PERBANDINGAN SINDROM NEFROTIK SENSITIF STEROID DENGAN SINDROM NEFROTIK RESISTEN STEROID SEBAGAI FAKTOR RISIKO OBESITAS PADA ANAK

Nina Lestari, dr. Madarina Julia, MPH, Ph.D, Sp.A(K).

2013 | Tesis | S2 Ked.Klinik/MS-PPDS

Latar belakang:Penderita sindrom nefrotik mendapat regimen glukokortikoid dosis tinggi untuk mempertahankan remisi. Dari beberapa efek samping potensial terapi glukokortikoid, obesitas merupakan salah satu yang sering ditemui. Penelitian terdahulu mengestimasi prevalensi obesitas sebesar 35-43 % selama terapi glukokortikoid. Tujuan penelitian:Untuk mengetahui prevalensi obesitas pada anak sindroma nefrotik yang mendapat terapi steroid dan mengetahui seberapa besar risiko obesitas pada anak dengan sindrom nefrotik sensitif steroid dibandingkan anak dengan sindrom nefrotik resisten steroid. Metode Penelitian:Studi cohort retrospektif dilakukan pada 50 anak dengan sindrom nefrotik yang mendapatkan terapi steroid, terbagi dalam dua kelompok yaitu kelompok sindom nefrotik sensitif steroid dan sindrom nefrotik resisten steroid. Penelitian ini dilakukan di Yogyakarta sejak September 2012 sampai Oktober 2013.Pemilihan subyek penelitian dengan consecutive sampling.Obesitas apabila IMT terletak di atas +2 Standard Deviasi(SD) menurut WHO growth Chart Standart BMI for Age 2007. Z score dihitung menggunakan komputer denganWHO AnthroPlus for Personal Computers.Analisis data dilakukan dengan uji Chi-Square atau apabila syarat tidak terpenuhi maka dipakai ujiFisher dengan derajat kemaknaan p<0,05, kemudian dilakukan analisis untuk mencari risiko relatif. Hasail penelitian:Prevalensi obesitas sebesar 29% pada kelompok SNSS. Meskipun tidak bermakna secara statistik, pasien SNSS berhubungan dengan meningkatnya risiko terhadap obesitas dibandingkan pada pasien SNRS (RR (95% CI): 2.53 (0.58- 10.99) (p= 0.31)). Simpulan:Prevalensi obesitas sebesar 29% pada kelompok SNSS.Sindrom nefrotik sensitif steroid berhubungan dengan meningkatnya faktor risiko obesitas terkait glukokortikoid, namun secara statistik tidak bermakna.

Background: Patients with nephrotic syndrome received high-dose glucocorticoid regimen to maintain remission. Of some potential side effects of glucocorticoid therapy, obesity is one that is often encountered. Previous studies estimated the prevalence of obesity by 35-43 % during glucocorticoid therapy. Objective:To determine the prevalence of obesity in children with nephrotic syndrome who received steroid therapy and find out how much the risk of obesity in children with steroid-sensitive nephrotic syndrome than in children with steroid-resistant nephrotic syndrome. Methods:A retrospective cohort study was conducted to 50 children with nephrotic syndrome who received steroid therapy. They were divided into two groups of steroid-sensitive nephrotic syndrome and steroid-resistant nephrotic syndrome. This research was conducted in Yogyakarta, Indonesia since September 2012 until October 2013. Consecutive sampling was used to select the subjects of the study. Obese when BMI is above +2 Standard Deviation ( SD ) according to the WHO Growth Standards Chart BMI for Age in 2007. Z score is computer-calculated using WHO AnthroPlus for Personal Computers. Data analysis was performed with Chi-Square test or if the condition was not met then Fisher test is used with a significance level of p < 0.05, and then analysis were conducted to look for relative risk. Results:The prevalence of obesity was 29 % in SNSS group. Although not statistically significant, SSNS patients are associated with the increasing risk of obesity compared to SRNS patients (RR (95 % CI): 2.53 (0.58-10.99) (p = 0:31)). Conclusion:The prevalence of obesity was 29 % in SSNS group. Steroidsensitive nephrotic syndrome is associated with the increasing risk of obesityrelated glucocorticoid, but is not statistically significant.

Kata Kunci : Sindrom nefrotik, glukokortikoid, obesitas, index masa tubuh.