Tesis

Status besi pada pasien sindrom nefrotik idiopatik aktif dan remisi = Iron status in active and in remission idiopathic nephrotic syndrome.

Latar belakang. Zat besi merupakan mineral yang memiliki fungsi penting dalam masa pertumbuhan dan perkembangan anak. Sindrom nefrotik (SN) idiopatik merupakan penyakit glomerulus yang sering ditemukan pada anak. Pada SN idiopatik terdapat peningkatan permeabilitas glomerulus sehingga terjadi proteinuria. Transferin merupakan salah satu protein yang keluar di urin dan dapat mengganggu homeostasis besi pada pasien SN. Keadaan kekurangan zat besi dapat menyebabkan gangguan seperti anemia defisiensi besi (ADB). Penelitian sebelumnya menunjukkan hasil inkonklusif terhadap status besi pada pasien SN. Saat ini belum terdapat data mengenai status besi pada pasien anak SN idiopatik di Indonesia. Tujuan. Mengetahui perbedaan status besi, transferin urin, proporsi defisiensi besi dan ADB pada pasien SN idiopatik aktif dan remisi. Metode. Penelitian dengan desain potong lintang dilakukan pada pasien SN idiopatik aktif dan remisi usia 1 – 18 tahun di rumah sakit Cipto Mangunkusumo (RSCM). Pasien dengan penurunan laju filtrasi ginjal estimasi < 60 ml/menit/1,73 m 2 , penyakit sistemik, SN sekunder, penyakit hematologi lain, tanda infeksi akut, riwayat transfusi darah dalam 3 bulan terakhir, riwayat penggunaan suplementasi besi, dan perdarahan pada tubuh lain dieksklusi. Pengukuran status besi menggunakan hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), reticulocyte hemoglobin equivalent (Ret-He), serum iron (SI), total iron-binding capacity (TIBC), ferritin, dan saturasi transferin (ST). Pengukuran transferin urin menggunakan metode enzyme-linked immunosorbent assay (ELISA). Hasil. Terdapat 65 subyek penelitian, dengan 32 pasien SN idiopatik aktif dan 33 pasien remisi. Mayoritas subyek adalah laki-laki (70,8%) dengan rerata usia adalah 8,4 (±4,3) tahun. Penelitian ini menunjukkan perbedaan kadar SI, TIBC, dan transferin urin yang bermakna antara kelompok aktif dan remisi. Kadar SI antara kelompok aktif dan remisi adalah 60,7±33,5 µg/dL dan 84,6±35,3 µg/dL (p < 0,05; IK95% -41 – (-6,9)). Kadar TIBC antara kelompok aktif dan remisi adalah 220±90,7 µg/dL dan 309,4(±47,7) µg/dL (p < 0,05; IK95% -125-(-53,6)). Kadar transferin urin antara kelompok aktif dan remisi adalah 435,3(7,7 – 478,4) ng/mL dan 23,4 (0 – 358) ng/mL (p < 0,05). Tidak terdapat perbedaan parameter besi lain antara kelompok aktif dan remisi. Proporsi defisiensi besi dan ADB pada kelompok aktif adalah 7(21,9%) dan 5 (15,6%) subyek, sedangkan pada kelompok remisi adalah 4(12,6%) dan 1(3%) subyek. Perbedaan proporsi tersebut tidak bermakna (p=0,04; RR 2,47; IK95% 0,98 – 6,23). Kesimpulan. Kelompok SN idiopatik aktif memiliki nilai SI dan TIBC yang rendah serta transferin urin yang tinggi. Proporsi defisiensi besi dan ADB pada kelompok SN idiopatik aktif lebih tinggi walaupun tidak bermakna secara statistik.
Kata kunci: status besi, sindrom nefrotik idiopatik, transferin urin, defisiensi besi, anemia defisiensi besi


Background. Iron is an important mineral in the child’s growth and development. Idiopathic nephrotic syndrome (NS) is a common glomerular disease in children, which cause increased glomerular permeability resulting in proteinuria. Transferrin is one of the protein that is excreted in the urin, thus disturbing iron homeostasis and may lead to iron deficiency or iron deficiency anemia (IDA). Previous studies have shown inconclusive results on the iron status in NS patients. Currently, there are no data about iron status in children with idiopathic NS in Indonesia. Objectives. To know the differences in iron status, urinary transferrin, and the proportion of IDA in children with active and remission idiopathic NS Method. A cross-sectional design study was conducted on patients with active and remission idiopathic NS aged 1-18 years at Cipto Mangunkusumo Hospital (RSCM). Patients with decreased estimated glomerular filtration (eGFR) rate < 60 ml/min/1.73 m2, systemic disease, secondary NS, other haematological diseases, signs of acute infection, history of blood transfusion in the last 3 months, history of taking iron supplementation, and bleeding in other bodies were excluded. Measurement of iron status using hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), reticulocyte hemoglobin equivalent (Ret-He), serum iron (SI), total iron-binding capacity (TIBC), ferritin, and transferrin saturation (ST). Measurement of urinary transferrin using enzyme-linked immunosorbent assay (ELISA). Results. There were 65 study subjects, with 32 patients with active idiopathic NS and 33 subjects were in remission. The majority of subjects were male (70.8%) with mean age of 8.4 (±4.3) years. This study showed significant differences in the levels of SI, TIBC, and urinary transferrin between the active and remission groups. The SI levels between the active and remission groups were 60.7±33.5 g/dL and 84.6±35.3 g/dL (p < 0.05; 95% CI -41 – (-6.9)). The TIBC levels between the active and remission groups were 220±90.7 g/dL and 309.4(±47.7) g/dL (p < 0.05; 95% CI -125-(-53.6)). The median of urinary transferrin levels between the active and remission groups were 435.3(7.7 – 478.4) ng/mL and 23.4 (0 – 358) ng/mL (p < 0.05). There were no differences in other iron parameters between the active and remission groups. The proportions of iron deficiency and IDA in the active group were 7(21.9%) and 5(15.6%) subjects, while in the remission group were 4(12.6%) and 1(3%) subjects. Nonetheless the difference were not statistically significant (p=0.04; RR 2.47; CI95% 0.98 – 6.23). Conclusion. Active idiopathic NS had significant lower values of SI and TIBC, and higher urinary transferrin levels. The proportion of iron deficiency and IDA in the active group was higher, although not significant.
Keywords: iron status, idiopathic nephrotic syndrome, urinary transferrin, iron deficiency, iron deficiency anemia