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Abstrak :
[ABSTRAK
Lesi tubular lebih sering ditemukan pada sindrom nefrotik resisten steroid (SNRS) dengan proteinuria masif, yang menyebabkan disfungsi tubulus proksimal. Cedera tubular dapat pula didiagnosis dengan uji fungsi tubulus, diantaranya adalah fraksi ekskresi magnesium (FE Mg) dan β2-mikroglobulin (β2M) urin. Tujuan penelitian ini membandingkan FE Mg dan β2M urin pada SNRS dan SN sensitif steroid (SNSS) remisi. Penelitian potong lintang dilakukan di Departemen Ilmu Kesehatan Anak RSUPN Dr. Cipto Mangunkusumo Jakarta, RSUD Ulin Banjarmasin, RSUP Fatmawati dan RSAB Harapan Kita Jakarta pada Juli sampai Desember 2015 pada penderita SNRS dan SNSS remisi berusia 2 ? 15 tahun. Pada subyek diperiksakan kadar β2M urin dan FE Mg. Didapatkan 62 subyek yang terdiri dari 31 subyek SNRS dan 31 subyek SNSS remisi. Rerata FE Mg pada SNRS lebih tinggi secara bermakna dibandingkan SNSS remisi (p=0,0065). Median kadar β2M urin pada SNRS lebih tinggi dibandingkan SNSS remisi (p < 0,001). Peningkatan kadar β2M urin lebih banyak secara bermakna pada SNRS dibandingkan SNSS (p=0,007). Dengan titik potong 1,64%, peningkatan FE Mg pada SNRS lebih banyak dibandingkan SNSS remisi (p=0,022). Simpulan: Fraksi ekskresi Mg dan β2M urin pada SNRS lebih tinggi dibandingkan SNSS remisi. Terdapat perbedaan proporsi peningkatan FE Mg antara SNRS dan SNSS remisi. Proporsi peningkatan β2M urin pada SNRS lebih besar dibandingkan SNSS remisi.

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ABSTRACT
Tubular lesions more often found in steroid-resistant nephrotic syndrome (SRNS) with massive proteinuria, leading to proximal tubular dysfunction. Tubular injury can also be diagnosed by tubular function test, such as fractional excretion of magnesium (Mg FE) and urinary β2-microglobulin (β2M). The aim of this study is to compare the FE Mg and urinary β2M on SRNS and steroid-sensitive nephrotic syndrome (SSNS) in remission. A cross-sectional study was conducted in the Department of Pediatrics RSUPN Dr. Cipto Mangunkusumo Jakarta, RSUD Ulin Banjarmasin, RSUP Fatmawati and RSAB Harapan Kita Jakarta from July to December 2015. Children aged 2-15 years who either had SRNS or SSNS in remission were recruited. Fractional excretion of magnesium and urinary β2M levels were examined. There were 62 subjects consisted of 31 subjects SRNS and 31 subjects SSNS in remission. The mean FE Mg on SRNS was significantly higher than SSNS in remission (p=0.0065). Median levels of urinary β2M on SRNS was higher than SNSS remission (p<0.001). Increased levels of urinary β2M was more significantly in SRNS compared to SSNS (p=0.007). With a cutoff point of 1.64%, an increased of FE Mg proportion on SRNS was more than SSNS in remission (p = 0.022). Conclusion: Fractional excretion of Mg and urinary β2M on SRNS were higher than SSNS in remission. There is a difference between the increased of FE Mg on SRNS and SSNS in remission. The increased of urinary β2M on SRNS was higher than SSNS in remission.;Tubular lesions more often found in steroid-resistant nephrotic syndrome (SRNS) with massive proteinuria, leading to proximal tubular dysfunction. Tubular injury can also be diagnosed by tubular function test, such as fractional excretion of magnesium (Mg FE) and urinary β2-microglobulin (β2M). The aim of this study is to compare the FE Mg and urinary β2M on SRNS and steroid-sensitive nephrotic syndrome (SSNS) in remission. A cross-sectional study was conducted in the Department of Pediatrics RSUPN Dr. Cipto Mangunkusumo Jakarta, RSUD Ulin Banjarmasin, RSUP Fatmawati and RSAB Harapan Kita Jakarta from July to December 2015. Children aged 2-15 years who either had SRNS or SSNS in remission were recruited. Fractional excretion of magnesium and urinary β2M levels were examined. There were 62 subjects consisted of 31 subjects SRNS and 31 subjects SSNS in remission. The mean FE Mg on SRNS was significantly higher than SSNS in remission (p=0.0065). Median levels of urinary β2M on SRNS was higher than SNSS remission (p<0.001). Increased levels of urinary β2M was more significantly in SRNS compared to SSNS (p=0.007). With a cutoff point of 1.64%, an increased of FE Mg proportion on SRNS was more than SSNS in remission (p = 0.022). Conclusion: Fractional excretion of Mg and urinary β2M on SRNS were