Anemia pada Sindrom Nefrotik Anak: Patogenesis dan Tata Laksana

Sudung O. Pardede

Sari


Sindrom nefrotik merupakan penyakit ginjal yang sering  pada anak, ditandai dengan  proteinuria masif, hipo­albuminemia, edema, dan hiperkolesterolemia. Sindrom nefrotik dapat menyebabkan komplikasi hipovolemia, renjatan, gangguan ginjal akut, infeksi, tromboembolisme, gangguan elektrolit, gangguan endokrin, dan anemia. Komplikasi ini disebabkan hilangnya protein melalui urin, seperti albumin, faktor koagulasi, imunoglobulin, hormone-binding protein, transferin, dan eritropoietin. Anemia pada sindrom nefrotik dapat disebabkan perubahan homeostasis besi dan transferin, pengeluaran eritropoietin melalui urin, defisiensi vitamin B12, serta peran obat dan logam. Ekskresi besi dan transferin melalui urin menyebabkan kadar transferin  plasma menurun yang mengakibatkan penurunan kadar besi plasma dan anemia mikrositik hipokrom. Kehilangan erItropoietin melalui urin menyebabkan anemia defisiensi eritropoietin. Kehilangan transkobalamin dan vitamin B12 melalui urin menurunkan kadar vitamin B12 plasma. Kehilangan seruloplasmin melalui urin dapat menyebabkan defisiensi tembaga yang mengakibatkan anemia. Obat angiotensin converting enzyme inhibitors (ACEIs) dapat menyebabkan anemia dengan mekanisme inhibisi eritropoiesis dengan menurunkan kadar eritropoietin sirkulasi. Keberhasilan terapi anemia pada sinrom nefrotik bergantung pada penyebab anemia. Anemia defisiensi besi diterapi dengan suplementasi besi. Pemberian eritropoietin rekombinan efektif dan aman dalam tata laksana anemia pada sindrom nefrotik. Defisiensi vitamin B12 diterapi dengan vitamin B12 dan anemia defisiensi tembaga diterapi dengan suplementasi tembaga glukonat.  


Kata Kunci


anemia defisiensi; eritropoietin; ferritin; sindrom nefrotik

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Referensi


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DOI: http://dx.doi.org/10.14238/sp22.1.2020.57-64

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