Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
Latar belakang. Profil hormon tiroid belum banyak dipelajari pada anak dengan sindrom nefrotik idiopatik (SNI). Prevalens disfungsi tiroid pada anak dengan SNI di Indonesia belum jelas. Beberapa studi mempunyai hipotesis bahwa hipotiroidisme pada SNI dapat terjadi akibat peningkatan ekskresi protein pengikat hormon tiroid dan hormon tiroid. Terapi steroid merupakan salah satu faktor yang memengaruhi terjadinya hipotiroidisme. Tujuan. Mengetahui angka kejadian hipotiroidisme pada anak dengan SNI aktif dan remisi. Metode. Penelitian potong lintang yang dilakukan pada 103 pasien sindrom nefrotik idiopatik berusia 1-18 tahun di RSCM. Prevalens abnormalitas hormon tiroid adalah sebanyak 15,5% mengalami hipotiroidisme overt, 1,9% mengalami hipotiroidisme sekunder, 1,9% mengalami hipotiroidisme subklinis, 47,6% mengalami low-T3 syndrome, 10,7% mengalami low-T3 dan low-T4 syndrome dan sebanyak 22,3% subjek dengan status eutiroid. Sebanyak 16/103 subjek pada penelitian ini mengalami hipotiroidisme overt. Pada penelitian ini, seluruh subjek yang mengalami hipotiroidisme overt tersebut berasal dari kelompok SNI aktif. Secara statistik terdapat hubungan bermakna antara status SNI aktif dengan kejadian hipotiroidisme overt dengan nilai p <0,001. Pada penelitian ini, 13/16 subjek yang mengalami hipotiroidisme overt tersebut mengalami hipoalbuminemia Secara statistik terdapat hubungan bermakna antara hipoalbuminemia pada SNI dengan kejadian hipotiroidisme overt dengan nilai p <0,001. Rasio protein/kreatinin urin sewaktu berkorelasi negatif dengan kadar T3, T4, dan T4 bebas serum (r=-0,563, p=<0,001; r=-0,586, p=<0,001; r=-0,405, p=<0,001), secara berturut-turut. Rasio protein/kreatinin urin sewaktu berkorelasi positif dengan kadar TSH serum (r=0,618, p=<0,001). Kesimpulan. Prevalens abnormalitas hormon tiroid pada anak dengan SNI adalah sebanyak 15,5% mengalami hipotiroidisme overt. Proteinuria masif dan hipoalbuminemia merupakan salah satu faktor risiko terjadinya hipotiroidisme pada pasien anak dengan SNI. Pemeriksaan penapisan hipotiroidisme overt (TSH dan T4 bebas) dapat dilakukan pada kelompok SNI fase aktif dan/atau kelompok SNI yang mengalami hipoalbuminemia. ......Background. Thyroid hormone profiles in Indonesian pediatric idiopathic nephrotic syndrome (INS) patient has not been fully studied. The prevalence of hypothyroidism in INS has not been established. Nephrotic syndrome is a common kidney disease among children which is characterized by proteinuria, hypercholesterolemia, hypoproteinemia, and edema. The urinary losses of proteins including albumin, thyroid hormone and thyroid-binding globulin might affect the thyroid hormone levels in those children. Glucocorticoid might also affect the occurrence of hypothyroidism in INS patients. Objectives. To evaluate the prevalence of hypothyroidism in active and remission pediatric INS patients. Methods. In this cross-sectional study included 103 pediatric INS patients. The thyroid hormone profiles included serum levels of triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH), and free T4. Results. In this study we recruited 103 children aged 1-18 years with active and remission phase INS. Of the 103 patients, 15.5% had overt hypothyroidism, 1.9% had subclinical hypothyroidism, and had 47.6% low-T3 syndrome and 10.7% had low-T3 and low-T4 syndrome. Of the 16/103 patients, 16 had overt hypothyroidism. All subjects with overt hypothyroidism are active INS patients. There was significant relationship between active INS and overt hypothyroidism. There was also significant relationship between hypoalbuminemia and overt hypothyroidism. The urinary protein/ creatinine ratio was significantly negatively correlated with serum T3, T4, and free T4 levels (r=-0.563, P=<0.001; r=-0.586, P=<0.001; r=-0.405, P=<0.001, respectively) as well as it positively correlated with TSH levels (r=0.618, P=<0.001). Conclusion. Overt hypothyroidisms was observed in 15.5% pediatric patients with active INS. Massive proteinuria and hypoalbuminemia are risk factors of overt hypothyroidism in INS patients. Thyroid profile should be evaluated routinely in active and/or hypoalbuminemia subset of patients.

