Sindrom Nefrotik Idiopatik Sensitif Steroid pada Anak: Telaah Perbandingan Panduan Klinis
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Latar belakang. Sindrom nefrotik idiopatik merupakan penyakit ginjal tersering pada anak di dunia. Penelitian terkait sindrom nefrotik idiopatik pada anak terus berkembang. Namun, pada praktiknya masih terdapat variasi yang lebar terkait evaluasi dan tata laksana sindrom nefrotik idiopatik pada anak di dunia.
Tujuan. Membandingkan panduan klinis sindrom nefrotik idiopatik sensitif steroid pada anak.
Metode. Membandingkan empat panduan klinis sindrom nefrotik idiopatik sensitif steroid pada anak, yaitu panduan klinis sindrom nefrotik idiopatik Ikatan Dokter Anak Indonesia tahun 2012, Kidney Disease Improving Global Outcome tahun 2021, International Pediatric Nephrology Association tahun 2022, dan Indian Society of Pediatric Nephrology tahun 2021. Dikembangkan 7 lingkup bahasan kajian, meliputi diagnosis, pemeriksaan penunjang awal, batasan kriteria, dan terapi sindrom nefrotik inisial, sindrom nefrotik relaps jarang, sindrom nefrotik relaps sering dan sindrom nefrotik dependen steroid.
Hasil. Didapatkan beberapa perbedaan mendasar yang ditemukan, antara lain, terkait batasan proteinuria dan hipoalbuminemia yang digunakan, dosis maksimal steroid, definisi relaps sering, pilihan terapi imunosupresan pada SN relaps sering, dependen steroid, dan pemeriksaan genetik yang dirasonalisasikan berdasarkan bukti-bukti penelitian terbaru.
Kesimpulan. Terdapat beberapa perbedaan mendasar antara panduan klinis sindrom nefrotik idiopatik Ikatan Dokter Anak Indonesia tahun 2012 dengan panduan klinis terbaru lainnya. Perlu dipertimbangkan pembaharuan konsensus sindrom nefrotik di Indonesia dengan menelaah bukti ilmiah terbaru dan disesuaikan dengan ketersediaan obat serta fasilitas pemeriksaan di Indonesia.
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Pais P, Avner ED. Nephrotic syndrome. Dalam: Kliegman RM, Stanton BF, St Geme III JW, Schor NF, Behrman, penyunting. Nelson Textbook of Pediatrics. Edisi ke-20. Philadelphia: Elsevier; 2016.h.2521-8.
Eddy AA, Symons JM. Nephrotic syndrome in childhood. Lancet 2003;362:629-39.
McKinney PA, Feltbower RG, Brocklebank JT, Fitzpatrick MM. Time trends and ethnic patterns of childhood nephrotic syndrome in Yorkshire. Pediatr Nephrol 2002;16:1040-4.
Seedat YK. Nephrotic syndrome in the Africans and Indians of South Africa. A ten-year study. Trans R Soc Trop Med Hyg. 1978;72:506-12.
Wila WIGN. Penelitian beberapa aspek klinis dan patologi anatomis sindrom nefrotik primer pada anak di Indonesia [disertasi]. Jakarta: Fakultas Kedokteran Universitas Indonesia; 1992.
Zotta F, Vivarelli M, Emma F. Update on the treatment of steroid-sensitive nephrotic syndrome. Pediatr Nephrol 2022;37:303-14.
Özlü SG, Demircin G, Tökmeci N, Y?lmaz AÇ, Aydo? Ö, Bülbül M, dkk. Long-term prognosis of idiopathic nephrotic syndrome in children. Ren Fail 2015;37:672-7.
Trihono PP, Alatas H, Tambunan T, Pardede SO, penyunting. Tata laksana sindrom nefrotik idiopatik pada anak. Edisi kedua. Jakarta: UKK Nefrologi IDAI; 2012.h.1-3
Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int 2021;100:S1–276.
Trautmann A, Boyer O, Hodson E, Bagga A, Gipson DS, Samuel S, et al. IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome. Pediatr Nephrol. 2022;38:877-919.
