ABSTRAK Latar Belakang. Sindrom nefrotik resisten steroid (SNRS) merupakan penyakit
ginjal kronik yang dapat berkembang menjadi end stage renal disease dalam 5
tahun jika penanganannya tidak adekuat. Pencapaian remisi yang optimal
merupakan salah satu faktor penentu luaran yang lebih baik pada pasien SNRS.
Tujuan. Mengetahui kesintasan remisi, luaran jangka panjang, beserta faktorfaktor
yang memengaruhi remisi jangka panjang pasien SNRS pasca terapi
siklofosfamid (CPA).
Metode. Penelitian retrospektif dilakukan pada 33 anak (24 lelaki) SNRS yang
mencapai remisi setelah mendapat terapi CPA. Kesintasan remisi jangka panjang
dianalisis menggunakan metode Kaplan-Meier. Evaluasi faktor-faktor yang
memengaruhi remisi jangka panjang dilakukan dengan analisis univariat dan
multivariat menggunakan uji regresi cox.
Hasil. Median usia awitan SN adalah 3,0 tahun (7 bulan-14,0 tahun). Median usia
saat diberikan CPA adalah 5,0 (1,0-15) tahun. Rerata dosis kumulatif CPA adalah
155,61 ± 16,31 mg/kg berat badan. Sebanyak 18/33 (54,5%) anak tetap remisi
hingga akhir 2 tahun pemantauan dan 10/15 (66,67%) anak yang relaps kembali
sensitif dengan terapi steroid. Kesintasan remisi jangka panjang didapatkan
sebesar 78,8%, 69,7%, dan 54,5% berturut-turut setelah pemantauan selama 6
bulan, 1 tahun, dan 2 tahun pasca terapi CPA. Hasil analisis uji regresi cox
mendapatkan tidak ada hubungan yang bermakna antara remisi jangka panjang
pada anak SNRS pasca terapi CPA dengan usia awitan SN, tipe resistensi,
hipertensi, hematuria, jenis regimen obat, maupun dosis kumulatif (semua nilai
p>0.05).
Simpulan. Penelitian ini mendapatkan hasil bahwa terapi CPA untuk anak SNRS
cukup baik dalam mempertahankan remisi hingga periode 2 tahun dengan kesintasan sebesar (54,5%).
ABSTRACT Background: Nephrotic syndrome is a chronic renal disease that can lead to end
stage renal disease (ESRD) within 5 years. The achievement of an optimal
remission is one of most important factors resulting a better outcome on steroidresistant
nephrotic
syndrome
(SRNS).
Many
There
have
been
variative
results
on
the
use
of cyclophosphamide
in treating
SRNS.
Objective:
To
determine
survival,
long-term
outcomes,
and
factors
associated
in
sustaining
remission
in
SRNS
patients
after
cyclophosphamide
(CPA)
treatment.
Method:
We retrospectively studied the data from 33 children (24 boys) with
SNRS treated with CPA over 2 years. Relapse-free survival was estimated by
Kaplan-Meier method. The determinants of long-term remission were assessed by
univariate and multivariate analyses using Cox proportional hazard models.
Results: Median age at onset was 3.0 years (7 months-14.0 years). Median age at
CPA treatment was introduced was 5.0 (1.0-15.0) years. Patients received a mean
cummulative dose of 155,61 ± 16.31 mg/kg body weight. There were 18/33
(54,5%) children sustained remission until 2 years after CPA treatment and as
many as 10/15 (66.67%) relapsed children back responded to steroid therapy.
Relapse-free survival after CPA therapy were 78.8%, 69.7%, and 54.5% after 6
months, 1 year, and 2 years respectively. The Cox proportional hazards regression
identified no association between remission two years after CPA treatment and
other factors such as age at onset of SNRS, type of resistency, hypertension,
hematuria, routes of administration, and cummulative dose (all p>0.05).
Conclusion: We revealed that CPA appears beneficial to SRNS children in sustaining favourable 2 years remission with survival rate 54.5%. ;Background: Nephrotic syndrome is a chronic renal disease that can lead to end
stage renal disease (ESRD) within 5 years. The achievement of an optimal
remission is one of most important factors resulting a better outcome on steroidresistant
nephrotic
syndrome
(SRNS).
Many
There
have
been
variative
results
on
the
use
of cyclophosphamide
in treating
SRNS.
Objective:
To
determine
survival,
long-term
outcomes,
and
factors
associated
in
sustaining
remission
in
SRNS
patients
after
cyclophosphamide
(CPA)
treatment.
