SKENARIO II - HEMATURIA BLOK 10

1. Scenario :
Seorang anak umur 7 th dibawa ibunya ke poliklinik karena keluhan mengalami
hematuria dan bengkak-bengkak sejak 2 hari yang lalu. 24 jam terakhir hanya berkemih
2 kali. Ia juga mengeluh nyeri kepala dan tidak reda dengan pemberian parasetamol.
Orangtuanya membawa anak tersebut ke bidan dan disarankan untuk periksa ke dokter.
2. Unfamiliar terms
1. Hematuria :
i. Blood in urin urine become black, brown or red (contain RBC). 5-more
blood cell/high power field in 3 speciment. (ono, aira, yovi)

3. Problem Identification, Brainstorming and Analyzing
1. Why this patient have swollen in the body?
i. Retention of Na+ (NANA)
1. Glomerulonefritis decrease of plasma volume ren activating
RAAS Aldosterone ADH water reabsorbtion
compensation to make plasma volume stable imbalance of
pressure in blood pressure OSMOTIC>ONCOTIC edema
2. Causing Hypertention
ii. Protein loss (albumin) (YOVI)
1. Glomerulonefritis glomerulus disturb the filtration of the
protein protein lost causing osmorality changes
2. Filtration of albumin decreasing osmotic pressure down
decrease persist of the fluid in reabsorbtion will under normal.
Make CIS full of fluid.
iii. Have a relation with hypertension (NINDA)
1. Hypertension related with water balance. Hypertension
eliminating pressure in vessel wall disturb the water balance.
2. (Temporary or permanent) will be disappeared when the
causes removed
3. HT will permanent if the disease is chronic, usually after 2-3 weeks


2. What is the relation between hematuria and edema?
i. Problem in renal (filtration) wesa
1. Hematuria?? macroscopic (by eye) and microscopic (should
using microscope)
2. streptococcal glomerulonefritis make tiny damage blood vessel
in filtration unit. hematuria
3. They are symtoms of disease. Different things but have same
etiology sometimes or can happen together.
4. Glomerulus like a window broken bigger hole bigger
bigger too big
3. Headache and why it isnt cure by paracetamol?
i. Cure the symptoms but not the disease (nana).
ii. Edema Hypertension headache (almas). Or it doesnt strong enough
to pass BBB or has unsufficient dosage
iii. The etiology hypertension is still exist because paracetamol doesnt

4. Why the patient only urinate 2 times in 24 hours?
i. Decreasing of Filtration in glomerolus
1. If there is no blood pass glomerolus. There will be no urin
produced.
2. Hypertensi belum tentu increasing blood flow to the ren
3. Very big reabsorption happen in proximal tubulus. The problem
maybe in tubulus proximal or distal. For glomerolus -
permeable for water or ion. But glomerolus only permeable for
protein And RBC
ii. Obstruction in UT
1. Blood clotting in urinary tract reducing the amount of urination

5. Additional test to diagnose? + radiology
i. Urinanalisis Aira
1. Shape and size of eritrosit
a. Glomerular changed
b. Non glomerular didnt changed
ii. Examination of urinary sediment
1. Protein evaluation protein + kidney disease
a. Or infection detection
iii. Plain abdomen and BNO-IVP nana
1. Must did if the patient has abnormality in urinary tract. We can
see the problem in UT, like hidronefrosis.
iv. Biopsy of renal yovi
1. To culturing bacterias

6. DD?
i. Glomerulonefritis yovi
1. Symptoms: hematuria, edema, hypertension
ii. Acute post-streptococcal glomerulonefritis aira
1. ASPGN sudden edema, and hematuria,
2. Most common form in children
3. Uncommon in adult f:1/10.000 people (BOSTON HOSPITAL)
4. Self-limiting disease cured without treatment 80%
a. 20% chronic

iii. Nephritic syndrome ninda
iv. Haemolytic uremic syndrome dena
1. One of the common causes of nephritic syndrome
a. Symp: Low urine output

conclusions of ono, nana, dewina :
Infection nephritic syndrome glomerulonefritis kidney failure
Complement system Antibody complex damaging glomerulus
glomerulonefritis.
3-12 years old --> common to get streptococcal infection

7. Patophysiology?
8. Etiology & Risk Factors?
9. Complication
10. Treatment?
i. Curative
ii. Prevention
11. Prognosis



1. PICO,
a. Try to discuss 2-4 journals that correlated with hematuria in children : (therapy
for hematuria in children).
b. Choose one to do this work (untuk dibikin pico sama resepnya).
c. Tugas ngisi PICO kelompok
d. Tugas buat resep sendiri-sendiri :q
2. Another information about DD.
Orang tua pasien tidak demam, kencing sedikit, merah agak keruh, tidak ada kemerahan
kulit, bercak muntah. Bab biasa, mata sembab saat bangun tidur, siang hari muka
normal, riwayat makan baik, 2 minggu lalu anak sakit tenggorokan dan sembuh sendiri.
Tidak ada trauma.

i. KU:
Anak tampak lemah, gizi baik, ada edema muka
ii. VS :
TD 140/95, (Hipertensi Stadium I)
RR/menit costoabdominal,
Nadi : 100x menit regular, isi tekanan cukup kuat
iii. kepala :
mesocephal,
edema periorbital,
konjungtiva anemis
sclera tidak ikterik.
iv. Leher:
Limfonodi tidak teraba
JVP tidak terlihat/ normal
v. Thorax : dalam batas normal
vi. Jantung : normal
vii. Abdomen :
Dinding perut setinggi dada, supel, tidak teraba massa atau tekanan, peristaltic usus
normal
viii. Ekstremitas:
Akral hangat
Perfusi jaringan baik
Nadi kuat
Edem tungkai negative
ix. Anogenital:
Oue (-)
Skrotum testis tidak edem, Tidak ada nyeri
x. EM. Lab dasar Urine
1. Warna : kemerahan
2. Bj : normal
3. Eritrosit +3
4. Leukosit 5-10/lap pandang
5. Silinder eritro +
6. Darah Al 7000
7. HB. 10