Sinha A, Bagga A, Banerjee S, Mishra K, Mehta A, Agarwal I, dkk. Steroid sensitive nephrotic syndrome: revised guidelines. Indian Pediatr 2021;58:461-81.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, dkk. GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ (Clinical research ed.) 2008;336:924-6.
American Academy of Pediatrics Steering Committee on Quality Improvement and Management. Classifying recommendations for clinical practice guidelines. Pediatrics 2004;114:874-7.
Hogg RJ, Portman RJ, Milliner D, Lemley KV, Eddy A, Ingelfinger J. Evaluation and management of proteinuria and nephrotic syndrome in children: recommendations from a pediatric nephrology panel established at the National Kidney Foundation conference on proteinuria, albuminuria, risk, assessment, detection, and elimination (PARADE). Pediatrics 2000;105:1242-9.
Slev PR, Bunker AM, Owen WE, Roberts WL. Pediatric reference intervals for random urine calcium, phosphorus and total protein. Pediatr Nephrol 2010;25:1707-10.
Clase CM, St Pierre MW, Churchill DN. Conversion between bromcresol green- and bromcresol purple-measured albumin in renal disease. Nephrol Dial Transplant 2001;16:1925-9.
van de Logt AE, Rijpma SR, Vink CH, Prudon-Rosmulder E, Wetzels JF, van Berkel M. The bias between different albumin assays may affect clinical decision-making. Kidney Int 2019;95:1514-7.
Sinha A, Saha A, Kumar M, Sharma S, Afzal K, Mehta A, dkk. Extending initial prednisolone treatment in a randomized control trial from 3 to 6 months did not significantly influence the course of illness in children with steroid-sensitive nephrotic syndrome. Kidney Int 2015;87:217-24.
Teeninga N, Kist-van Holthe JE, van Rijswijk N, de Mos NI, Hop WCJ, Wetzels JFM, dkk. Extending prednisolone treatment does not reduce relapses in childhood nephrotic syndrome. J Am Soc Nephrol 2013;24:149-59.
Yoshikawa N, Nakanishi 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 Int 2015;87:225–32.
Webb NJA, Woolley RL, Lambe T, Frew E, Brettell EA, Barsoum EN, dkk. Long term tapering versus standard prednisolone treatment for first episode of childhood nephrotic syndrome: phase III randomised controlled trial and economic evaluation. BMJ (Clinical research ed.) 2019;365:l1800.
Borovitz Y, Alfandary H, Haskin O, Levi S, Kaz S, Davidovits M, dkk. Lower prednisone dosing for steroid-sensitive nephrotic syndrome relapse: a prospective randomized pilot study. Eur J Pediatr 2020;179:279-83.
Hoyer PF, Brodeh J. Initial treatment of idiopathic nephrotic syndrome in children: prednisone versus prednisone plus cyclosporine A: a prospective, randomized trial. J Am Soc Nephrol 2006;17:1151-7.
Ehren R, Benz MR, Brinkkötter PT, Dötsch J, Eberl WR, Gellermann J, dkk. Pediatric idiopathic steroid-sensitive nephrotic syndrome: diagnosis and therapy -short version of the updated German best practice guideline. Pediatr Nephrol 2021;36:2971-85.
Veltkamp F, Khan DH, Reefman C, Veissi S, van Oers HA, Levtchenko E, dkk. Prevention of relapses with levamisole as adjuvant therapy in children with a first episode of idiopathic nephrotic syndrome: study protocol for a double blind, randomised placebo-controlled trial (the LEARNS study). BMJ Open 2019;9:e027011.
Czock D, Keller F, Rasche FM, Häussler U. Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids. Clin Pharmacokinet 2005;44:61-98.
Christian MT, Webb NJA, Mehta S, Woolley RL, Afentou N, Frew E, dkk. Evaluation of daily low-dose prednisolone during upper respiratory tract infection to prevent relapse in children with relapsing steroid-sensitive nephrotic syndrome: The PREDNOS 2 randomized clinical trial. JAMA Pediatr 2021.
Larkins NG, Liu ID, Willis NS, Craig JC, Hodson EM. Non-corticosteroid immunosuppressive medications for steroid-sensitive nephrotic syndrome in children. Cochrane Database Syst Rev 2020;4:CD002290.
DOI: http://dx.doi.org/10.14238/sp25.4.2023.231-42
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