Method:
We retrospectively studied the data from 33 children (24 boys) with
SNRS treated with CPA over 2 years. Relapse-free survival was estimated by
Kaplan-Meier method. The determinants of long-term remission were assessed by
univariate and multivariate analyses using Cox proportional hazard models.
Results: Median age at onset was 3.0 years (7 months-14.0 years). Median age at
CPA treatment was introduced was 5.0 (1.0-15.0) years. Patients received a mean
cummulative dose of 155,61 ± 16.31 mg/kg body weight. There were 18/33
(54,5%) children sustained remission until 2 years after CPA treatment and as
many as 10/15 (66.67%) relapsed children back responded to steroid therapy.
Relapse-free survival after CPA therapy were 78.8%, 69.7%, and 54.5% after 6
months, 1 year, and 2 years respectively. The Cox proportional hazards regression
identified no association between remission two years after CPA treatment and
other factors such as age at onset of SNRS, type of resistency, hypertension,
hematuria, routes of administration, and cummulative dose (all p>0.05).
Conclusion: We revealed that CPA appears beneficial to SRNS children in sustaining favourable 2 years remission with survival rate 54.5%. ;Background: Nephrotic syndrome is a chronic renal disease that can lead to end
stage renal disease (ESRD) within 5 years. The achievement of an optimal
remission is one of most important factors resulting a better outcome on steroidresistant
nephrotic
syndrome
(SRNS).
Many
There
have
been
variative
results
on
the
use
of cyclophosphamide
in treating
SRNS.
Objective:
To
determine
survival,
long-term
outcomes,
and
factors
associated
in
sustaining
remission
in
SRNS
patients
after
cyclophosphamide
(CPA)
treatment.
Method:
We retrospectively studied the data from 33 children (24 boys) with
SNRS treated with CPA over 2 years. Relapse-free survival was estimated by
Kaplan-Meier method. The determinants of long-term remission were assessed by
univariate and multivariate analyses using Cox proportional hazard models.
Results: Median age at onset was 3.0 years (7 months-14.0 years). Median age at
CPA treatment was introduced was 5.0 (1.0-15.0) years. Patients received a mean
cummulative dose of 155,61 ± 16.31 mg/kg body weight. There were 18/33
(54,5%) children sustained remission until 2 years after CPA treatment and as
many as 10/15 (66.67%) relapsed children back responded to steroid therapy.
Relapse-free survival after CPA therapy were 78.8%, 69.7%, and 54.5% after 6
months, 1 year, and 2 years respectively. The Cox proportional hazards regression
identified no association between remission two years after CPA treatment and
other factors such as age at onset of SNRS, type of resistency, hypertension,
hematuria, routes of administration, and cummulative dose (all p>0.05).
Conclusion: We revealed that CPA appears beneficial to SRNS children in sustaining favourable 2 years remission with survival rate 54.5%. ;Background: Nephrotic syndrome is a chronic renal disease that can lead to end
stage renal disease (ESRD) within 5 years. The achievement of an optimal
remission is one of most important factors resulting a better outcome on steroidresistant
nephrotic
syndrome
(SRNS).
Many
There
have
been
variative
results
on
the
use
of cyclophosphamide
in treating
SRNS.
Objective:
To
determine
survival,
long-term
outcomes,
and
factors
associated
in
sustaining
remission
in
SRNS
patients
after
cyclophosphamide
(CPA)
treatment.
Method:
We retrospectively studied the data from 33 children (24 boys) with
SNRS treated with CPA over 2 years. Relapse-free survival was estimated by
Kaplan-Meier method. The determinants of long-term remission were assessed by
univariate and multivariate analyses using Cox proportional hazard models.
Results: Median age at onset was 3.0 years (7 months-14.0 years). Median age at
CPA treatment was introduced was 5.0 (1.0-15.0) years. Patients received a mean
cummulative dose of 155,61 ± 16.31 mg/kg body weight. There were 18/33
(54,5%) children sustained remission until 2 years after CPA treatment and as
many as 10/15 (66.67%) relapsed children back responded to steroid therapy.
Relapse-free survival after CPA therapy were 78.8%, 69.7%, and 54.5% after 6
months, 1 year, and 2 years respectively. The Cox proportional hazards regression
identified no association between remission two years after CPA treatment and
other factors such as age at onset of SNRS, type of resistency, hypertension,
hematuria, routes of administration, and cummulative dose (all p>0.05).
Conclusion: We revealed that CPA appears beneficial to SRNS children in sustaining favourable 2 years remission with survival rate 54.5%.
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