Pengobatan Terkini Sindrom Nefrotik (SN) pada Anak
Sari
Pengobatan sindrom nefrotik pada anak mengalami perubahan dari masa ke masa. Sudah sejak lama kita mengadopsi rekomendasi
International study of kidney disease in children (SKDC) yaitu pemberian kortikosteroid 8 minggu, 4 minggu dosis penuh dilanjutkan
dengan 4 minggu dosis alternating. Dengan skema pengobatan ini 80% sindrom nefrotik idiopatik pada anak mengalami remisi,
tetapi 70%-80% di antaranya mengalami relaps dan separuhnya relaps berulang/frekuen. Pengobatan hanya 8 minggu dirasakan
kurang adekuat (Kidney Disease Improving Global Outcome= KDIGO), maka KDIGO membuat rekomendasi baru pada tahun
2013. Pengobatan inisial dapat dipilih dengan pemberian kortikosteroid 12 minggu atau tetap 8 minggu dan dilanjutkan dengan
penurunan dosis selama 2-3 bulan (tapering-off). Namun usulan KDIGO dibantah oleh Japanese Study Group of Kidney Disease in
Children (JSKDC) tahun 2015 dengan melakukan penelitian untuk membandingkan prednisolon 4-4 minggu selama 6 bulan yaitu
4-4 minggu + tapering off. Hasil penelitian tersebut membuktikan bahwa pemberian prednison 4-4 minggu tidak lebih inferior dan
pemberian 6 bulan tidak mengurangi relaps. Rekomendasi lain dari KDIGO 2013 diterima dengan sedikit modifikasi yang akan
dikemukakan pada makalah ini secara rinci, baik untuk pengobatan sindrom nefrotik sensitif steroid (SNSS) maupun sindrom nefrotik
resisten steroid (SNRS). Juga diajukan pemberian beberapa preparat kortikosteroid “sparing agent†yang dapat dipakai pada sindrom
nefrotik relaps frekuen/dependen steroid.
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International study of kidney disease in children. The
primary nephrotic syndrome in children. J Pediatr
;98:561-65
Churg T, Habib R dan White RHR. Pathology of
nephrotic syndrome in children. A report of the
International study of kidney disease in children. Lancet
;2:1299-1302
International study of kidney disease in children. The
primary nephrotic syndrome in children. Identification
of patients with minimal change nephrotic syndrome
from initial response to prednisone. J Pediatr 1980;98:
-4.
International study of kidney disease in children. Early
identification of frequent relapses among children
with minimal change nephrotic syndrome. Pediatrics
;105:492-5.
Kidney Disease Improving Global Outcome (KDIGO).
Kidney International 2012 suppl June;2:140-274
Lombel RM, Hodson EM, Gipson DS. Treatment of
steroid resistant nephrotic syndrome in children: new
guidelines from KDIGO. Pediatr Nephrol 2013;28:409-
Lombel RM, Hodson EM, Gipson DS. Treatment of
steroid sensitive nephrotic syndrome: new guidelines
from KDIGO. Pediatr Nephrol 2013;28:415-42.
Hodson EM, Graig JC, Willis NS. Evidence base
management of steroid sensitive nephrotic syndrome.
Pediatr Nephrol 2005;20:1523-30.
Trihono P, Marwali EM, Alatas H, Tambunan T, Pardede SO. Pengaruh lama pengobatan awal sindrom
nefrotik terhadap terjadinya kekambuhan. Sari Pediatri
;4:2-4
Brodehl J. Conventional therapy for idiopathic nephrotic
syndrome in children. Clin Nephrol 1991;25suppl1:58-
Ehrlich JH, Brodehl J. Long versus standard prednisone
for initial treatment of idiopathic nephrotic syndrome
in children. Eur J Pediatr 1993;152:357-61.
Noer M. Efficacy and safety of single versus divided dose
corticosteroid. Therapy in nephrotic syndrome (A Preliminary
Report). Pediatr Indones 2014;54Suppl:225
Elzouki AY, Jaiswal OP. Longterm, small dose prednisone
therapy in frequently relapsing nephrotic syndrome of
childhood. Effect on remission, statural growth, obesity
and infection rate. Clin Pediatr (Phila) 1988;27:387-
Yoshikawa N, Nakamishi K, Sako M, Oba MS, Mori
R, Ota E, dkk. A multicenter randomized trial indicates
initial prednisolone treatment for childhood nephrotic
syndrome for two months is not inferior to six-month
treatment. Kidney International 2015;87:225-32.