Abstrak :
Latar belakang: Pengukuran proteinuria kuantitatif sewaktu (rasio protein/kreatinin urin sewaktu) merupakan metode terbaik untuk evaluasi proteinuria sebagai penanda remisi komplit dan nephrotic-range proteinuria pada pasien anak sindrom nefrotik (SN), karena dianggap lebih praktis dibandingkan baku emas (protein urin tampung 24 jam). Tujuan: Mencari cut-off optimal rasio protein/kreatinin urin sewaktu untuk evaluasi nephrotic-range proteinuria dan remisi komplit dalam penelitian kami serta membandingkan sensitivitas, spesifisitas, nilai duga positif, dan nilai duga negatif antara cut-off yang ditemukan dalam penelitian versus KDIGO (Kidney Disease: Improving Global Outcomes) untuk evaluasi nephrotic-range proteinuria dan remisi komplit. Metode: Penelitian ini merupakan studi potong lintang dengan uji diagnostik yang melibatkan 96 sampel urin 24 jam dan urin sewaktu yang diambil dari anak dengan sindrom nefrotik berusia 3−18 tahun. Subjek penelitian selain diambil sampel urin untuk pemeriksaan protein urin tampung 24 jam dan rasio protein/kreatinin urin sewaktu, juga dilakukan pemeriksaan antropometri untuk menentukan status nutrisi. Analisis menggunakan kurva ROC untuk menentukan cut-off optimal rasio protein/kreatinin urin sewaktu untuk evaluasi nephrotic-range proteinuria dan remisi komplit dalam penelitian kami, kemudian dihitung nilai sensitivitas, spesifisitas, nilai duga positif, dan nilai duga negatif serta dibandingkan nilainya dengan cut-off yang telah ditetapkan oleh KDIGO. Hasil: Cut-off optimal rasio protein/kreatinin urin sewaktu dalam peneltian kami untuk evalusi proteinuria yang menandai remisi komplit adalah <0,4 g/g dan yang menandai nephrotic-range proteinuria (tidak remisi/relaps) adalah >1,5 g/g. Perbandingan nilai sensitivitas, spesifisitas, PPV, dan NPV antara cut-off rasio protein/kreatinin urin sewaktu <0,4 g/g (temuan penelitian) berturut-turut 80,1%, 82,3%, 89,1%, dan 68,3% versus cut-off rasio protein/kreatinin urin sewaktu <0,2 g/g (KDIGO) berturut-turut 95,2%, 44, 1%, 75,6 %, dan 83,3%. Perbandingan nilai sensitivitas, spesifisitas, PPV, dan NPV antara cut-off rasio protein/kreatinin urin sewaktu >1,5 g/g (temuan penelitian) untuk evaluasi nephrotic-range proteinuria berturut-turut 88,5%, 84,3%, 67,7%, dan 95,2% versus cut-off rasio protein/kreatinin urin sewaktu >2 g/g (KDIGO) berturut-turut 84,6%, 91,4%, 78,6%, dan 94,1%. Kesimpulan: Cut-off rasio protein/kreatinin urin sewaktu untuk evaluasi proteinuria nephrotic-range proteinuria (tidak remisi/relaps) pada penelitian kami memperkuat cut-off yang telah dikeluarkan oleh KDIGO sebesar >2 g/g, sementara cut-off untuk evaluasi remisi komplit lebih tinggi nilainya dibandingkan KDIGO sebesar <0,4 g/g. ......Background: Quantitative measurement of proteinuria while (urinary protein/creatinine ratio) is the best method for evaluating proteinuria as a marker of complete remission and nephrotic-range proteinuria in nephrotic syndrome (NS) pediatric patients, because it is considered more practical than the gold standard (24 hours urine protein collection). Objective: Finding the optimal cut-off of urinary protein/creatinine ratio while evaluating nephrotic-range proteinuria and complete remission in our study and comparing sensitivity, specificity, positive predictive value, and negative predictive value between the cut-off found in the study versus KDIGO (Kidney Disease : Improving Global Outcomes) for evaluation of nephrotic-range proteinuria and complete remission. Method: This study is a cross-sectional study with diagnostic tests involving 96 24-hour urine samples and urine samples taken from children with nephrotic syndrome aged 3−18 years. The subjects of the study were not only taking urine samples for 24-hour storage of urine protein and urine protein/creatinine ratio, as well as anthropometric examination to determine nutritional status. Analysis used the ROC curve to determine the optimal cut-off of urinary protein/creatinine ratio while evaluating nephrotic-range proteinuria and complete remission in our study, then calculated the values of sensitivity, specificity, positive predictive value, and negative predictive value and compared their values with the cut-off values set by KDIGO. Result: The optimal cut-off of the urinary protein/creatinine ratio during our study for the evaluation of proteinuria that characterized complete remission was <0,4 g/g and that of nephrotic-range proteinuria (no remission/relapse) was >1,5 g/g. Comparison of the values of sensitivity, specificity, PPV, and NPV between the cut-off ratio of urine protein/creatinine when <0,4 g/g (study finding) were 80,1%, 82,3%, 89,1%, and 68,3% versus cut-off urinary protein/creatinine ratio at <0,2 g/g (KDIGO) 95,2%, 44,1%, 75,6%, and 83,3%. Comparison of the values of sensitivity, specificity, PPV, and NPV between the cut-off ratio of urine protein/creatinine when >1,5 g/g (study finding) for evaluation of nephrotic-range proteinuria 88,5%, 84,3%, 67,7%, and 95,2% versus cut-off urinary protein/creatinine ratio at >2 g/g (KDIGO) 84,6%, 91,4%, 78,6%, and 94,1%. Conclusion: The cut-off of the urine protein/creatinine ratio during the evaluation of nephrotic-range proteinuria (non-remitting/relapsed) in our study reinforces the cut-off that has been issued by KDIGO of >2 g/g, while the cut-off for evaluation of complete remission is more higher value compared to KDIGO of <0,4 g/g.