higher than SSNS in remission. There is a difference between the increased of FE Mg on SRNS and SSNS in remission. The increased of urinary β2M on SRNS was higher than SSNS in remission., Tubular lesions more often found in steroid-resistant nephrotic syndrome (SRNS) with massive proteinuria, leading to proximal tubular dysfunction. Tubular injury can also be diagnosed by tubular function test, such as fractional excretion of magnesium (Mg FE) and urinary β2-microglobulin (β2M). The aim of this study is to compare the FE Mg and urinary β2M on SRNS and steroid-sensitive nephrotic syndrome (SSNS) in remission. A cross-sectional study was conducted in the Department of Pediatrics RSUPN Dr. Cipto Mangunkusumo Jakarta, RSUD Ulin Banjarmasin, RSUP Fatmawati and RSAB Harapan Kita Jakarta from July to December 2015. Children aged 2-15 years who either had SRNS or SSNS in remission were recruited. Fractional excretion of magnesium and urinary β2M levels were examined. There were 62 subjects consisted of 31 subjects SRNS and 31 subjects SSNS in remission. The mean FE Mg on SRNS was significantly higher than SSNS in remission (p=0.0065). Median levels of urinary β2M on SRNS was higher than SNSS remission (p<0.001). Increased levels of urinary β2M was more significantly in SRNS compared to SSNS (p=0.007). With a cutoff point of 1.64%, an increased of FE Mg proportion on SRNS was more than SSNS in remission (p = 0.022). Conclusion: Fractional excretion of Mg and urinary β2M on SRNS were higher than SSNS in remission. There is a difference between the increased of FE Mg on SRNS and SSNS in remission. The increased of urinary β2M on SRNS was higher than SSNS in remission.]

Abstrak :
Pendahuluan: Gejala sindroma nefrotik (SN) adalah proteinuria massif. Penambahan Angiotensin Converting Enzyme Inhibitor (ACEi) atau Angiotensin Receptor Blocker (ARB) membantu menurunkan proteinuria pasien SN yang telah mendapat steroid. Belum ada penelitian mengenai efektivitas dan keamanan kombinasi ACEi+ARB dalam penatalaksanaan pasien SN sensitif steroid (SNSS) relaps sering atau SN dependen steroid (SNDS). Metode: Penelitian kohort retrospektif yang menggunakan data rekam medis anak RSUPN dr. Cipto Mangunkusumo 2014-2018. Hasil: Dari 63 pasien yang dievaluasi, 33 pasien menggunakan ACEi+ARB dan 30 pasien menggunakan ACEi. Tidak terdapat perbedaan bermakna onset tercapainya proteinuria negatif (ACEi+ARB minggu ke-3 vs ACEi minggu ke-4, p=0.125). Tidak terdapat perbedaan bermakna proporsi pasien yang mencapai proteinuria negatif dalam 4 minggu terapi (ACEi+ARB 72.7% vs ACEi 63.3%, RR=1.148; IK95%: 0.815-1.619, p=0.424). Tidak terdapat perbedaan efek samping yang bermakna dalam hal hipotensi, peningkatan ureum dan kreatinin, hiperkalemia dan penurunan laju filtrasi glomerulus. Kesimpulan: Tidak terdapat perbedaan bermakna efektivitas dan keamanan kombinasi ACEi+ARB dibandingkan ACEi sebagai antiproteinuria pada pasien anak SNSS relaps sering atau SNDS. ......Introduction: Symptoms of nephrotic syndrome (NS) is a massive proteinuria. The addition of Angiotensin Converting Enzyme Inhibitors (ACEi) or Angiotensin Receptor Blocker (ARB) can help to reduce proteinuria in NS patients who received steroids. There has been no study on the effectiveness and safety of ACEi+ARB combinations in the management of patients with frequent relapse NS (FRNS) or steroid-dependent NS (SDNS). Method: A retrospective cohort study using data collected from medical record of pediatrics with FRNS or SDNS at Cipto Mangunkusumo Hospital between 2014-2018 was conducted. Results: Out of the 63 patients who were evaluated, 33 patients were in ACEI+ARB while 30 other patients were in ACEi. There was no significant difference in the onset of negative proteinuria (3 weeks in ACEi+ARB vs 4 weeks in ACEi, p=0.125. There was no significant difference in the proportion of patients who achieved negative proteinuria in 4 weeks therapy (ACEi+ARB 72.7% vs ACEi 63.3%, RR=1,148; 95% CI: 0.815-1,619, p=0.424). There was no significant difference between ACEi+ARB and ACEi groups in the occurrence of hypotension, hyperkalemia, increased of creatinine serum, and decreased of glomerular filtration rate. Conclusion: There was no significant difference in the effectiveness and safety of the use of ACEi+ARB compared to ACEi as antiproteinuric in patients with FRNS or SDNS.

