Risky Vitria Prasetyo
Division of Nephrology/Department of Child Health, Faculty of Medicine/Airlangga University, Soetomo Hospital, Surabaya.

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EVALUATION OF CAPD AS RENAL REPLACEMENT THERAPY IN CHILDREN Prasetyo, Risky Vitria; Ramadhani, Noershanti; Soemyarso, Ninik Asmaningsih; Noer, Mohammad Sjaifullah
Indonesian Journal of Urology Vol 19, No 2 (2012)
Publisher : Indonesian Urological Association

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Abstract

Objective: To evaluate the outcome of pediatric patients treated with continuous ambulatory peritoneal dialysis (CAPD) performed by experienced pediatric urologists. Material & Method: A retrospective study of children with end-stage renal disease (ESRD) by peritoneal dialysis (PD) in Division of Nephrology Department of Child Health, Faculty of Medicine Airlangga University, Soetomo Hospital, Surabaya, from January 2003 to February 2012 was conducted. Children with acute kidney injury treated by PD were excluded.Data reviewed were age, sex, primary renal disease, age at start of CAPD, duration of CAPD, outcome and cause of death. Descriptive statistics were used to analyze the data.Results: Twenty seven cases of children with CAPD within 9-year period were included. Most patients were 11-15 years old with 62,9% being male. Chronic glomerulonephritis and nephrotic syndrome were the main primary renal diseases. Fifteen (55,6%) patients had peritonitis. The longest duration on CAPD was 53 months. Outcome of 27 children was as follows, 11 patients died (40,8%), 8 patients survived (29,6%), and another 8 were lost to follow-up (29,6%). All (100%) patients had cardiovascular abnormalities as cause of death. Conclusion: The outcome and mortality rate of children with CAPD remain unfavourable. This is a challenge still to be overcomed. Keywords: Continuous ambulatory peritoneal dialysis, children, outcome.   
Risk factors for hypertensive crisis in children with acute glomerulonephritis Yuniarchan, Sherly; Prasetyo, Risky Vitria; Soemyarso, Ninik Asmaningsih; Noer, Mohammad Sjaifullah
Paediatrica Indonesiana Vol 56 No 2 (2016): March 2016
Publisher : Indonesian Pediatric Society

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Abstract

Background Hypertensive crisis occurs in 1-4% of the hypertensive pediatric population, mostly due to acute glomerulonephritis (AGN). Some factors have been suggested to affect blood pressure (BP) in children, such as age, sex, race/ethnicity, obesity, and socioeconomic status, but little is known for risk factors for hypertensive crisis in AGN.Objective To analyze the risk factors for hypertensive crisis in children with AGN.Methods Retrospectively, we studied possible risk factors for hypertensive crisis in children with AGN at Dr. Soetomo Hospital from 2007 to 2011. Hypertensive crisis was defined as systolic BP ≥180 mmHg or diastolic BP ≥120 mmHg (for children ≥ 6 years of age); and systolic and/or diastolic BP >50% above the 95th percentile (for children aged <6 years). We evaluated the demographic and clinical characteristics as potential risk factors. Statistical analysis was done with Chi-square, Fisher’s exact, and logistic regression tests. Variables with P <0.25 in the univariable analysis were further analyzed by the multivariable logistic regression model. A P value of < 0.05 was considered statistically significant.Results There were 101 children included (mean age 9.7 (SD 2.17) years), with a male-to-female ratio of 2.7:1. Hypertensive crisis occurred in 42 (41.6%) children, of whom 8 had hypertensive urgency and 34 had hypertensive emergency. Proteinuria was seen in 53 children with AGN (52.5%) and was the significant risk factor for hypertensive crisis in our subjects (OR=2.75; 95%CI 1.16 to 6.52; P=0.021). Gender, clinical profiles, ethnicity, nutritional status, blood urea nitrogen (BUN), and glomerular filtration rate (GFR) were not significant risk factors for hypertensive crisis.Conclusion Proteinuria is the significant risk factor for hypertensive crisis in children with AGN.
Comparison of the efficacy and safety of hydroxyethyl starch 130/0.4 and Ringer's lactate in children with grade III dengue hemorrhagic fever Prasetyo, Risky Vitria; Azis, Abdul Latief; Soegijanto, Soegeng
Paediatrica Indonesiana Vol 49 No 2 (2009): March 2009
Publisher : Indonesian Pediatric Society

