Partini P Trihono, Partini P
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Acute renal failure in children: outcome and prognostic factors

Paediatrica Indonesiana Vol 43 No 6 (2003): November 2003
Publisher : Indonesian Pediatric Society

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Abstract

Background Acute renal failure (ARF) is an emergency conditionwith a high mortality rate despite the long-known dialysis and ad-vanced supportive care. Only few studies on prognostic factors ofARF in children are available in the literature, which are difficult tocompare to each other due to the different definitions of the ARFoutcome used.Objective To find out the clinical and laboratory characteristics ofchildren with acute renal failure and the prognostic factors affect-ing the outcome.Methods This observational prospective study was conducted onchildren with acute renal failure hospitalized in the Department ofChild Health, Cipto Mangunkusumo Hospital, between July andDecember 2001. Patients with acute on chronic renal failure wereexcluded. Clinical and laboratory data were taken at the time ofdiagnosis and the outcomes were noted after 2 weeks of observa-tion. We classified the outcome as cured, uncured, and dead. Ana-lytical study was done to find out the relationships among variousprognostic factors.Results Fifty-six children with ARF were recruited in this study.Male to female ratio was 1.3:1; the mean age was 4.4 year-old.The most frequent presenting symptom was dyspnea (34%), fol-lowed by oliguria (29%). The most frequent primary disease wasmalignancy (20%). Most of the patients had renal-type of ARF(73%). The outcomes were cure (71%), no cure (16%), and death(13%). Bivariate analysis and logistic regression revealed thatyounger age (OR=13.6; 95%CI 1.01;183.60) and the need for di-alysis (OR=10; 95%CI 1.53;65.97) had significant relationships withmortality or no cure.Conclusion We should be aware when finding ARF patientsless than 5 year-old and have the indications for dialysis, due tothe poor prognosis they might have

Pengaruh Lama Pengobatan Awal Sindrom Nefrotik terhadap Terjadinya Kekambuhan

Sari Pediatri Vol 4, No 1 (2002)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

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Abstract

Sebagian besar sindrom nefrotik pada anak memberikan respons yang baik padapengobatan awal dengan steroid. Namun sekitar 57% di antaranya menunjukkankekambuhan berulang yang memerlukan pengobatan steroid yang berulang-ulang, hinggasebagian menunjukkan efek toksik. Pemberian steroid awal yang lebih lama dapatmengurangi jumlah pasien yang mengalami kambuh sering. Di Bagian Ilmu KesehatanAnak FKUI-RSCM telah dilakukan penelitian uji klinik terhadap 2 kelompok pasienbaru sindrom nefrotik. Kelompok I mendapat terapi steroid 60mg/m2/hari (FD) selama4 minggu yang dilanjutkan dengan dosis 40mg/m2/hari selang sehari (AD) selama 4minggu, sedang kelompok II mendapat terapi steroid FD dan AD masing-masing selama6 minggu. Terhadap kedua kelompok tersebut diikuti selama 1 tahun untuk melihatkekeraban kekambuhannya. Dalam tahun 1994-1998 terdapat 35 anak yang memenuhikriteria inklusi, namun hanya 18 anak (10 anak kelompok I dan 8 anak kelompok II)yang menyelesaikan terapi dan ikut dalam observasi selama 1 tahun. Tidak didapatkanperbedaan klinis dan laboratoris pada kedua kelompok tersebut. Kekambuhan pertamakali timbul dalam 4 minggu setelah pengobatan pada 2 dari 8 (25%) anak kelompok IIdan 3 dari 10 (30%) anak kelompok I. Kekambuhan lebih dari 2 kali atau lebih dalam 6bulan pertama setelah pengobatan terdapat pada 4 (40%) anak kelompok I dan 2 (25%)anak kelompok II, sedangkan kekambuhan 4 kali atau lebih dalam 1 tahun setelahpengobatan tidak ditemukan pada kelompok II, namun didapatkan pada 2 (20%) anakkelompok I. Terdapat 1 (10%) anak kelompok I dan 2 (25%) anak kelompok II yangtidak pernah kambuh. Disimpulkan bahwa sindrom nefrotik yang mendapat terapi steroidawal lebih lama (12 minggu) mempunyai kecenderungan lebih jarang kambuh biladibandingkan dengan kasus yang mendapat terapi steroid awal lebih pendek (8 minggu).

