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Perbaikan urinalisis setelah 3 bulan siklofosfamid pada pasien pediatri dengan lupus eritematosus sistemik

Abstract

Background: Renal involvement was the most common clinical manifestation in pediatric systemic lupus erythematosus (SLE). Urinalysis was a simple laboratory test that might be used to monitor therapy in pediatric SLE with renal involvement. This study aimed to analyze the improvement of urinalysis abnormality at 3 months of cyclophosphamide.

Methods: This study was a retrospective analytical observational study. The population was pediatric SLE at Prof. dr. IGNG Ngoerah General Hospital, Denpasar. Inclusion criteria were children under 18 years old diagnosed in 2015 to 2020, with kidney involvement in the form of urinalysis abnormality and managed with cyclophosphamide. Exclusion criteria were incomplete 3 months of therapy and incomplete data. Data were derived from the Bali Pediatric SLE database (BEATLES study). The different proportions of proteinuria, erythrocyturia, leukocyturia and glucosuria at diagnosis and 3 months of cyclophosphamide were compared using the McNemar test with SPSS 23.

Results: From 63 subjects, there were 10 males (15.9%), mean age was 15.34±2.61 years. Proteinuria at diagnosis and 3 months of cyclophosphamide were 58.7% and 31,7%. Erythrocyturia at diagnosis and 3 months of cyclophosphamide were 63.5% and 42.9%. Leukocyturia at diagnosis and 3 months of cyclophosphamide were 23.8% and 9.5%. Glucosuria at diagnosis and 3 months of cyclophosphamide were 4.8% and 3.2%. McNemar test showed a significant difference in proteinuria (P<0.001), erythrocyturia (P=0.002) and leukocyturia (P=0.035), but not in glucosuria (P=1).

Conclusion: Urinalysis abnormality includes proteinuria, erythrocyturia and leukocyturia, but not glucosuria, improved in pediatric SLE who completed 3 months of therapy cyclophosphamide.

 

Latar belakang: Keterlibatan ginjal merupakan manifestasi klinis yang paling umum pada lupus eritematosus sistemik (SLE) pediatrik. Urinalisis adalah tes laboratorium sederhana yang dapat digunakan untuk memantau terapi pada SLE pediatrik dengan keterlibatan ginjal. Penelitian ini bertujuan untuk menganalisis perbaikan kelainan urinalisis pasca pemberian siklofosfamid 3 bulan.

Metode: Penelitian ini merupakan penelitian observasional analitik retrospektif. Populasi penelitian adalah pasien SLE pediatrik di Prof. dr. RSU I.G.N.G Ngoerah Denpasar. Kriteria inklusi adalah anak berusia di bawah 18 tahun yang didiagnosis pada tahun 2015 hingga 2020, yang mengalami gangguan ginjal berupa kelainan urinalisis dan ditangani dengan siklofosfamid. Kriteria eksklusi adalah terapi 3 bulan tidak lengkap dan data tidak lengkap. Data berasal dari database Bali Pediatric SLE (studi BEATLES). Perbedaan proporsi proteinuria, eritrosituria, leukosituria dan glukosuria saat diagnosis dan siklofosfamid 3 bulan dibandingkan menggunakan uji McNemar dengan SPSS 23.

Hasil: Dari 63 subjek didapatkan 10 laki-laki (15,9%), rerata usia 15,34±2,61 tahun. Proteinuria saat diagnosis dan pasca siklofosfamid 3 bulan adalah 58,7% dan 31,7%. Eritrosituria saat diagnosis dan pasca siklofosfamid 3 bulan adalah 63,5% dan 42,9%. Leukosituria saat diagnosis dan pasca siklofosfamid 3 bulan adalah 23,8% dan 9,5%. Glukosuria saat diagnosis dan pasca siklofosfamid 3 bulan adalah 4,8% dan 3,2%. Uji McNemar menunjukkan perbedaan bermakna pada proteinuria (P<0,001), eritrosituria (P=0,002) dan leukosituria (P=0,035), tetapi tidak pada glukosuria (P=1).

Simpulan: Kelainan urinalisis termasuk proteinuria, eritrosituria dan leukosituria, tetapi tidak pada glukosuria, membaik pada SLE pediatrik yang menyelesaikan siklofosfamid 3 bulan.

