Page 321 - Abstract Book KONIKA 18

Nephrology

P-NEP-005
Practical Use of Ambulatory Blood Pressure Monitoring in Children:
A Case Report

Retno Palupi-Baroto , Henny A. Puspitasari , Eka L. Hidayati 2
1
2
Department of Child Health, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta,
1
Central Java and Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital, Jakarta , Indonesia
2
Abstract
Background Ambulatory blood pressure monitoring (ABPM) is a procedure used to diagnose hypertension
(HT), detect white-coat effect, masked HT, and monitor blood pressure (BP) control. In compared to office
BP, ABPM provides additional data such as circadian variability and dipping status. ABPM in children
has not been widely used due to its scarcity in most health centers in Indonesia Objective To demonstrate
the benefit of ABPM in supporting management of HT in children Case A boy, 15-year-old complaining
headache in the morning and high BP readings using home BP measurement oscillometer devices. He had
a positive family history of HT. Office BP showed grade 1 HT and normal weight. ABPM showed normal
diurnal BP, dipping status, and normal BP load; consistent with white-coat HT. A 12-year-old girl with end-
stage kidney disease (ESKD) was on chronic hemodialysis (HD) due to lupus nephritis. She experienced
multiple episodes of HT encephalopathy and was resistant to multiple combinations of antihypertensive
agents. ABPM showed high BP reading during wake and sleep, high BP load, and non-dipper. The highest
BP was found during early morning and afternoon, thus antihypertensive scheduling was tailored accordingly
Conclusion Our cases displayed that ABPM was useful to assess white-coat HT and tailor the therapy of a
patient with refractory HT. ABPM provides important information which impacts diagnosis, monitoring and
clinical decision-making ability for pediatricians in treating hypertension in children.
Keywords: hypertension; ambulatory blood pressure monitoring; children

P-NEP-006
Urogenital Tuberculosis in A Child with Recurrent Urinary Tract Infections:
A Case Report

Ahmad Ismatullah, Eka L. Hidayati, Wahyuni Indawati
Department of Child Health, Medical Faculty Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital,
Jakarta, Indonesia

Abstract
Background Urogenital tuberculosis is a classification of tuberculosis that affects the urinary tract and
genital organ. The incidence of urogenital tuberculosis is less than 3% of all cases of childhood tuberculosis.
Diagnosis urogenital tuberculosis is challenging because the symptoms are nonspecific. The clinician's lack
of awareness causes delays in diagnosis and treatment. Objective To emphasizes the diagnostic approach of
urogenital tuberculosis in children. Case A 10-year-old girl was present with complaints of cloudy urine and
pus in the umbilical and urine since one month before hospital admission. She had also lower abdominal pain,
dysuria, painful urination, incontinence, and weight loss in the last six months prior to hospital admission. She
previously had hospitalization due to recurrent urinary tract infections. Further examination found anaemic
conjunctiva and pus in the umbilical and urine catheter. Laboratory examination revealed hypochromic
microcytic anaemia, urinalysis showed pyuria, bacteriuria, with P. aeruginosa in urine culture. Imaging tests
(USG, VCUG, and MRI) showed bilateral renal hydronephrosis and hydroureter, vesicoureteral reflux (VUR),
and suggestive of infected urachal cyst in the supravesical region. After administration of antibiotics, the
urine became sterile, but pyuria was still present. Tuberculin test and urine culture was negative, but Xpert®
MTB/RIF (GeneXpert) urine was positive and sensitive to rifampicin. She was diagnosed with renal TB and
treated with antituberculosis. After 2 months of medication, the complaints disappeared, and body weight
increased. Conclusion Urogenital tuberculosis should be considered in children with recurrent urinary tract
infections who don’t respond to standard therapy (antibiotics).
Keywords: tuberculosis; urogenital; children

KONIKA XVIII Abstract Book 273