Kelainan Kardiovaskular pada Anak dengan Berbagai Stadium Penyakit Ginjal Kronik

Sari Pediatri Vol 18, No 3 (2016)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

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Abstract

Latar belakang. Penyakit kardiovaskular (PKV) merupakan penyebab orbiditas dan mortalitas tersering pada penyakit ginjal kronik (PGK) anak. Hipertrofi ventrikel kiri (LVH) dan disfungsi diastolik paling awal terlihat.Tujuan. Mengetahui proporsi PKV pada PGK stadium 1, hubungan stadium PGK dengan LVH, dan disfungsi jantung.Metode. Penelitian potong lintang analitik komparatif 26 subjek PGK anak di RS M Djamil Padang/ RS Hasan Sadikin Bandung. Dilakukan pemeriksaan urinalisis, hematologi rutin, ureum, kreatinin (eLFG), EKG, foto toraks, ekokardiografi. LVH dengan ekokardiografi bila left ventricular mass index (LVMI) >persentil 95 (38g/h2,7). Uji stastistik bermakna bila p<0,05.Hasil. Rerata umur subjek 9,1(3,8) tahun. LVH pada 1 dari 3 subjek PGK stadium 1 dan 61,5% pada PGK seluruh stadium, terbanyak stadium 5. Tidak terdapat hubungan bermakna stadium PGK dengan LVH (p=0,055), disfungsi diastolik (p=0,937) dan disfungsi sistolik (p=0,929).Kesimpulan. Pada PGK stadium 1 ditemukan LVH dan disfungsi diastolik. Tidak terdapat hubungan antara stadium PGK dengan LVH dan disfungsi jantung.

The influence of stressor on blood pressure in school children

Paediatrica Indonesiana Vol 43 No 2 (2003): March 2003
Publisher : Indonesian Pediatric Society

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Abstract

Background Physical and psychological stress such as child anxi-ety, can increase blood pressure.Objective To evaluate the role of vein puncture as a stressor caus-ing alteration of blood pressure in school children.Methods This study was a descriptive, pre and post test study asa part of a screening study on primary school children at Cibubursubdistrict in East Jakarta. Blood pressure was measured beforeand after a vein puncture procedure in 449 children. Nine childrenwere excluded because of incomplete data.Results The increase of systolic blood pressure was found in 121(27.5%) subjects, decrease in 42 (9.5%), and no change in 227(63%). Diastolic blood pressure increased in 123 (28.0%) subjects,decreased in 38 (8.6%), and did not change in 279 (63.4%). Theincrease of both systolic and diastolic blood pressure was found in61 (13.8%), increased systolic with no change of diastolic in 58(13.2%), and increased systolic with decreased diastolic in 2 (0.5%)children. Decreased systolic with increased diastolic was found in2 (0.5%) subjects, decreased systolic with no change of diastolicin 26 (5.9%), and decrease of both systolic and diastolic in 14 (3.2%)children. No changes in both systolic and diastolic blood pressurewere found in 195 (44.3%); no change in systolic with decreaseddiastolic blood pressure was found in 22 (5.0%) children.Conclusion In most of the school children, vein puncture proce-dure did not cause alteration on blood pressure

Association of geohelminths infection and asthma in elementary school children in Kalibaru, North Jakarta

Paediatrica Indonesiana Vol 50, No 2 (2010): March 2010
Publisher : Indonesian Pediatric Society

