Perbaikan fungsi ginjal pada preeklamsia setelah pemberian L. Arginin per oral :: Kajian tentang Proteinuria,Hiperurisemia dan Endoteliosis Glomerular pada Rattus norvegicus Strain Water

JUSUP, Sinu Andhi, Prof.Dr. H. Moh. Hakimi, PhD.,Sp.OG

2006 | Tesis | S2 Ilmu Kedokteran Dasar dan Biomedis

Pre eklampsia masih merupakan penyebab penting terhadap morbiditas dan mortalitas ibu dan bayi, serta merupakan 40% penyebab kelahiran premature iatrogenik. Pengetahuan tentang etiologi dan mekanisme patofisiologinya belum jelas, sehingga pencegahan dan pengobatan penyakit ini belum memuaskan. Beberapa penelitian menunjukkan bahwa pada pre eklampsia terjadi penurunan sintesis NO, dibanding dengan kehamilan normal (p<0,001), yang diperkirakan menjadi sebab peningkatan resistensi vaskuler dan tekanan arterial selama pre eklampsia. Sel endotel mamalia mampu mensintesis NO dari substratnya yaitu asam amino L-Arginine dengan bantuan enzim Nitric Oxide Synthase (NOS), melalui L-Arginine–Nitric Oxide Pathway. Penelitian ini bertujuan mengukur penurunan proteinuria dan hiperurisemia, serta mengkaji gambaran endoteliosis glomerular pada pre eklampsia setelah pemberian L-Arginin, dimana ketiganya menggambarkan fungsi ginjal dan prognosis penyakit serta out come janin. Wistar rat hamil 32 ekor, dibagi secara random menjadi 4 kelompok. Hari ke-7 sampai ke-14 semua kelompok diberi stress bising dan over populasi. Hari ke-14 diukur tekanan darah, dan proteinuria. Setelah itu sampai hari ke-20 kelompok I diberi aquabidest, kelompok II, III, IV masing-masing diberi L-Arginin peroral 25 mg/hari, 50 mg/hari, dan 75 mg/hari. Hari ke-18 dilakukan stress akut dan pengukuran tekanan darah, kemudian hari ke-20 pengukuran proteinuria, kadar asam urat plasma, serta pembuatan preparat ginjal. Terdapat perbaikan proteinuria pada kelompok perlakuan dibanding kelompok kontrol, dan penurunan tersebut terutama pada dosis L-Arginin 75 mg. (p < 0,05). Tingkat hiperurisemia kelompok perlakuan lebih rendah tinggi dibanding kelompok kontrol, terutama pada kelompok dosis 75 mg (p < 0,05). Glomerulus tikus pada kelompok perlakuan L-Arginin seluleritasnya menurun dan tampak sel eritrosit mengisi lumen- lumen kapiler glomerulus. Dari penelitian ini disimpulkan bahwa L-Arginin dapat memperbaiki proteinuria, hiperurisemia serta kelainan endoteliosis glomerular pada sindroma pre eklampsia.

Pre-eclampsia is considered as an important cause of maternal and neonatal mortality and morbidity as well as the cause of 40% of iatrogenic preterm labour. The etiology and patophysiology of pre-eclampsia have not been fully uncovered, therefore preventive and therapeutic treatments for pre-eclampsia are not satisfactory. Previous study indicated a decrease in Nitric Oxide (NO) synthesis in pre-eclampsia as compared to normal pregnancy (p<0,001). The decrease in NO synthesis is assumed to be the underlining mechanism of the increase of vascular resistance and arterial pressure in pre-eclampsia. Mamalian endothel cells are known to posses the capacity to synthesis NO from the substrate L-Arginine through L-Arginine-Nitric Oxide Pathway. The aim of this research was to measure the level of proteinuria and hyperuricemia and to study glomerular endotheliosis in pre-eclampsia upon the administration of L-Arginin, as a predictor of renal function, prognosis and outcome of pregnancy. In this experiment 32 of pregnant wistar rat were divided at random into four groups. All group were exposed to noise stress and over population from day 7 to 14. The blood pressure and the level of proteinuria were measured in day 14. Afterward, group I received aquabidest and group II, III, IV were treated peroraly with L-Arginine 25 mg/day, 50 mg/day, 75 mg/day respectively until the day 20. On the day 18, all group were exposed to acute stress and the blood pressure was measured. On the day 20, the proteinuria level and the plasma level of uric acide were measured. Histological examination of the kidney was conducted at the end. The result showed there was an improvement on proteinuria of the treated group as compared to the control group. Profound improvement was observed on the group receiving 75 mg/day of L-Arginine (p<0,05). The level of hyperuricemia was lower in treated groups as compared to the control group. The remarkable decline of hyperuricemia level was observed on the group receiving 75 mg/day of L-Arginine (p<0,05). Histological examination on kidney of treated rats showed a reduction in glomerular cellurity and erythrocytes filled in the glomerular capillaries. This experiment indicated that L-Arginine administration improved proteinuria, hyperuricemia and glomerular endotheliosis in preeclampsia.

Kata Kunci : Pre eklampsia, L-Arginin, NO, Pre-eclampsia