References

  1. Parikh SV, Almaani S, Brodsky S, Rovin BH. Update on lupus nephritis: core curriculum 2020. Am J Kidney Dis. 2020;76(2):265-281.
  2. Aragon CC, Tafur RA, Avellaneda AS, Martinez T, Salas ADL, Tobon GJ. Urinary biomarkers in lupus nephritis. J Transl Autoimmun. 2020;3:100042.
  3. Liberski S, Marczak D, Mazur E, Mietkiewicz K, Leis K, Galazka P. Systemic lupus erythematosus of the urinary tract: focus on lupus cystitis. Reumatologia. 2018;56(4):255-258.
  4. Ogino MH, Tadi P. Cyclophosphamide. 2021. Cited October 10, 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553087/#!po=30.0000.
  5. Trisnia PA, Wati KDK, Witarini KA, Sutawan IBR, Santoso H. Efficacy of high-dose methylprednisolone and cyclophosphamide in childhood-onset systemic lupus erythematosus. Paediatr Indones. 2020;60:117-24.
  6. Falk RJ, Dall'Era M, Appel GB. Lupus nephritis: Initial and subsequent therapy for focal or diffuse lupus nephritis. 2021. Cited October 10, 2021. Available from: https://www.uptodate.com/contents/lupus-nephritis-initial-and-subsequent-therapy-for-focal-or-diffuse-lupus-nephritis/print.
  7. Goilav B, Putterman C, Rubinstein TB. Biomarkers for kidney involvement in pediatric lupus. Biomark Med. 2015;9(6):529–543.
  8. Quan XY, Chen HT, Liang SQ, Yang C, Yao CW, Xu YZ, Liu HF, An N. Revisited cyclophosphamide in the treatment of lupus nephritis. Hindawi. 2022:1-9.
  9. Pinheiro SVB, Dias RF, Fabiano RCG, Araujo SDA, Silva ACS. Pediatric lupus nephritis. J Bras Nefrol. 2019:41(2).
  10. Engli KA, Handono K, Eko MH, Susianti H, Gunawan A, Kalim H. Proteinuria severity in lupus nephritis is associated with anti-dsDNA level and immune complex deposit location in kidney. J of Tropical Life Science. 2018;8(3):217–226.
  11. Beck N, Walz G, and Schneider J. Effect of cyclophosphamide and glucocorticoid therapy in IgA nephropathy: a single-center retrospective analysis. Kidney360. 2022;3(3):506–515.
  12. Tamirou F, Lauwerys BR, Dall’Era M, Mackay M, Rovin B, Cervera R, Houssiau FA. A proteinuria cut-off level of 0.7 g /day after 12 months of treatment best predicts long-term renal outcome in lupus nephritis: data from the MAINTAIN Nephritis Trial. Lupus Science & Medicine. 2015;2:e000123.
  13. Touma Z, Urowitz MB, Ibañez D, Gladman DD. Time to recovery from proteinuria in subjects with lupus nephritis receiving standard treatment. The Journal of Rheumatology. 2014;41:4.
  14. Ding JYC, Ibanez D, Gladman DD, Urowitz MB. Isolated hematuria and sterile pyuria may indicate systemic lupus erythematosus activity. J Rheumatol. 2015;42(3):437-440.
  15. Bertsias G, Cervera R, Boumpas DT. Systemic lupus erythematosus: pathogenesis and clinical features. 2012. Cited January 1, 2023. Available from: https://www.eular.org/myuploaddata/files/sample%20chapter20_mod%2017.pdf.
  16. Trilistyoati D, Agustina B, Awalia. Clinical profile and incidence of infection in systemic lupus erythematosus subjects at Medical Inpatient Installation, Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia in 2016. Majalah Biomorfologi. 2021;31:49-56.
  17. Yuan M, Li JZ, Yu XJ, Zhang H, Tan Y. Urinary sediments could differentiate the endocapillary proliferative lupus nephritis and endocapillary proliferative IgA nephrology. Research Square. 2020.
  18. Hechanova LA. Renal Glucosuria. 2022. Cited October 10, 2022. Available from: https://www.merckmanuals.com/professional/genitourinary-disorders/renal-transport-abnormalities/renal-glucosuria.

How to Cite

Wati, K. D. K., Wijaya, F. A. ., Nilawati, G. A. P. ., Sutawan, I. B. R., & Mahakrishna, B. N. . (2023). Perbaikan urinalisis setelah 3 bulan siklofosfamid pada pasien pediatri dengan lupus eritematosus sistemik. Medicina, 54(1), 23–27. https://doi.org/10.15562/medicina.v54i1.1230

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Ketut Dewi Kumara Wati
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Felicia Anita Wijaya
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Gusti Ayu Putu Nilawati
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Ida Bagus Ramajaya Sutawan
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Bagus Ngurah Mahakrishna
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