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Abstract

Background Theoretically hydroxyethyl starch (HES) will givemore rapid recovery from shock, including in dengue shocksyndrome (DSS) and currently gained popularity for its lessdeleterious effects on renal function and blood coagulation.Objectives To compare the efficacy and safety ofHES 130/0.4 andRinger's lactate (RL) for shock recovery in children with DSS.Methods A randomized controlled study was performed on 39children admitted with DSS at Dr. Soetomo Hospital, Surabaya,between March and May 2007. Children were grouped intograde III (n=25) and grade IV (n=14) dengue hemorrhagicfever (DHF) according to the WHO criteria. Within eachgroup, subjects were randomly assigned to receive initial fluidresuscitation with either HES 130/0.4 (n=9 in the DHF grade IIIgroup, 10 in the DHF grade IV) or RL (n= 16 in the DHF gradeIII group, 4 in the DHF grade IV). Clinical and laboratory datawere collected to determine improvements in shock recovery andadverse reactions.Results In both the grades III and IV DHF, HES 130/0.4significantly decreased hemoglobin and hematocrit levels. Clinicalimprovements in pulse pressure and pulse rate were seen aftertreatment with HES 130/0.4 although these were statisticallyinsignificant if compared to the RL group. No differences in fluidrequirement and recurrent shock episodes were noted betweenthe RL and HES groups. No adverse reactions were found duringthe study.Conclusion HES 130/0.4 administration is effective and safe inchildren with DSS.
Management of childhood Gitelman syndrome: a case study Prasetyo, Risky Vitria; Saraswati, Putu Dian; Soemyarso, Ninik Asmaningsih; Noer, Mohammad Sjaifullah
Paediatrica Indonesiana Vol 56 No 3 (2016): May 2016
Publisher : Indonesian Pediatric Society

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Abstract

Gitelman syndrome is a rare, autosomal recessive, renal tubular salt wasting disorder characterized by hypokalemia, and metabolic alkalosis in combination with significant hypomagnesemia and hypocalciuria.1,2 The prevalence is estimated to be 1 in 40,000 individuals. The condition affects both males and females of all ethnic backgrounds. The prevalence of heterozygotes is approximately 1% in Caucasian populations.2,3In the majority of cases, symptoms do not appear before the age of six years and the disease is usually diagnosed during adolescence or adulthood. Symptoms, such as transient episodes of muscle weakness and tetany, sometimes accompanied by abdominal pain, vomiting and fever, are often seen in Gitelman syndrome patients. Paresthesias, especially in the face, frequently occur. Remarkably, some patients are completely asymptomatic except for the appearance of chondrocalcinosis at adult age that causes swelling, local heat, and tenderness over the affected joints. Blood pressure is lower than that in the general population. Sudden cardiac arrest has been reported occasionally. In general, growth is normal but can be delayed in those Gitelman syndrome patients with severe hypokalemia and hypomagnesemia.2,4
Repeat urine cultures in children with urinary tract infection Prasetyo, Risky Vitria; Soemyarso, Ninik Asmaningsih; Noer, Mohammad Sjaifullah
Paediatrica Indonesiana Vol 52 No 3 (2012): May 2012
Publisher : Indonesian Pediatric Society

