On bacteriological examination found gram / methyline blue and culture of the examination of throat removal or pus

(impetigo) for isolation and identification of streptococcus. Positive culture results found only 25% of patients who
were not receiving antibiotics during acute infection by streptococcus. It should be noted, however, that positive
culture results have not been able to ascertain the etiology of acute glomerulonephritis may be only a secondary
infection. Increased antibody titer against streptolysin-O (ASTO) occurs 10-14 days after streptococcal infection.
The increase in ASTO titre is present in 75-80% of patients who are not receiving antibiotics. ASTO titres post
streptococcal infections of the skin rarely increase and occur in only 50% of cases. Other antibody titers such as
antihururonidase (Ahase) and anti deoxyribonuclease B (DNase B) are generally increased. The best antibody titer
measurements in this state are against DNase B antigens which increase in 90-95% of cases. A joint examination of
ASTO, Ahase and ADNase B titers can detect previous streptococcal infections in nearly 100% of cases.8 Increase
in O streptolysin (ASO) titer is found only in 80% of patients not receiving antibiotics during the phase of the
streptococcal infection. ASO titer increments can be found in several situations such as carrier (carrier),
hypercholesterolemia and new streptococcal infection but not nephritogenic.3,5,10 Ultrasound imaging examination
results from mild bilateral renal enlargement with some cases indicating an increase ecogenicity. Chest X-rays are
often found to represent central venous congestion in the hilum area according to an increase in extracellular
volume.5,10-12
Decline in complement C3 was present in 80-90% of cases within the first 2 weeks, while the properdin level
decreased in 50% of cases. The decrease in C3 is very marked, with levels of about 20-40 mg / dl (normal 80-170
mg / dl). IgG levels often increase by more than 1600 mg / 100 ml in nearly 93% of patients. At the beginning of the
disease most patients have cryogenic crioglobulins containing IgG or IgG together with IgM or C3.8 Decrease in
complement levels results from complementary depletion

Intravenous steroid therapy is particularly indicated for cervical type

glomerulonephritis with a lesion area of more than 30% of the total
glomerulus. Methyl prednisolone 500 mg intravenously daily divided
into 4 doses for 3-5 days. Some references, however, are not
indicated for long-term steroid therapy.5,10 Antibiotics are indicated
for eradication of streptococcal infection. Antibiotic administration of
GNAPS is still often contested. Party one only gives antibiotics when
cultures remove the throat or skin positive for streptococcus, while
others give it regularly with the reason for the negative culture has not
been able to exclude streptococcal infection. Negative cultures may
occur by having received antibiotics before admission or latent periods
are too long (> 3 weeks). Penicillin class medical therapy, can be
given erythromycin dose 30mg / kgbb / hari.1
The main goal of treatment is to control hypertension and edema. During the acute phase, the patient is restricted by
dieting 35 cal / kg body weight per day, limiting the diet of animal protein from 0.5 to 0.7 grams / kg of body weight
per day, unsaturated fat, and low in salt, 2 grams of sodium per day. Electrolyte intake should also be limited.
Sodium 20 meq per day, low potassium is less than 70-90 meq per day and calcium 600. 1000 mg per day. Strict
fluid restriction with fluid restriction of 1 liter per day, in order to overcome hypertension.8
Treatment of hypertension may be by using a strong diuretic, or if hypertension remains unresolved, the next option
is a class of calcium channel blockers, ACE inhibitors or even intravenous nitroprugs for malignant hypertension. In
some severe cases with hyperkalemi and severe uremia syndromes are indicated for hemodialysis19. Hypertensive
patients may be given diuretics or anti-hypertension.23 If mild hypertension (systolic blood pressure 130 mmHg and
diastolic 90 mmHg) is generally observed without therapy.10 Moderate hypertension (systolic blood pressure> 140 -
150 mmHg and diastolic> 100 mmHg) treated with oral or intramuscular hydralazine (IM), oral or sublingual
nifedipine.14 In practice it is preferable to take a day's treatment of hypertensive patients 1-2 days rather than giving
older anti-hypertensive agents. In severe hypertension, hydralazine is given 0.15-0.30 mg / kbBB intravenously, can
be repeated every 2-4 hours or 0.03-0.10 mg / kgBB (1-3 mg / m2) iv reserpin, or sodium nitroprussid 1 -8 m / kgBB
/ min. In hypertensive crisis (systolic> 180 mmHg or diastolic> 120 mmHg) given diazoxide 2-5 mg / kgBW iv
rapidly with furosemide 2 mg / kgBW iv. Alternatively, clonidine drip 0.002 mg / kgBB / times, repeated every 4-6
hours or given sublingual nifedipine 0.25-0.5 mg / kgBb and may be repeated every 6 hours when needed.3,8,14

Young children have a better prognosis than older children or adults

because GNAPS in adults are often accompanied by glomerular
necrotic lesions.
Clinical improvement and normal urine test show a good prognosis.
Incidence of renal function disorder ranges from 1-30%. The chances
of GNAPS becoming chronic 5-10%; about 0.5-2% of cases show
rapid and progressive kidney function failure.