Morning report

1. Anemia
eGFR 40.33
Laboratory Findings
At Pulang Pisau General Hospital
21/08/23 Referenced value
Hb (g/dL) 10.0 11.5 - 14.5
Hematocrit (%) 28 34 - 40
RBC (milion/ul) 3.67 3.9-5.3
Leukocyte (/µL) 12.470 5.000 – 14.500
Thrombocyte (/uL) 295.000 150.000 – 450.000
Neut % 54 33-76
Lymph % 41 15 - 61
Urea (mg/dL) 184 5–25
Creatinine (mg/dL) 1.5 0.57 – 1.11
Sodium (mEq/L)
138.14
136-145
Potassium (mEq/L)
5.32
3.5-5.5
Chloride (mEq/L)
105.34
95-105
Antigen Covid 19
Negative
Negative

2. Urinalysis
At Pulang Pisau General
Hospital
21/08/2023
2
Result Referrence
Macroscopic
Color Brown Yellow
Turbidity Cloudy Clear
PH 6.0 4-9
Ketone Negative Negative
Protein-Albumin 2+ Negative
Glucose Negative Negative
Bilirubin Negative Negative
Nitrite Negative Negative
Urobilinogen 0.3 <2.0
Leukocyte Negative Negative
Erythrocyte 3+ Negative
Sediment
Leukocyte 2-4 0-4
Erythrocyte Many Cells 0-4
Epithelia 1+ 0-4
Crystal Negative Negative
Cylinder Cylinder leukocyte Negative
Bacteria Positive Negative
other Negative Negative
Hematuria
Proteinuria
Bacteriuria

3. 3
Chest X-ray
At Pulang Pisau Hospital (21/8/2023)
AP + lat D position
• Skeletal and soft tissue within
normal limit.
• Centered trachea.
• Cor: CTR 53%, Normal size
heart.
• Lungs :
- Normal hillus
- Bronchovascular pattern
within normal limit
- No
infiltrate/nodule/cloudy
appearance at both
lungs
• Sharp costophrenic angles
and dome shaped diaphragm.
Conclusion :
- Normal

4. Differential Diagnosis
I. Hematuria e.c Susp.
dd/1. Acute Glomerulonephritis post Streptococcal infection B94
2. Non-infectious Glomerulonephritis N00.3
II. Hypertension Stage II I10
III. AKI Stage Risk N17
IV. Anemia D64.9
V. Incomplete Immunization Z28.3
VI. Normal weight Z68.2
VII. Normal stature Z68.52
VIII. Well nourished Z68.1
4

5. Working Diagnosis
I. Hematuria e.c Susp.
dd/1. Acute Glomerulonephritis post Streptococcal infection B94
2. Non-infectious Glomerulonephritis N00.3
II. Hypertension Stage II I10
III. AKI Stage Risk N17
IV. Anemia D64.9
V. Incomplete Immunization Z28.3
VI. Normal weight Z68.2
VII. Normal stature Z68.52
VIII. Well nourished Z68.1
5

6. Initial Managements
Fluid IV Plug
Diuretic IV Furosemide 2x20 mg (0.5 – 1 mg/KgBW/day)
Antibiotics Po. Azithromycin 1x180 mg (10 mg/kgBW/dose)
Ace Inhibitor Po Captopril 3 x 6.25 mg (0.1 - 1 mg/kgBW/dose)
Analgetic Po. Paracetamol 3x180 mg (10 – 15 mg/kgBW/dose)
Planning Diagnostic Complete Blood Count, peripheral blood smear, CRP,
ureum, creatinine, Electrolyte serum (Na, K, Cl, Ca),
ESR, Urinalysis, C3, ASTO, albumin, uric acid
Planning Monitoring Vital signs, sign of infection, work of breathing,
diuresis, balance, abdominal circumference
Family Education Educate the family about diagnosis, planning,
treatment and prognosis
Consult to Supervisor in Charge
Consult to Nephrology Division
Hospitalized at Nephrology Ward
6

7. Hypoalbuminemia
Hyperuricemia
eGFR 47.8 ml/min/1.73 m2
Ca Corrected 9.2
Laboratory Findings
at Ulin Hospital
21/08/23 Referenced value
Hb (g/dL) 10.6 11.5 - 14.5
Hematocrit (%) 30.1 34 - 40
RBC (milion/ul) 3.97 3.9-5.3
Leukocyte (/µL) 16.800 5.000 – 14.500
Thrombocyte (/uL) 368.000 150.000 – 450.000
MCV (fl) 75.8 76.0 - 90.0
MCH (pg) 26.7 25.0 – 30.0
MCHC (g/dl) 35.2 32- 36
Neut % 56.0 37-71
Lymph % 33.2 17 - 67
Albumin (g/dL) 2.5 3.8-5.4
RBG (mg/dl) 94 ≤200
Urea (mg/dL) 151 5–25
Creatinine (mg/dL) 1.31 0.57 – 1.11
AST(U/L) 28 15-50
ALT(U/L) 9 10-25
Uric Acid 12.3 3.5-7.2
21/8/23
Reference
value
Sodium
(Mmol/L)
139 136-145
Potassium
(Mmol/L)
5.1 3.5-5.5
Chloride
(Mmol/L)
111 95-105
Calcium
(mg/dl)
8.2 8.8-10.8

8. Urinalysis
At Ulin hospital
21/08/2023
8
Result Referrence
Macroscopic
Color Yellow Yellow
Turbidity Cloudy Clear
Density 1.025 1.001-1.035
PH 6.0 4-9
Ketone Negative Negative
Protein-Albumin 4+ Negative
Glucose Negative Negative
Bilirubin Negative Negative
Occult Blood 3+ Negative
Nitrite Negative Negative
Urobilinogen 0.1 <2.0
Leukocyte 1+ Negative
Sediment
Leukocyte 5-10 0-4
Erythrocyte 15-20 0-4
Epithelia 1+ 0-4
Crystal Negative Negative
Cylinder Negative Negative
Bacteria 2+ Negative
other Negative Negative
Hematuria
Proteinuria
Bacteriuria

