Page 324 - Abstract Book KONIKA 18

Nephrology

P-NEP-011
Tandem Therapeutic Plasma Exchange and Continuous Renal Replacement
Therapy in Children, When is Indicated? A Case Report

Reza Fahlevi, Eka L. Hidayati, Niken W Puspaningtyas, Sastiono, Henny A. Puspitasari, Hanifah Oswari
Department of Child Health, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital,
Jakarta, Indonesia

Abstract
Background In critical condition when CRRT treatment should not be hold when TPE is needed, simultant use
of both modalities, defined as tandem therapies, is available as an option. Objective To describe how tandem
CRRT and TPE was performed in post-living donor liver transplantation (LDLT) child. Case A 1-year-9
month-girl, 11.3 kg, BSA 0.49 m , post-LDLT experiencing septic shock and AKI. At day-5 she had 12 %
2
fluid overloaded and oliguria. Hence, CRRT was initiated. Due to severe infection; she developed acute liver
injury indicated by high level of ammonia, bilirubin, and C-reactive protein (CRP). As TPE and CRRT were
the only available option in our hospital, tandem treatment was performed to increase treatment efficiency.
CRRT was set on CVVHDF mode using M60 filter, while TPE 1000 was used with FFP replacement. We
performed 6 hours duration of TPE for 3 sessions, every day. Priming was done with 20% albumin 100 cc
for total 29% extracorporeal volume for both machines. Low dose heparin is used continuously (5 IU/kg/
hour) as anticoagulant with careful monitoring of aPTT. With this setting, bleeding was evident although
aPTT was well controlled. No other complication occurred. Conclusion Tandem CRRT and TPE treatment
can be done safely in hemodynamically unstable children with AKI and multiorgan involvement in the ICU
setting. Such treatments need to be planned carefully with interdisciplinary teams to address indications,
technicalities, and complications.
Keywords: CRRT; TPE; tandem therapy; post-LDLT

P-NEP-012
Experience on the Management of Rapidly Progressive Glomerulonephritis
in Pediatric Patients at RSMH Palembang: Case Series

Fatimatuzzahra, Hertanti I. Lestari, Eka I. Fitriana
Department of Child Health, Faculty of Medicine Universitas Sriwijaya/Dr. Mohammad Hoesin General Hospital,
Palembang, South Sumatera, Indonesia

Abstract
Background Rapidly progressive glomerulonephritis (RPGN) is a rare but serious disease in the pediatric
patient. In RPGN, kidney function damage occurs very quickly, progressing to chronic kidney disease (CKD).
Therefore, early treatment of suspected RPGN cases is more preferred rather than waiting for diagnostic
confirmation. There are only a few studies of RPGN, with small specific information to pediatric patients, and
there is no Indonesian’s national guideline for RPGN therapy. Objective To report the outcome of treatment
in 2 children with RPGN. Cases Two patients with RPGN, boys, 8 and 14 yo, were referred to our hospital
with generalized edema, oliguria, hypertension, and hematuria. Both patients had a progressive decrease
of glomerular filtration rate (GFR) of more than 75%, so we directly treated with high dose intravenous
methylprednisolone and perform renal biopsy. The renal biopsy showed more than 50% glomeruli in
crescentic appearance. In the first patient, we added intravenous cyclophosphamide (CPA) because the renal
function had not improved and gross hematuria. After that, the patient showed improvement and didn’t need
dialysis therapy. The second patient discontinued intravenous methylprednisolone therapy for three months
and then back to our hospital with hypertension, anuria and uremia. He was treated with intravenous high
dose methylprednisolone, plasmapheresis, CPA, oral immunosuppressant and needed routine hemodialysis.
Conclusion In our little experience, early diagnosis and aggressive therapy with an appropriate dose of
intravenous methylprednisolone and immunosuppressant are likely to give a better outcome.
Keywords: RPGN; immunosuppressant; high dose methylprednisolone

276 KONIKA XVIII Abstract Book