcal glomerulonephritis (APSGN) is an inflammation of the glomeruli due to immunologic mechanism caused by group A β-hemolytic Streptococcus infection. The clinical triad of APSGN includes are gross or microscopic hematuria, edema (mostly periorbital), and arterial hypertension. This condition is generally self-limiting and is recommended to be managed symptomatically. APSGN rarely occurs in pregnancy, with estimated incidence of 1:40,000.This report discusses a rare case of stage III acute kidney injury due to APSGN in a 36-year-old pregnant woman at 9 weeks of gestation. The patient presented with fever, oliguria, hypertension, and a history of sore throat. Kidney function tests revealed elevated serum creatinine (12.49 mg/dl) and low glomerular filtration rate (GFR) (3.62 ml/minute/1.73 m2). Urinalysis showed proteinuria, microscopic hematuria, leukocytes, and granular cast. No microorganisms were found in the throat swab culture, however the anti-Streptolysin O (ASO) titer was found elevated. A chest X-ray revealed findings consistent with pneumonia. The patient received supportive treatment, including fluid resuscitation, intravenous antibiotic for pneumonia, and underwent several sessions of hemodialysis. On the seventh day of treatment, her kidney functionimproved, and she was discharged five days later. Several previous case reports on APSGN in pregnancy have also indicated a favorable prognosis for both the mother and fetus.
Karakteristik Pasien dan Tata Laksana Infeksi Malaria di RSUP Prof. dr. I.G.N.G. Ngoerah Denpasar Tahun 2019-2023 I Dewa Gede Agung Suta Ariwangsa; Harris Hardian; I Made Susila Utama
MEDICINUS Vol. 38 No. 12 (2025): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/1xmve570

Abstract

Introduction: Malaria remains a major public health concern, affecting resident and travellers to endemic areas. Severemalaria is a complication of infection that can lead to poor outcomes when late to be diagnosed. The use of artemisininRESEARCH22 VOL. 38 ISSUE 12, DECEMBER 2025derivatives or artemisinin-based combination therapy (ACT) has been reported to improve outcomes and survival in malaria patients. Methods: This was a descriptive study. Data were collected retrospectively from medical records ofpatients treated at RSUP Prof. dr. I.G.N.G. Ngoerah, Denpasar from 2019 to 2023. Descriptive analyses were conducted to summarize patient's characteristics, infection etiology, malaria severity, and treatment outcomes. Results: A total of37 malaria cases were treated at RSUP Prof. dr. I.G.N.G. Ngoerah, Denpasar between 2019 and 2023. The mean age of patients was 29.85 years, and the majority were male (78.37%). Plasmodium vivax was identified as the most commonetiologic agent, in 19 cases (51.35%), followed by Plasmodium falciparum in 17 cases (45.94%), and Plasmodium malariae in 1 case (2.7%). Severe malaria was diagnosed in 9 cases (24.32%), predominantly caused by P. falciparum (7 cases,94.5%). Jaundice and renal dysfunction were the most frequent clinical findings in severe malaria, seen in 7 (77.77%) and 4 (44.44%) cases, respectively. The most common treatment regimens were 3-day dihydroartemisinin-piperaquine (DHP) plus 14-day primaquine in 10 patients (48.64%), and 3-day DHP plus 1-day primaquine in another 10 patients (27.02%).Intravenous artesunate followed by 3-day DHP and 3-day primaquine was administered to 7 patients (18.91%); artesunate followed by DHP and 1-day primaquine to 1 patient (2.7%), and artesunate followed by DHP alone to 1 patient (2.7%). Nodeaths were reported during treatment. Discussion: Severe malaria was identified in 9 out of 37 cases (24.3%), with P. vivax being the most common malaria species overall. Although severe malaria is typically associated with P. falciparumand P. vivax, this study also reported one severe case caused by P. malariae. Jaundice was the most common clinical presentation, often accompanied by renal impairment. All patients received artemisinin-based combination therapy andachieved complete recovery at the end of treatment. Conclusion: Severe malaria occurred in one-quarter of malariacases, with P. falciparum being the most frequent cause. Jaundice and renal dysfunction were the most common clinical manifestations. All patients recovered and were discharged from the hospital.