Tesis

Hubungan antara Kadar Aktivitas Renin Plasma dengan Hipertensi pada Penderita Hiperplasia Adrenal Kongenital Defisiensi Enzim 21-Hidroksilase = Association between Plasma Renin Activity with Hypertension in Children with Congenital Adrenal Hyperplasia due to 21-Hydroxylase Enzyme Deficiency.

Latar belakang: Hipertensi bukan merupakan manifestasi klinis pasien hiperplasia adrenal kongenital defisiensi enzim 21-hidroksilase (HAK 21-OHD), oleh karena itu perlu diketahui angka kejadian hipertensi pada pasien HAK 21-OHD serta kemungkinan penyebabnya. Tujuan: Mengetahui hubungan antara kadar aktivitas renin plasma (PRA) dengan hipertensi pada anak HAK 21-OHD. Metode: Suatu studi analitik observasional dengan rancangan penelitian potong lintang. Sampel penelitian adalah anak HAK 21-OHD yang berusia > 6 bulan-18 tahun, dipilih secara consecutive sampling, kemudian dibandingkan antara 2 kelompok, hipertensi dan tidak hipertensi. Hasil: Sebanyak 40 anak dianalisis, 20 subjek di kelompok hipertensi dan 20 subjek tidak hipertensi. Hipertensi ditemukan pada 16 dari 27 subjek (59,3%) HAK tipe salt wasting dan 4 dari 13 subjek (30,8%) HAK tipe simple virilizing. Diperoleh perbedaan rerata yang bermakna kadar PRA antara kelompok hipertensi dengan tidak hipertensi pada tipe salt wasting (p=0,016). Risiko mengalami hipertensi pada pasien HAK tipe salt wasting dengan kadar PRA rendah adalah 1,09 kali setelah dikontrol variabel jenis kelamin, kadar 17-OHP, dan dosis terakhir fludrokortison. Dosis terakhir hidrokortison memiliki hubungan yang signifikan terhadap kejadian hipertensi pada pasien HAK tipe salt wasting. Kesimpulan: Kejadian hipertensi pada pasien HAK 21-OHD saat penelitian berlangsung adalah 32%. Risiko hipertensi pada pasien HAK tipe salt wasting dengan kadar PRA rendah adalah 1,09 kali setelah dikontrol variabel jenis kelamin, kadar 17OHP awal, dan dosis terakhir fludrokortison.
Kata Kunci : Anak, hiperplasia adrenal kongenital; hipertensi; aktivitas renin plasma, faktor risiko.


Background: Hypertension is an uncommon manifestation of congenital adrenal hyperplasia due to 21-hydroxylase enzyme deficiency (21-OHD CAH), therefore it is necessary to estimate the incidence of hypertension in 21-OHD CAH patients and the possible causes. Objective: To evaluate the association between plasma renin activity levels (PRA) with hypertension in children with 21-OHD CAH. Methods: An observational analytic study with a cross sectional study design. The subjects were 21-OHD CAH children, aged > 6 months to 18 years, selected by consecutive sampling and then compared between 21-OHD CAH with hypertension and non hypertension groups. Results: A total of 40 subjects were analyzed, 20 subjects in the hypertension and 20 subjects in non hypertension groups. There were 16 from 27 (59.3%) and 4 from 13 subjects (30.8%) with hypertension in CAH salt wasting and simple virilizing types, respectively. There was significant mean difference in PRA levels between hypertension and non hypertension groups in CAH salt wasting patients (p=0,016). The risk of hypertension in CAH salt wasting patients with low PRA levels was 1,09 times after controlling for sex variables, 17-OHP levels, and the last dose of fludrocortisone. The last dose of hydrocortisone had a significant relationship with the incidence of hypertension in CAH salt wasting type patients. Conclusion: The incidence of hypertension in 21-OHD CAH patients during the study period was 32%. The risk of hypertension in CAH salt wasting patients with low PRA levels was 1.09 times after being controlled by sex, 17 OHP level, and the last dose of fludrocortisone.
Keywords: Children, congenital adrenal hyperplasia; hypertension; risk factor