SPECTRUM AND OUTCOME OF PEDIATRIC RENAL DISEASES IN DR. WAHIDIN SUDIROHUSODO HOSPITAL MAKASSAR

ABSTRACT Objectives: To find out thespectrum and outcome of renal diseases in children hospitalized in the pediatric ward of dr. Wahidin Sudirohusodo Hospital Makassar. Methods: We carried out a retrospective review of standard medial recordof all childrenhospitalizedinthe pediatric ward of the dr.Wahidin Sudirohusodo Hospital Makassar. Review was based on the final diagnosis on their medical records to investigate the spectrum and outcome of the pediatric renal diseasesfrom January 2009 to December 2013. Results: A total number of 9573 children were admitted during the study period, out of which 580 had renal diseases accounting for 16.5% of all pediatric admission. Age of the patients ranged from 10 months to 16.7 years with mean age of 7.39 years and majority of the cases aged 5-10 years (37.2%). Boys (55.3%)were more encountered than girls(44.7%) with a boy to girl ratio of 1.2:1 and most of the patients were in good nutritional status (48.6%). According to their final diagnosis, the commonness pediatric renal diseases in this hospital was Acute Post Streptococcal Glomerulonephritis (27.6%), followed by Nephrotic Syndrome (25.2%), Urinary Tract Infection (19.1%), and  Others are Acute Glomerulonephritis (8.3%), Acute Kidney Injury(5.1%), Chronic Kidney Injury(5.0%), Wilm’s Tumor(4.7%), Hydronephrosis (3.4%), Henoch-Schoenlein Nephritis (0.9%), and Lupus Nephritis (0.7%).  Length of stay of the patients was mostly in 7-14 days (46.0%) and varying from 3 up to 28 days. Mortality in pediatric patients of renal diseases in this study was 11.2% and usually in those entering the hospital with late deteriorating conditionand die before getting optimal treatment. Conclusions: In conclusion, our study shows that pediatric renal disease in the pediatric ward of dr. Wahidin Sudirohusodo Teaching Hospital Makassar accounts for 16.5%of all pediatric admission and APSGN was the commonest pediatric renal disease, followed by NS and UTI. It seems that spectrum of pediatric renal diseases in dr. Wahidin Sudirohusodo Hospital Makassar was relatively similar to that reported from other developing countries. Mortality in patients with pediatric renal diseases in our study was 11.2% and usually in those entering the hospital with late deteriorating condition and die before getting optimal treatment.  Key words: Spectrum, Outcome, Renal Disease, Children, Makassar

Risk factors for relapse in pediatric nephrotic syndrome

Background Nephrotic syndrome (NS) is the most common kidney disease in children and is characterized by edema, massive proteinuria, hypoalbuminemia, and hyperlipidemia. High relapse rate remains a major problem in the management of this syndrome. Objective To identify risk factors for relapse in pediatric nephrotic syndrome. Methods This study was carried out in the Wahidin Sudirohusodo Teaching Hospital in Makassar, South Sulawesi, Indonesia, from January to August 2017 using complete medical records of children diagnosed with NS. Subjects were divided into 2 groups: 1) relapsed NS or 2) non-relapsed NS.  The following potential risk factors for relapse were analyzed using Chi-square test: age, sex, nutritional status, hypertension, serum creatinine level, and infection at the time of established diagnosis of NS. Results A total of 142 children with NS who fulfilled the inclusion criteria aged 1.4 to 17.5 years were included in the study. Subjects were mostly boys (66.2%), with a male: female ratio of 1.95:1. The relapsed NS group had 80 cases (56.3%) and the non-relapsed NS group had 62 cases (43.7%). Statistical analysis revealed that nutritional status was a significant risk factor for relapse in pediatric nephrotic syndrome (P<0.05). Conclusion Nutritional status is an independent risk factor for relapse in pediatric nephrotic syndrome

Kidney injury molecule type-1, interleukin-18, and insulin-like growth factor binding protein 7 levels in urine to predict acute kidney injury in pediatric sepsis

