Page 319 - Abstract Book KONIKA 18

Nephrology

P-NEP-001
Infective Endocarditis in Children with Chronic Kidney Disease
Receiving Hemodialysis: A Case Series

Dara N. Santoso, Henny A. Puspitasari, Eka L .Hidayati, Anisa Rahmadhany
Department of Child Health, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital,
Jakarta, Indonesia

Abstract
Background Patients with chronic kidney disease (CKD) receiving haemodialysis (HD) are associated
with recurrent and metastatic bloodstream infections, including infective endocarditis (IE) due to long-term
vascular access. IE poses HD children at higher risk of life-threatening complications. Objective To analyze
IE cases in HD children and the associated factors. Cases The diagnosis of IE was based on The Modified
Duke Criteria. All patients underwent routine HD through tunnelled double lumen catheter, which were
located on right internal jugular vein. Fever during session led to investigation of IE. The primary etiologies
of CKD were nephrotic syndrome, right kidney agenesis, contracted kidney and chronic glomerulonephritis.
Two out of four patients were diagnosed as definite IE based on 2 major criteria, i.e. valvular vegetations and
positive blood cultures of S. aureus. The other 2 out of four patients were diagnosed as possible IE as they
had valvular vegetations and fever, while the blood cultures were negative and K. pneumoniae. Infective
endocarditis was diagnosed within two, 14, 10 and 14 months after the initiation of HD, respectively. All
patients received combinations of intravenous antibiotics for 42 days. After treatment, vegetation sizes
were decreased in 3 out of 4 patients, and all patients were discharged from hospital. Persistent vegetations
may due to the microbe-vegetation-host interaction that potentially cause ongoing vegetation formation.
Conclusion Infective endocarditis is a potential lethal disorder in HD patients and should be considered in
all HD children presenting with fever during session, particularly in those with dual lumen vascular access.
Keywords: chronic kidney disease; haemodialysis; infective endocarditis; dual lumen catheter

P-NEP-002
Diagnosis and Management of Glomerulonephritis Acute Post Streptococus
at Pamanukan Medical Center Hospital: A Case Report

Bayu Puspita Rani
Department of Child Health, Pamanukan Medical Center Subang, West Java, Indonesia

Abstract
Background Ten to fifteen percent of patients infected with Group A Streptococcus will develop into
glomerulonephritis acute post Streptococcus GNAPS and 45% of cases will be preceded by a respiratory
tract infection. Objective The importance of proper diagnostics and management in the case of GNAPS to
prevent complications and maintain the quality of life. Case A 12-year-old boy came in with complaints
of swollen faces and feet, coca-colored urine in the last 3 days and have history of cough, runny nose, sore
throat in the two weeks before hospital admission. Vital signs are obtained bp 150/100mmhg, pulse 116 x/
minute, breathing 24 x/minute, temperature 36.4°C, SpO 99%, weight 32 kg and height 140cm. Physical
2
examination obtained bilateral palpebra edema, tonsil T3-T3, non pitting edema in dorsum pedis. Laboratory
results obtained ureum 50 mg/dL, creatinine 0.9μL, albumin 3.03 g/dL. On a complete urine examination
obtained dark yellow urine color, cloudy, positive protein (+3), cryptic blood positive (+3). The results of
ASTO positif examination and kidney ultrasound found no abnormalities. Given nonpharmacological therapy
low in salt and protein diet and pharmacological therapy given erythromycin 960 mg/day, captopril 25 mg/day
and furosemide injection 32 mg/day.On the 3rd day of treatment, the patient has no complaints and allowed to
go home with oral therapy. Seven days after hospitalization, patient control to polyclinics with no complaints.
Conclusion Proper enforcement of diagnosis and management in the case of GNAPS, especially in the acute
phase, can minimize complications due to acute kidney disorders, as well as hypertensive encephalopathy.
Keywords: urination redness; oedema; respiratory tract infection; ASTO

KONIKA XVIII Abstract Book 271