Page 322 - Abstract Book KONIKA 18

Nephrology

P-NEP-007
Newly Diagnosed Immunoglobulin A Nephropathy in Adolescent
Presenting as Spontaneous Kidney Laceration and Abdominal Pain:
A Case Report

2
1
Afiffa Mardhotillah , Retno Palupi-Baroto , Monik E Miranda , Meilania Saraswati , Henny A. Puspitasari1
2
1
2
Department of Child Health1 and Department of Anatomical Pathology , Faculty of Medicine Universitas Indonesia/
Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
Abstract
Background Immunoglobulin A nephropathy (IgAN) is one of the most common primary glomerulonephritis
in children and adolescents. Gross hematuria appearing after infection is the presenting complaint. However,
various atypical presentations have been reported. Here, we reported a case of IgAN that presented as right
lower abdominal pain and spontaneous renal laceration as the initial manifestation. Objective To demonstrate
rare clinical manifestation of IgAN in an adolescent patient. Case A 15-year-old boy was referred to our
hospital with right lower abdominal pain and persistent hematuria. He had been in recurrent general
seizures, severe hypertension, generalized edema since 4 months prior to admission and was diagnosed
with post-streptococcal glomerulonephritis. However, the symptoms persisted and he started to develop
abdominal pain. No history of palpable purpura, acute infection, abdominal trauma and surgery. Abdominal
examination showed tenderness at right lower quadrant and CT imaging showed laceration in the inferior
pole of the right kidney and hematoma in the right perirenal space (AAST grade 3). Laboratory examination
revealed normal kidney function, nephrotic range proteinuria, and gross hematuria. After hypertension was
controlled by bisoprolol, valsartan, lisinopril; kidney biopsy was performed. It showed minimal mesangial
hypercellularity and focal segmental sclerosis, 3 glomeruli showed subepithelial expansion. There was
positivity of IgA staining in immunofluorescence microscopy, confirming diagnosis of IgAN. High dose
intravenous methylprednisolone followed by oral steroid and mycophenolic acid were started for IgAN,
along with antihypertensive drugs. Conclusion Immunoglobulin A nephropathy is more common primary
glomerulonephritis in adolescent.
Keywords: IgA Nephropathy; kidney laceration; abdominal pain

P-NEP-008
Hypertension Crisis, Acute Post-streptococcal Glomerulonephritis,
and COVID- 19 in Pediatric Patient: A Case Report

Francisca A. Sjahli, Giyati Retnowati, Aga D. Aristyaputra , Omega Mellyana 2
1
Department of Child Health, Bhayangkara Sartika Asih Hospital, Bandung, West Java and
1
Dr. Kariadi General Hospital, Semarang, Central Java, Indonesia
Abstract
Background Acute Post-Streptococcal Glomerulonephritis (APSGN) is the most common glomerulonephritis
in children. Simultaneously, the coronavirus disease (COVID-19) affecting all age groups including children.
Data suggested that co-infection is common in children and might influence morbidity and mortality.
However, there were still limited report of COVID- 19 co-infection with APSGN. Objective To determine
treatment’s outcome in co-infection of COVID- 19 and acute post streptococcal glomerulonephritis.
Case An 11-year-old boy, presented to Emergency Department with seizures, headache and vomiting,
followed by history of pharyngeal infection a week before admission. He was at soporous state, hypertensive,
decreased oxygen saturation, accompanied with acute pulmonary edema. Initial examination and laboratory
work up lead to APSGN complicated with hypertensive crisis, acute kidney injury, and sign of respiratory
failure due to pulmonary edema. At first, patient showed deteriorating condition with significant decrease
of kidney function, elevated ASTO, CRP, and D- Dimer. PCR COVID-19 test was also positive. Patient was
immediately intubated and put on mechanical ventilator. Furosemide, sublingual and oral nifedipine, oral
irbesartan, antibiotics, vitamin-C, and Zinc were administered to treat both diseases. On day 6, patient started
to regain consciousness and showed remarkable improvement. After two weeks, patient was discharged from
hospital. Conclusion COVID-19 accompanied with APSGN, acute renal injury, and hypertensive crisis can
still have a good outcome with early diagnosis and promptly treatment of the co-infection and complication.

Keywords: post-streptococcal glomerulonephritis; COVID- 19; children; complication; outcomed

274 KONIKA XVIII Abstract Book