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Abstract

Background Urinary tract infections (UTIs) are the secondleading cause of infection in children, following respiratorytract infections. Repeat urine cultures after antibiotic treatmentare routinely obtained in clinical practice to verify proof ofbacteriologic cure. The American Academy of Pediatrics doesnot recommended repeat cultures, due to increased cost anddiscomfort to patients.Objective To determine the frequency of positive repeat urinecultures after 3 days of antibiotics in children 'With UTIs.Methods We conducted a retrospective study on childrenwith UTIs who visited the Division of Pediatric Nephrology,Department of Child Health at Dr. Soetomo Hospital, Surabayafrom January 2006 to December 2011. Results of repeat urinecultures were obtained after 3 days of antibiotic treatment.Descriptive statistics were used to analyze the data.Results Of the 779 pediatric UTI cases, repeat urine cultureswere performed in 264 (33.9%) cases. Of the 264 patients whocomprised our study, there were similar numbers of girls and boys(50.4% vs. 49.6%, respectively). The mean age of patients was43.9 (SD 1.59) months and 35.5% of subjects were aged under 1year. In the initial urine cultures of our subjects, Escherichia coliwas the most common organism found, v,ith 92 cases (34.8%),compared to 58 cases (21.9%) of Klebsiella pneumoniae and 29cases (10.9%) of Pseudom.onas aeruginosa. Repeat urine culturesshowed no bacterial growth in 168 cases (63.6%).Conclusion Mostly negative repeat urine cultures v,ill probablyobviate the need of this test in daily routine practice. [PaediatrIndanes.2012,52:170·4].
Management of Lowe syndrome: a case report Prasetyo, Risky Vitria; Setiawan, Heru; Soemyarso, Ninik Asmaningsih; Noer, Mohammad Sjaifullah; Irwanto, Irwanto; Gunawan, Prastiya Indra; Loebis, Rozalina; Utomo, Sri Andreani; Tirthaningsih, Ni Wayan
Paediatrica Indonesiana Vol 55 No 3 (2015): May 2015
Publisher : Indonesian Pediatric Society

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Abstract

Lowe syndrome (the oculocerebrorenal syndrome of Lowe, OCRL) is a multisystem disorder characterized by anomalies affecting the eyes, nervous system and kidneys.1-3 The disorder was first recognized by Lowe et al. in 1952, and described as a unique syndrome with organic aciduria, decreased renal ammonia production, hydrophthalmos, and mental retardation. In 1954, renal Fanconi syndrome was recognized as being associated with Lowe syndrome and in 1965, a recessive X-linked pattern of inheritance was determined.2,4 Lowe syndrome is a very rare disease, with an estimated prevalence in the general population of 1 in 500,000. According to the Lowe Syndrome Association (LSA) in the USA, the estimated prevalence is between 1 and 10 affected males in 1,000,000 people, with 190 living in the year 2000. The Italian Association of Lowe Syndrome estimated that there were 34 Lowe syndrome patients (33 boys and one girl) living in Italy in the year 2005.2,4,5 It almost exclusively affects males.6 Physicians may not be familiar with Lowe syndrome due to its rarity.4
Persistent proteinuria as an indicator of renal disease in HIV-infected children Hisbiiyah, Yuni; Prasetyo, Risky Vitria; Puspitasari, Dwiyanti; Soemyarso, Ninik Asmaningsih; Moedjito, Ismoedijanto; Noer, Mohammad Sjaifullah
Paediatrica Indonesiana Vol 56 No 6 (2016): November 2016
Publisher : Indonesian Pediatric Society

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Abstract

Background Persistent proteinuria (microalbuminuria) has been reported to be a precursor of HIV-related renal disease. Screening allows for early management in order to prevent the progression of renal disease and decrease morbidity and mortality associated with chronic kidney disease in HIV. Several studies have been done on renal manifestation in HIV-infected children from American and African regions, but similar studies from Asia are lacking.Objective To determine the prevalence of persistent proteinuria in HIV-positive children on antiretroviral therapy (ARV) in Dr. Soetomo Hospital, Surabaya.Methods A cross-sectional study on children with HIV and treated with  highly active antiretroviral therapy (HARRT) was done from August 2014 to February 2015. Microalbuminuria was measured by the ratio of urine albumin to creatinine (ACR), while proteinuria was measured by dipstick. Measurements were performed 3 times in 4-8 weeks. All subjects underwent complete evaluation of blood tests, serum creatinine, blood urea nitrogen (BUN), CD4 counts, and urinalysis. Data were analyzed using Chi-square and logistic regression tests.Results Of 38 children on HARRT enrolled in this study, 2 subjects developed acute kidney injury (AKI), 4 subjects were suspected to have urinary tract infection (UTI), and 1 subject was suspected to have urinary tract stones. The prevalence of persistent microalbuminuria was 2.6%. There was no correlation between immunological status, WHO clinical stage, or duration of ARV and the incidence of persistent proteinuria (P>0.05).Conclusion The prevalence of persistent proteinuria is  lower in younger HIV-infected children at a non-advanced stage and HIV-infected children with normal immunological status who are on HAART. We provide baseline data on the renal conditions of HIV-infected children in the era of HAART, before tenovofir is  increasingly used as an antiretroviral therapy regimen in Indonesia.