BackgroundThis study aimed to observe the role of urinary kidney injury molecule (KIM-1), interleukin (IL-18), and insulin-like growth factor-binding protein 7 (IGFBP-7) levels in predicting acute kidney injury (AKI) in children with sepsis.Material and MethodsThis prospective cohort observational study was conducted at Dr. RSUP. Wahidin Sudirohusodo, Makassar, South Sulawesi, from January to December 2021. Inclusion criteria were septic patients treated in the pediatric intensive care unit (PICU) aged 1 month to 18 years with normal serum creatinine or normal urine output (&gt;5 ml/kg/body weight (BW)/h in 6–12 h). Patients with a history of kidney disease, prior urinary tract infection, or history of using nephrotoxic drugs were excluded.ResultsThere was a significant difference in urinary KIM-1, IL-18, and IGFBP-7 levels between septic patients with and without AKI. The cut-off point for urinary KIM-1 level in sepsis with and without AKI was 1.666 ng/ml, with sensitivity of 82.5%, specificity of 82.2%, and a relative risk (RR) [95% confidence interval (CI)] of 6.866 (95% CI, 3.329–14.165). The cut-off point for urinary IL-18 levels was 3.868 ng/ml, with sensitivity of 92.50%, specificity of 91.78%, and RR of 20.078 (95%CI, 6.593–61.142). The cut-off point for urinary IGFBP-7 levels was ≥0.906 ng/ml with a sensitivity of 75.00%, specificity of 75.34%, and RR of 4.063 (95% CI, 2.206–7.483).ConclusionUrinary KIM-1, IL-8, and IGFBP-7 levels could be used to predict AKI in septic patients. Urinary IL-8 has a higher sensitivity and specificity as a predictor of AKI in patients with sepsis

Tata laksana Sindrom Nefrotik Kelainan Minimal pada Anak

Sindrom nefrotik kelainan minimal (SNKM) berdampak pada kesehatan fisik anak serta mental anak dan orang tua karena penyakit ini sering relaps, pengobatan lama, dan toksisitas obat yang serius. Pengobatan yang tidak adekuat potensial membahayakan hidup anak karena infeksi sekunder dan dapat menyebabkan tromboemboli, kelainan lipid, dan malnutrisi. Tata laksana SNKM meliputi tata laksana suportif, tata laksana komplikasi, dan tata laksana spesifik dengan obat imunosupresif untuk induksi dan mempertahankan remisi tanpa toksisitas obat yang serius. Sampai saat ini, kortikosteroid masih merupakan pilihan pertama pada anak dengan SNKM dan obat imunosupresif lain digunakan bila tidak respons dengan pengobatan standar kortikosteroid atau pada relaps frekuen atau dependen steroid. Pemberian kortikosteroid sebaiknya tidak segera dimulai setelah onset gejala karena remisi spontan dapat terjadi pada 5% kasus SNKM kecuali kalau edema menetap atau gejala berat pada onset awal

The profile of acute glomerulonephritis among Indonesian children

Background Acute glomerulonephritis (AGN) is a form of glom- erulonephritis characterized by sudden and explosive onset of glom- erular injury symptom. It usually occurs after recent infection by group A beta-hemolytic streptococcus. AGN among Indonesian children seems to be less frequently reported than that among other countries. Objective To determine the current profile of AGN among Indo- nesian children hospitalized in eleven teaching centers. Methods This was a descriptive, cross-sectional study, based on a review of the standard medical records of 509 children with AGN hospitalized in 11 teaching centers in Indonesia over a five-year period (1997-2002). Data extracted from the medical records con- sisted of history of illness, clinical and laboratory findings, and chest X-rays. Results Age of the patients at the onset of AGN ranged from 2.5 to 15 years, with peak age of 8.5 years. The majority (76.4%) was above 6 years old with male predominance (58.3%). About 68.9% and 82% of the patients came from low socioeconomic and low edu- cational status families. Antecedent upper respiratory infections were observed in 45.8% cases and pyoderma in 31.6%. The disease seemed to be more commonly elicited by streptococcal infection than by other infections, as proved by an elevated anti-streptolisin O (ASO) titer (66.6%) and decreased C 3 concentrations (60.4%). The frequent clinical features included periorbital edema (76.3%), hypertension (61.8%), and gross hematuria (53.6%). The most preva- lent laboratory findings were microhematuria (99.3%), proteinuria (98.5%), raised erythrocyte sedimentation rate (85.3%). The initial chest X-rays showed pleural effusion (81.6%) and cardiomegaly (80.2%), whereas echocardiogram documented pericardial effusion (81.6%). Acute pulmonary edema (11.5%), hypertensive encepha- lopathy (9.2%), and acute renal failure (10.5%) were frequent com- plications noted in our study. Conclusion Despite no adequate data on throat or skin cul- tures, AGN among Indonesian children seems mostly to be poststreptococcal AGN as proved by the elevated ASO titer and decrease in serum C 3 concentratio