Abstrak :
Latar belakang: Komplikasi neurologis dan tumbuh-kembang sering diteliti pada neonatus cukup bulan (NKB), tetapi masalah pada ginjal masih jarang diperhatikan. Mayoritas NKB lahir ketika ginjal masih berkembang, sehingga lebih rentan mengalami gangguan fungsi ginjal. Profil fungsi ginjal dan faktor yang memengaruhinya penting untuk diketahui. Tujuan: Penelitian ini bertujuan untuk mengetahui profil fungsi ginjal, prevalens gangguan fungsi ginjal, dan faktor yang memengaruhi fungsi ginjal pada NKB. Metode: Penelitian ini merupakan studi deskriptif analitik dengan rancangan penelitian kohort retrospektif observasional di Rumah Sakit Cipto Mangunkusumo menggunakan data rekam medik dari Oktober 2022-Oktober 2023. Partisipan penelitian adalah seluruh NKB yang dirawat dan melakukan pemeriksaan kreatinin darah dengan kriteria eksklusi meninggal sebelum usia 48 jam. Faktor risiko yang diteliti adalah nutrisi maternal, diabetes gestasional, hipertensi pada kehamilan, anemia pada kehamilan, steroid antenatal, berat lahir, pertumbuhan janin terhambat, sepsis neonatorum, asfiksia neonatorum, anemia prematuritas, steroid pascanatal, dan gentamisin. Hasil: Kreatinin serum diperiksa pada 26,1% (192/737) NKB. Terdapat 169 subyek yang diinklusi. Median usia gestasi subyek adalah 31 (24–36) minggu dan berat lahir (BL) 1.335 (500–2.815) gram. Gangguan fungsi ginjal ditemukan pada 66,3% (112/169) subyek. Gangguan fungsi ginjal yang ditemukan berupa penurunan LFG 6(3,6%), hipertensi 91(53,8%), proteinuria 1(0,6%), dan campuran dari ketiganya 71(42,0%) subyek. Neonatus yang mengalami gangguan fungsi ginjal terbanyak pada usia gestasi 28–31 minggu (45,5%). Berdasar berat lahir terbanyak < 1000 g (81,6%), 1000–1499 (67,2%), 1500–2499 (59,6%). Variabel yang secara bersama-sama memengaruhi gangguan fungsi ginjal pada pasien neonatus kurang bulan adalah BL < 1.000 gram (OR 8,38; IK 95% 1,14–61,34; p=0,036), sepsis berat (OR 2,20; IK 95% 1,06–4,54; p=0,034) dan adanya anemia prematuritas (OR 2,86; IK 95% 1,15–7,12; p=0,024). Simpulan: Faktor risiko terjadinya gangguan fungsi ginjal pada NKB adalah BL < 1.000 gram, sepsis berat, dan anemia prematuritas. ......Background: Neurodevelopmental complication is often studied in preterm neonates (PTNs), but nephrological problem is usually overlooked. The majority of PTNs are born when the kidneys are still developing. Therefore, PTN is more susceptible to impaired kidney function (IKF) and is important to know the risk factors. Objective: his study aims to determine the prevalence of IKF and identify risk factors in PTN. Methods: This research is an analytical descriptive study with an observational cohort retrospective study methods at Cipto Mangunkusumo Hospital using medical record data from October 2022-October 2023. Subjects studied were all treated PTN who had creatinine evaluated during treatment and criteria exclusion of death within 48 hours was applied. The risk factors studied were maternal nutrition, gestational diabetes, hypertension in pregnancy, anemia in pregnancy, antenatal steroids, birth weight, fetal growth restriction, neonatal sepsis, neonatal asphyxia, anemia of prematurity, postnatal steroids, and gentamycin use. Results: Serum creatinine was assessed in 26,1% (192/737) PTN. One-hundred-and-sixtynine subjects were included. The median gestational age (GA) was 31 (24–36) weeks and birth weight (BW) 1,335 (500–2,815) grams. Impaired kidney function was found in 112/169 (66,33%) subjects. Abnormalities found were decreased in GFR 6(3.6%), hypertension 91(53.8%), proteinuria 1(0.6%), and mixture of the aboves 71(42.0%) subjects. Neonates with IKF mostly found with GA 28–31 weeks (45,5%). Based on birth weight, IKF was found in < 1000 g (81.6%), 1000–1499 (67.2%), 1500–2499 (59.6%). Variables that influence IKF in PTN are BW < 1,000 grams (OR 8.38; 95% CI 1.14 – 61.34; p=0.036), severe sepsis (OR 2.20; CI 95% 1.06–4.54; p=0.034), and the presence of anemia of prematurity (OR 2.86; 95% CI 1.15 – 7.12; p=0.024). Conclusion: Risk factors for IKF in PTN were BW < 1,000 grams, severe sepsis and anemia of prematurity.