9. Problem List
Laboratory Findings:
• eGFR 47.8 ml/min/1.73 m2
• Hypoalbuminemia
• Hyperuricemia
• Hematuria
• Proteinuria
• Bacteriuria
Thorax X-ray
• Normal
10

10. Final Diagnosis
I. Hematuria e.c Susp. Acute Glomerulonephritis post Streptococcal infection B94
II. Hypertension Stage II I10
III. AKI Stage Risk N17
IV. Hypoalbuminemia R77.0
V. Hyperuricemia E79.0
IV. Incomplete Immunization Z28.3
V. Normal weight Z68.2
VI. Normal stature Z68.52
VII. Well nourished Z68.1
11

11. Final Managements
Fluid IV Plug
RDA requiments
Calorie 90 x 19 = 1,710 kcal/day
Protein 1 x 19 = 19 g/day
Fluid (90-110) x 18 = 1,620 – 1,980 ml/day
Fulfilled via oral route with:
Regular meal 3 x 500 kcal = 1,500 kcal
Snack 2 x 150 kcal = 300 kcal
(105% RDA, 12.3% PER)
Diuretic IV Furosemide 2x20 mg (0.5 – 1 mg/KgBW/day)
CCB Po Nifedipine 3 x 5 mg (0.25 - 5 mg/kgBW/dose)
Analgetic Po. Paracetamol 3x180 mg (10 – 15 mg/kgBW/dose)
Uric acid Po. Allopurinol 1x100 mg (10 mg/kgBW/day)
Planning Diagnostic Peripheral blood smear, CRP, ESR, Urinalysis, C3, ASTO
Planning Monitoring Vital signs, sign of infection, work of breathing, diuresis, balance,
abdominal circumference
Family Education Educate the family about diagnosis, planning, treatment and prognosis
Consult to Supervisor in Charge
Consult to Nephrology Division
Hospitalized at Nephrology Ward
12

12. Pediatric Nutrition Care
1. Assessment
Hematuria e.c Acute Glomerulonephritis post Streptococcal infection +
Hypertension Stage II + AKI Stage Risk + Hypoalbuminemia + hyperuricemia +
Incomplete Immunization + Normal weight + Normal stature + Well nourished
2. Determination of calorie needs
RDA requiments
• Calorie 90 x 19 = 1,710 kcal/day
• Protein 1 x 19 = 19 g/day
• Fluid (90-110) x 18 = 1,620 – 1,980 ml/day
3. Route of feeding: Oral route
4. Determining type of food
Regular Meals 3 x 500 kcal = 1,500 kcal/day
Snack 2x 150 kcal = 300 kcal/day
(RDA fulfilled 105%, PER 12.3%)
5. Monitoring and evaluation
Feeding tolerance, body weight increment
13

13. 14
Total score: 1  Low Risk

14. Consult to Supervisor in Charged
Dr. dr. Edi Hartoyo, Sp. A (K)
• Agree to current therapy and management
• Consult to nephrology division
15

15. Consult to Nephrology Division
dr. Hana C. E. Sembiring, M. Ked(Ped), Sp. A
• Give the therapy:
– Venflon
– IV Furosemide 2x20 mg
– Po. Nifedipine 3x5 mg
– Po. Allopurinol 1x100 mg
• Balance and diuresis per 8 hrs
• Observe the vital sign per 6 hrs
• Check ASTO and C3
• Diet with salt restriction
• Stop azithromycin if there was no any infection sign
16

16. Follow up
Aug 22nd 2023, 07.00 AM
S : Swollen face (+), pale (-), cough (-), shortness of breath (-)
O : E4V5M6
BP: 120/80 mmHg (P95 – P95+12) Balance diuresis: + 89 ml
Pulse : 82x/m, regular, adequate Diuresis: 1.4 ml/kgBW/hour
Temp : 36.8 0C
RR : 24 x/m, regular
SpO2 : 98% RA
Head: Pale conjunctiva (-), edema palpebra (+)
Abd: Distended, minimal ascites (+), abdominal circumferences 51 cm
Genital: edema scrotum (+)
Ext: CRT <2 seconds, petechiae (+), pale extremities (+), edema on both lower extremities (+)
A : I. Hematuria e.c Susp. Acute Glomerulonephritis post Streptococcal infection B94
II. Hypertension Stage II I10
III. AKI Stage Risk N17
IV. Hypoalbuminemia R77.0
V. Hyperuricemia E79
VI. Incomplete Immunization Z28.3
IV. Normal weight Z68.2
V. Normal stature Z68.52
VI. Well nourished Z68.1

17. Follow Up
Aug 22nd 2023, 07.00 AM
P Planning Monitoring Vital signs, sign of infection, work of breathing, diuresis, balance,
abdominal circumference
Planning Diagnostic Peripheral blood smear, CRP, ESR, Urinalysis, C3, ASTO
G Normal blood pressure (P50-90)
No edema
Normal urinalysis
Established diagnosis
I IV Plug
IV Furosemide 2x20 mg (0.5 – 1 mg/KgBW/day)
Po Nifedipine 3 x 5 mg (0.25 - 5 mg/kgBW/dose)
Po. Paracetamol 3x180 mg (10 – 15 mg/kgBW/dose)
Po. Allopurinol 1x100 mg (10 mg/kgBW/day)
18

18. THANK YOU
19