Scarlet Fever – a Diagnostic Challenge for Physicians: a Case Report of Scarlet Fever, Hepatitis, and Sepsis in a 15 –year and 6 month– old Female Adolescent with Severe Acute Malnutrition

Scarlet fever is a term used for an infection caused by a Group a Streptococcal bacteria. The early treatment of scarlet fever is strongly essential either to prevent further spreading of infection or to prevent the risk of complications consisting of peritonsillar and retropharyngeal abscess, sepsis, hepatitis, acute rheumatic fever, glomerulonephritis, pneumonia, endocarditis, and meningitis. We present a case of scarlet fever with sepsis, hepatitis, and severe acute malnutrition in a 15 year and 6 months old female adolescent. Since the patient had specific clinical features of scarlet fever with continuous fever, sore throat, and productive cough for 4 days, followed by general red maculopapular rash initially from the head and progressively spreading to the rest of her body. The patient was also diagnosed with sepsis, hepatitis, and severe acute malnutrition. Erythromycin, ursodeoxycholic acid, vitamin C, folic acid, and vitamin b complex were given to the patient. Rapid diagnosis and prompt treatment are important to prevent other potential complications such as sepsis, abscess, and acute rheumatic fever.&nbsp; Early diagnosis of scarlet fever simultaneously with adequate treatment will prevent the complications of the disease and its spreading among other childre

Konsensus glomerulonefritis akut pasca streptokokus

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Hypertension due to renal artery stenosis

A case of a 12-year-old boy with renal artery stenosis as a cause of hypertension is presented. The diagnosis of renal artery stenosis was established based on the bruit heard over costovertebral angle and the increased plasma rennin secretion, and further confirmed by angiogram finding. The detection of bruit, either on the abdomen or costovertebral angle, in association Indones with hypertension should initially lead to the consideration of the presence of renal artery stenosis

A Child with HIV (Human Immunodeficiency Virus) Infection Accompanied by Severe Acute Malnutrition: A Case Report

Joint United Nations Programme in HIV/AIDS (UNAIDS) reported that 1.8 million children under 15 years old had HIV with 150,000 new pediatric cases in 2015, and only 49% had an antiretroviral (ARV) therapy. Mortality in HIV-infected children with severe acute malnutrition was 30.4% in Africa. A 1-year and 8-months-old girl was hospitalized due to diarrhea, vomiting, oral thrush, and recurrent fever before admission. She has been hospitalized for HIV infection one month ago and treated with ARV. Her mother was treated with ARV before. Physical examination showed a severely ill, poorly nourished, stunting, and conscious child with normal vital signs. There was oral thrush. The evidence of nutritional marasmus was old man face, piano sign, wasting, and baggy pants. Laboratory findings revealed anemia, positive antigen and antibody of HIV infection, and low Cluster of Differentiation 4 (CD4). She was treated with ARV, Cotrimoxazole, and management of malnutrition and diarrhea. The prognosis of the patient was poor. A 1-year and 8-months-old girl with HIV infection complicated with severe acute malnutrition, acute diarrhea, oral thrush, and anemia of chronic disease were reported. The diagnosis was based on clinical and laboratory findings. Management focused on the therapy of HIV and accompanying illness. The prognosis was poor