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Abstract

Background Asthma inflammation process and geohelminthinfection have the same immune response. Epidemiological studiesin developed countries show the increased asthma prevalenceand decreased geohelminth infection, while developing countriesusually have low asthma prevalence but high geohelminthinfection.Objectives To determine asthma proportion in children withgeohelminth infection and relationship between asthma andgeohelminth prevalence of elementary school students in NorthJakarta.Method A cross sectional study was done in February 2009 at anElementary School in North Jakarta. Asthma was diagnosed usingISAAC questionnaire which was answered by parents. We didfecal analysis using ether formaline test to establish geohelminthinfection.Results The proportion of students with asthma was 11.5%(33 of 286 children). Most of them were male, aged 6-10 yearsold, and well nourished. Geohelminth infection was foundin 71.9%of the students. Most of children with geohelminthinfection were male (55%), aged 6-10 years old (63%), and wellnourished (64%). Proportion of asthma in children with andwithout geohelminth infection is 12.6% and 8.8%, respectively.Geohelminth infection consisted of ascariasis (80%), trichuriasis(39%), and ankylostomiasis (9%). There was no significantrelationship between asthma and geohelminth infection(P=0.357), nor between asthma and ascariasis (P=0.202), asthmaand trichiuriasis (P=0.133).Conclusions The occurrence of asthma in children withgeohelminth infection is 12.6% and there is no difference ofasthma incidence among children with or without geohelminthinfection.

Anemia in children with chronic renal failure Special attention erythrocyte indices and iron deficiency anemia

Paediatrica Indonesiana Vol 46 No 4 (2006): July 2006
Publisher : Indonesian Pediatric Society

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Abstract

Background Anemia in chronic renal failure (CRF) has beenproved to influence the quality of life, increasing morbidity andmortality. Early diagnosis and prompt treatments of anemia aremandatory to manage CRF appopriately. So far data of anemia inCRF in Indonesia is limited.Objective To find out the profile of anemia in children with CRF atCipto Mangunkusumo Hospital (CMH), Jakarta, with special atten-tion in erythrocyte indices and iron deficiency anemia.Methods Cross-sectional descriptive study was carried out onpatients with CRF and anemia in CMH since October 2003 to April2004.Results There were 20 CRF patients, aged between 1 year 3 month-15 year old, mostly were above 10 year old, 11 patients were malesand 9 were females. The most frequent etiologies were urinarytract infection (UTI) in 10 cases and nephrotic syndrome in 6 cases.Of those 20 patients, 14 suffered from anemia with erythrocyteindices, normochrome normocytic in 9 patients and hypochromemicrocytic in 5 patients. Of 14 anemic patients only 1 patient suf-fered from iron deficiency anemia of less than 10 mg/l and transferinsaturation of less than 12%. Based on serum iron (SI) concentra-tion only, 7 patients were diagnosed as having iron deficiency ane-mia.Conclusion Most patients with chronic renal failure havenormochrome normocytic anemia. Hypochromic microcytic irondeficiency anemia is scarcely found in this group of patients.

Urinary tract infection among neonatal sepsis of late-onset in Cipto Mangunkusumo Hospital

Paediatrica Indonesiana Vol 45 No 5 (2005): September 2005
Publisher : Indonesian Pediatric Society

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Abstract

Background Urine culture, as part of a full septic work-up forlate-onset neonatal sepsis, was not routinely done in the Neona-tal Ward at Cipto Mangunkusumo Hospital, and as of today, theprevalence of urinary tract infection (UTI) among neonates withlate-onset sepsis remains unknown.Objectives To determine the prevalence and microbiological pat-terns of UTI among late-onset neonatal sepsis in CiptoMangunkusumo Hospital.Methods We conducted a cross-sectional study on all neonatesdiagnosed as suspected late-onset sepsis who underwent sep-sis evaluation between 20 October 2003 – 30 April 2004. Urinespecimens were collected by bladder catheterization for cultureand urinalysis.Results UTI was found in 14.9% (7/47) neonates who under-went urine culture (male: female ratio was 5:2). Six subjectswho had UTI were preterm neonates, Klebsiella pneumoniaewas found in both blood and urine cultures of 1 subject, while theothers showed different microorganisms. Forty-five out of 47subjects, who were suspected of late-onset sepsis, had posi-tive blood cultures. All subjects with UTI had positive bacteriuriafrom Gram-stained specimen.Conclusions The prevalence of UTI among neonates with late-onset sepsis in Cipto Mangunkusumo Hospital was 14.9%. Themicroorganisms most frequently found in urine cultures werePseudomonas sp., Staphylococcus epidermidis, and Klebsiellapneumoniae. Urine culture, urinalysis, and urinary Gram-stainshould be performed as part of sepsis evaluation for late-onsetneonatal sepsis, especially in male and preterm neonates

