Gangguan Ginjal terkait Obesitas pada Anak

Abstract

AbstrakPrevalensi obesitas pada anak serta komplikasinya cenderung mengalami peningkatan. Salah satu komplikasi obesitas adalah kelainan ginjal yang disebut obesity-related renal injury atau gangguan ginjal terkait obesitas. Banyak faktor yang berperan dalam terjadinya obesity-related renal injury. Overweight atau obesitas berhubungan erat dengan berbagai faktor risiko penyakit ginjal kronik yaitu hiperinsulinemia, gangguan metabolisme glukosa, hipertensi, hiperlipidemia, dan sindrom metabolik. Di antara semua faktor tersebut, faktor yang paling berperan antara obesitas dan kerusakan ginjal adalah berkurangnya sensitivitas insulin. Manifestasi klinis obesityrelated renal injury pada umumnya berupa proteinuria bermakna tanpa edema, albumin plasma sedikit menurun, dan kolesterol normal atau sedikit meningkat. Salah satu tata laksana obesity-related renal injury adalah penurunan berat badan. Pengurangan asupan diet dan penurunan berat badan dapat menyebabkan berkurangnya lesi glomerulosklerosis fokal segmental. Terapi lainnya adalah pemberian obat yang memiliki efek negatif terhadap sistem renin-angiotensin seperti inhibitor angiotensin-converting-enzyme dan angitensin receptor blocker. Dapat juga diberikan obat yang meningkatkan sensitivitas insulin. Golongan statin mempunyai peran dalam melindungi ginjal. Usaha mencegah atau menangani obesitas sejak dini memberikan dampak besar terhadap insidens, progresivitas, biaya, dan komorbiditas penyakit ginjal. Sari Pediatri 2017;18(6):504-12Kata kunci: obesitas, renal injury, glomerulosklerosis fokal segmental, anak Obesity-related Renal Injury in ChildrenSudung O. Pardede,* Alvina Christine,* Jumaini Andriana** AbstractThe prevalence of obesity and its complication in children tends to increase. One of obesity complications is renal abnormality called obesity-related renal injury. There are several factors that contribute to obesity-related renal injury. Overweight or obesity has a strong correlation with many risk factors of chronic kidney disease such as hyperinsulinemia, glucose metabolism disorder, hypertension, hyperlipidemia, and metabolic syndrome. Among those risk factors, decrease insulin sensitivity plays the most crucial role between obesity and renal injury. The clinical manifestations of obesity-related renal injury are usually significant proteinuria without edema, slight decrease of plasma albumin, and normal or slightly elevated cholesterol level. One of obesity-related renal injury management is reduction of body weight. Reduction of dietary intake and body weight can reduce focal segmental glomerulosclerosis lesion. Other management include drugs that have negative effect on renin-angiotensin system such as angiotensin-converting enzyme inhibitor and angiotensin receptor blocker; and drugs that can increase insulin sensitivity. Statins also have some roles in renal protection. Early efforts to prevent or manage obesity give great impact to incidence, progressivity, cost and renal disease comorbidity. Sari Pediatri 2017;18(6):504-12