Tata Laksana Sindrom Nefrotik Resisten Steroid pada Anak

Abstract

Abstrak Sindrom nefrotik resisten steroid adalah sindrom nefrotik yang tidak mengalami remisi dengan pengobatan prednison dosis penuh 60 mg/m2/hari selama 4 minggu. Sindrom nefrotik resisten steroid merupakan masalah karena risiko progesivitas yang tinggi untuk menjadi penyakit ginjal stadium akhir dan memerlukan imunosupresan selain steroid yang dapat menyebabkan berbagai efek samping. Tata laksana sindrom nefrotik resisten steroid terdiri atas tata laksana suportif dan medikamentosa. Terapi suportif meliputi tata laksana dietetik, pemberian diuretik, mencegah komplikasi seperti infeksi, tromboembolik, hipovolemia, gangguan elektrolit, hipertensi, dan hiperlipidemia. Edukasi kepada pasien dan orangtua, dukungan keluarga, dan kontrol teratur sangat penting karena sindrom nefrotik resisten steroid merupakan penyakit kronik yang sampai saat ini terapi belum memberikan hasil memuaskan. Terapi medikamentosa pada sindrom nefrotik resisten steroid antara lain kortikosteroid dosis tinggi berupa puls metilprednisolon, siklofosfamid, siklosporin-A, takrolimus, mikofenolat mofetil (MMF), dan rituximab. Imunosupresan steroid dan non steroid ini dapat menyebabkan berbagai efek samping. Meski obat ini sudah sering digunakan, hasil penelitian dan laporan kasus menunjukkan bahwa terapi dengan obat ini belum memberikan hasil yang memuaskan.
Kata kunci: sindrom nefrotik resisten steroid, prednison, siklofosfamid, siklosporin

Abstract Steroid resistant nephrotic syndrome is defined as nehrotic syndrome with no remission within 4 weeks of full dose prednisone therapy of 60 mg/m2/day. Steroid resistant nephrotic syndrome is a serious problems because of high risk progressivity to become an end stage renal disease and it needs non steroid immunosupressant drugs that may cause some side effects. The management of resistant steroid nephrotic syndrome consists of supportive and pharmacologic treatment. Supportive treatments include dietetic management, diuretic administration, prevention of complications such as infections, thromboembolic, hypovolemia, electrolyte imbalance, hypertension, and hyperlipidemia. Education for patients and parents, family support, and regular evaluation are important because resistant steroid nephrotic syndrome is a chronic diseases with unsatisfying result of treatment. Pharmacologic treatment of steroid resistant nephrotic syndrome consists of high dose corticosteroid (methylprednisolone pulse), cyclophosphamide, cyclosporine A, tacrolimus, mycophenolate mofetil (MMF), and rituximab. Steroid and non steroid immunosupressants may cause some side effects. Although these drugs have often been used in treatment of such cases, the results of many studies and case reports are varied and unsatisfying.
Keywords: steroid resistant nephrotic syndrome, prednisone, cyclophosphamide, cyclosporine