The influence of oral cimetidine administration on creatinine clearance in chilren with chronic renal failure: A preliminary study

Paediatrica Indonesiana Vol 45 No 1 (2005): January 2005
Publisher : Indonesian Pediatric Society

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Abstract

Background Serum creatinine and creatinine clearance are usedto assess glomerular filtration rate but have a major disadvantagesince a variable amount of creatinine is secreted in the proximaltubule. This may cause an unpredictable overestimation of GFR.Tubular creatinine secretion can be blocked by cimetidine throughcompetitive inhibition of cation transport in the proximal tubularluminal membrane.Objective Cimetidine administration might improve the reliabilityof creatinine as a marker of glomerular filtration.Methods A preliminary study with a one-group pretest-posttestdesign in 11 children with chronic renal failure. Serum cystatin Clevel as reference value was compared with creatinine clearancemeasured before and after oral ingestion of cimetidine. The doseof cimetidine was adjusted with the GFR using Schwartz formula.Statistical evaluation was done with the Wilcoxon signed rankstest.Result The mean creatinine clearance before cimetidine adminis-tration was 27.4 (SD 14.6) ml/minute/1.73 m 2 BSA, and decreasedafter cimetidine to 21.1 (SD 13,1) ml/minute/1.73 m 2 BSA (p=0.015).Conclusion Oral cimetidine was effective in inhibiting creatininetubular secretion. This study could not prove that cimetidine im-proves the accuracy of creatinine clearance

Pewarnaan Gram Urin untuk Diagnosis Infeksi Saluran Kemih pada Anak Usia 2 Bulan hingga 2 Tahun

Sari Pediatri Vol 20, No 4 (2018)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

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Abstract

Latar belakang. Infeksi saluran kemih (ISK) merupakan salah satu penyakit infeksi yang sering ditemukan pada anak usia 2 bulan hingga 2 tahun. Kondisi ini sulit dideteksi karena manifestasi klinis yang tidak spesifik. Kultur urin sebagai baku emas menegakkan diagnosis ISK membutuhkan waktu yang lama dan biaya yang mahal. Pewarnaan Gram urin adalah metode yang mungkin dapat digunakan untuk diagnosis dini ISK pada bayi dan anak. Tujuan. Membandingkan metode pewarnaan Gram dan kultur urin untuk mendiagnosis ISK pada anak usia 2 bulan hingga 2 tahun. Metode. Penelitian ini merupakan uji diagnostik dengan metode potong lintang di Rumah Sakit Cipto Mangunkusumo, Jakarta, Indonesia, dari Mei 2016 -Desember 2017. Penelitian ini melibatkan 59 anak usia 2 bulan hingga 2 tahun yang dicurigai menderita ISK yang direkrut dengan metode consecutive sampling. Sampel urin diambil dengan kateterisasi uretra dan dilakukan pemeriksaan urinalisis, pewarnaan Gram, dan pemeriksaan biakan urin. Hasil. Prevalens ISK didapatkan sebesar 38,9%. Pewarnaan Gram urin memiliki sensitivitas 47,8% (95% IK 26,8-69,4%), spesifisitas 97,2% (95% IK 85,5-99,9%), nilai duga positif 91,7% (95% IK 60,3-98,8%), nilai duga negatif 74,5% (95% IK 60,3-98,8%), LR(+) 17,2 (95% IK 2,4-124,6), LR(-) 0,54 (95% IK 0,36-0,8), dan akurasi sebesar 78%. Kesimpulan. Terdapat korelasi yang baik antara pewarnaan Gram urin dan hasil biakan urin untuk mendiagnosis ISK pada anak usia 2 bulan hingga 2 tahun. Antibiotik dapat segera diberikan setelah pewarnaan Gram menunjukkan hasil positif.