Faktor Prediktor Nefritis pada Anak dengan Purpura Henoch-Schonlein

Abstract

Latar belakang. Penyakit purpura Henoch-Schonlein (PHS) dapat menyebabkan komplikasi nefritis. Nefritis PHS dapat membaik sendiri atau berkembang menjadi penyakit ginjal kronik. Beberapa faktor prediktor telah diketahui berhubungan dengan kejadian nefritis PHS. Tujuan. Menentukan usia ≥10 tahun, purpura persisten, gejala abdomen berat dan relaps sebagai faktor prediktor nefritis pada PHS. Metode. Dilakukan studi kohort retrospektif. Sampel penelitian adalah anak berusia 1 tahun -18 tahun dengan PHS yang dirawat di Instalasi Kesehatan Anak RSUP Dr. Sardjito Yogyakarta periode Januari 2008-Agustus 2016 yang memenuhi kriteria inklusi. Sampel diambil secara konsekutif, kemudian diidentifikasi adanya faktor prediktor nefritis berdasarkan data rekam medis. Analisis bivariat untuk menghitung nilai p serta analisis multivariat dengan regresi logistik. Hasil. Diikutsertakan 80 pasien yang yang diikuti selama 6 bulan. Didapatkan nefritis pada 31 pasien (38,75%). Analisis bivariat dan multivariat menunjukkan bahwa hanya gejala abdomen berat yang merupakan faktor prediktor nefritis dengan nilai p=0,027 dan p=0,021, dan RR 3,759 (IK95%: 1,222-11,562). Kesimpulan. Gejala abdomen berat merupakan faktor prediktor pada kejadian nefritis PHS dan meningkatkan risiko 3,75 kali terjadinya nefritis PHS. Usia ≥10 tahun, purpura persisten, dan relaps tidak terbukti berpengaruh pada kejadian nefritis PHS. Sari Pediatri 2016;18(3):209-13Kata kunci: purpura Henoch-Schonlein, faktor prediktor, nefritis, gejala abdomen berat, purpura persiste Nephritis Predictive Factors in Children with Henoch-Schonlein PurpuraAhmad Wisnu Wardhana, Cahya Dewi Satria, Sunartini Background. Nephritis could be a complication of Henoch-Schonlein purpura (HSP). Henoch-schonlein purpura nephritis (HSPN) could be self limited or develop to chronic kidney disease. Some predictive factor for nephritis Henoch-Schonlein purpura has been identified . Objective. To determine age ≥ 10 years, persistent purpura, severe abdominal symptom and relaps are predictive factors for HSPN. Methods. A retrospective study was performed. Samples were children aged 1 years -18 years with HSP who came to the Pediatric Department of Dr. Sardjito hospital during January 2008-August 2016 and met the inclusion criteria. Samples were taken consecutively. We looked for the presence of predictive factors for HSP based on medical records. Bivariate analysis using chi-square test to calculate p value and multivariate analysis with logistic regression were conducted. Results. A total of 80 patients were included in the study. Their followed during six month after onset. There were 31 patients (38,75%) with nephritis. Bivariate and multivariate analysis showed that only severe abdominal symptom as a predictive factors for nephritis. (p value= 0,027 and p value=0,021, RR 3,759 95% CI 1,562). Conclusion. Severe abdominal symptom as a predictive factors for HSPN and it increase risk 3,7 times develop HSPN. Age ≥ 10 years at onset, persistent purpura and relapse were not affect HSPN. Sari Pediatri 20...

Management of Henoch-Schonlein Purpura with Gastrointestinal Manifestations in Children

“…Histopathologic examination of skin in HSP shows segmental inflammation of vessels, swollen endothelial cells, fibrinoid necrosis of blood vessel walls and infiltrates around vascular, called leukocytoclastic vasculitis. In this patient, the skin biopsy results revealed a hypocellular smear consisting of hyperkeratosis, red blood cell extravasation, with a distribution of squamous epithelial cells along with extensive neutrophilic inflammatory cells and lymphocytes compatible with leukocytoclastic vasculitis (22,23). Some cases of Henoch-Schonlein Purpura (HSP) are self-limiting and do not require treatment.…”

“…On the other hand, the medication can prevent bleeding, obstruction, and perforation of the gastrointestinal tract which can worsen the patient's condition. Corticosteroids can inhibit T-cell proliferation, T-cell dependent immunity, and cytokine gene transcription (IL-1, IL-2, IL-6, interferon gamma, TNF-α) (20,23,24). If HSP patients have renal complications, called nephritis, then the corticosteroids treatment can be combined with immunosuppressants.…”