Trihono PP, Alatas H, Tambunan T, Pardede SO.
Konsensus Tata Laksana Sindrom Nefrotik Idiopatik
pada Anak. Edisi-2. Balai Penerbit IDAI. 2008, h.1-
Hafeez F, Ahmed TM, Samina U. Levamisole in steroid
dependent and frequently relapsing nephrotic syndrome.
J Coll Physicians Surg 2006;16:35-7.
Niaudet P, Broyer M, Habib R. Treatment of idiopathic
nephrotic syndrome with cyclosporine A in children.
Clin Nephrol 1991;35(suppl1):S31-S36.
Dotsch J. Dittrich K, Plank C, Rascher W. Is tacrolimus
for childhood steroid-dependent nephrotic syndrome
better than cyclosporine A? Nephrol dial transplant.
;21:1761-3.
Dorrostein EM, Kost-van Holthe JE, Levtchenko EN,
Nauta J, Hop WL, Van der Heyden AJ.. Mycophenolate
mofetil versus cyclosporine for remission maintenance in
nephrotic syndrome. Pediatr Nephrol 2008;23:2013-20.
Afzal K, Bagga A, Menon S, Hari P, Jordan SC.
Treatment of mycophenolate mofetil dan prednisolone
for steroid dependent nephrotic syndrome. Pediatr
Nephrol 2007;22:2059-65.
Prytula A, Tijima K, Kamei K, Geary D, Gottlich E,
Majeed A, et al. Rituximab in refractory nephrotic
syndrome. Pediatr Nephrol 2010;25:461-68.
Yoshioka K, Ohashi Y, Sakai T, Ito H, Yoshikawa N,
Nakamura H, et al. A multicenter trial of mizoribinecompared with placebo in children with frequently
relapsing nephrotic syndrome. Kidney International
;58:317-24.
Arbeitgemeinshaft for Padiatrische Nephrologie. Effect
of cytotoxic drugs in frequent relapsing nephrotic
syndrome with and without steroid dependency. N Eng
J Med. 1982;306:451-54.
Prasad N, Galati, Sharma RK, Singh U, Ahmad M.
Puls cyclophosphamide therapy in steroid dependent
nephrotic syndrome. Pediatr Nephrol 2004;19:494-98
International study of kidney disease in children.
Prospective controlled trial of cyclophosphamide therapy
in children with nephrotic syndrome. Report of ISKDC.
Lancet 1979;2:423-7.
Hidayati EL, Pardede SO, Trihono PP. Comparison of
oral and intravenous cyclophosphamide in children with
steroid resistant nephrotic syndrome. Pediatr Indones
;51:266-71
Rio M, Kaskel F. Evaluation and management of steroid
unresponsive nephrotic syndrome. Curk Clin Pediatr
;20:151-6.
Bagga A, Mudiganda BD, Hari P, Vesuder V. Enalapril
dosage in steroid resistant nephrotic syndrome. Pediatr
Nephrol 2004;19:45-50.
Garin EH, Orak JK, Hioth KL, Suthaland SE.
Cyclosporin therapy for steroid resistant nephrotic
syndrome. A controlled study. Am J Dis Child
;42:985-8.
Choudhry S, Bagga A, Hari P, Sharma, Kalaivani M,
Dinda A. Efficacy and safety of tacrolimus versus
cyclosporin in children with steroid resistant nephrotic
syndrome: a randomized controlled trial. Am J Kidney
Dis 2009;53:760-9.
de Mello VR, Rodrigues MT, Mastrosinque TH,
Martina SP, de Andrade OV, Guidoni A, et al.
Mycophenolate mofetil in children with steroid
cyclophosphamide resistant nephrotic syndrome. Pediatr
Nephrol 2010;25:453-60.
Chaumais Mc, Garnier A, Chalard F, Peuchmaunt
M, Dauger S, Jacqz-Agrain E, et al. Fatal pulmonary
fibrosis after rituximab administration. Pediatr Nephrol
;24:1753-5.
DOI: http://dx.doi.org/10.14238/sp17.2.2015.155-62
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