Abstrak :
Katarak subkapsular posterior (SKP) dan peningkatan tekanan intraokular (TIO) adalah komplikasi okular tersering akibat penggunaan kortikosteroid oral. Hal ini dapat terjadi pada pemberian dosis tinggi dan jangka panjang. Di Indonesia, tidak data mengenai hubungan antara dosis dan lama terapi terhadap kedua komplikasi tersebut pada anak sindrom nefrotik idiopatik (SNI). Tujuan penelitian ini adalah untuk mengetahui hubungan antara dosis kumulatif, lama terapi dengan kejadian katarak SKP maupun peningkatan TIO dan faktor yang memengaruhinya pada anak SNI di rumah sakit Cipto Mangunkusumo (RSCM). Studi ini merupakan studi potong lintang pada anak SNI usia 4-18 tahun yang mendapat terapi kortikosteroid oral minimal enam bulan secara terus menerus. Pemeriksaan mata lengkap dilakukan untuk mengevaluasi katarak SKP, tajam penglihatan dan peningkatan TIO. Dari 92 anak yang dianalisis, terdapat 19,6% anak yang menderita katarak SKP, 12% anak dengan peningkatan TIO dan satu anak dengan best corrected visual acuity (BCVA) <6/20. Median dosis kumulatif kortikosteroid oral adalah 12.161 mg (rentang 1.795-81.398) dan median lama terapi adalah 23 bulan (rentang 6-84). Terdapat hubungan antara dosis kumulatif (P=0,007) dan lama terapi (P=0,006) terhadap kejadian katarak SKP dengan titik potong optimal 11.475 mg dan 24 bulan. Jenis kelamin perempuan akan meningkatkan kejadian katarak SKP sebesar empat kali dibandingkan lelaki (PR=4; IK 95%=1,57-13,38; P=0.001). Penelitian ini menunjukkan makin tinggi dosis kumulatif dan/atau makin lama terapi kortikosteroid oral, maka makin besar angka kejadian katarak SKP (nilai batasan ≥ 11.475 mg dan  ≥ 24 bulan). Dosis kumulatif dan lama terapi tidak berhubungan dengan kejadian peningkatan TIO. ......Posterior subcapsular cataract (PSC) and raised intraocular pressure (IOP) are the most common ocular complications due to administration oral corticosteroid. These can occur in high dose and long term use. In Indonesia, no data regarding correlation between dose, therapeutic duration and both complications in children with idiopathic nephrotic syndrome (INS). The aim of this study was to evaluate the correlation between cumulative dose, therapeutic duration with the occurrence of PSC and raised IOP and factors associated with these complications in children with INS at Cipto Mangunkusumo Hospital (CMH). This is a cross-sectional study of children with INS aged 4-18 years who received oral corticosteroid therapy for at least six months continuously. A complete eye examination was performed to evaluate PSC, raised IOP and visual acuity. Of the 92 children analyzed, 19.6% had PSC, 12% had raised IOP and one child with best corrected visual acuity (BCVA) <6/20. The median cumulative dose of oral corticosteroids was 12,161 mg (range 1,795-81,398) and the median duration of therapy was 23 months (range 6-84). There were associaton between cumulative dose (P=0.007) and duration of therapy (P=0.006) to the occurrence of PSC with cut off point 11,475 mg and 24 months. Female sex will increase the occurence of PSC four times compared to male (PR=4; 95% CI=1.57-13.38; P=0.001). This study revealed that the higher cumulative dose and/or the longer of oral corticosteroid therapy, the higher occurence of PSC (cut off point ≥ 11.475 mg and ≥ 24 months). Cumulative dose and therapeutic duration were not associated with the occurence of raised IOP.