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Nyoman Paramita Ayu
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Cedera Ginjal Akut akibat Glomerulonefritis Akut Pasca-Steptococcus pada Kehamilan  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.
Tata Laksana Cairan Isotonis pada Pasien Hiponatremia Simptomatik Luh Putu Dea Sasmita Pralambari; Nyoman Paramita Ayu
MEDICINUS Vol. 38 No. 12 (2025): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/3g1j1t90

Abstract

A case has been reported of a 66-year-old male patient presenting with decreased level of consciousness, suspected to be suffered from metabolic disorder — hyponatremia. In most cases of symptomatic hyponatremia, administrationof hypertonic fluids is often recommended. However, hypertonic fluid such as 3% NaCl carries a serious risk, the most severe of which is osmotic demyelination syndrome. Therefore, in cases of hypovolemic hyponatremia, some guidelinesrecommend correction with the administration of 0.9% NaCl isotonic saline solution. Precise administration of isotonic saline has been shown to adequately restore the sodium deficit caused by hypovolemia. In this case, following sodiumcorrection, the patient’s level of consciousness improved clinically, and serum sodium increased from 100 mmol/l to 106 mmol/l, and subsequently to 109 mmol/l within 24 hours. This 9 mmol/l increase was within the recommended target of an8–12 mmol/l over 24 hours. Based on these findings, sodium correction using isotonic fluids can be considered as a viable therapeutic option.
Co-Authors I Dewa Gede Agung Suta Ariwangsa Luh Putu Dea Sasmita Pralambari