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All Journal The Indonesian Biomedical Journal Sari Pediatri Paediatrica Indonesiana Archives of Pediatric Gastroenterology, Hepatology, and Nutrition
Eka Laksmi Hidayati, Eka Laksmi
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia/RS Cipto Mangunkusumo, Jakarta
Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology Public Health

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Insiden Hiponatremia Pasca operasi Mayor pada Anak di Ruang Rawat Intensif Nathanne Septhiandi; Rismala Dewi; Piprim B Yanuarso; Evita Kariani B. Ifran; Novie Amelia; Eka Laksmi Hidayati
Sari Pediatri Vol 17, No 5 (2016)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp17.5.2016.327-334

Abstract

Latar belakang. Penggunaan cairan yang tidak tepat sering menimbulkan peningkatan kejadian hiponatremia yang berhubungan erat dengan meningkatnya berbagai komplikasi, seperti edema otak, kejang, bahkan kematian.Tujuan. Mengetahui insiden hiponatremia pada anak pasca tindakan operasi mayor.Metode. Studi retrospektif potong lintang dilakukan terhadap anak usia 1 bulan hingga 18 tahun yang menjalani tindakan operasi mayor dan masuk ruang rawat intensif. Penelusuran status medik sesuai kriteria inklusi dilakukan sampai jumlah sampel terpenuhi. Dicatat data subjek pre operasi, intra operasi, serta pemantauan pasca operasi. Definisi hiponatremia <135 mEq/L, diklasifikasikan sesuai derajat hiponatremia dan dilakukan pencarian lebih lanjut terhadap komplikasi.Hasil. Didapat 90 subjek, terdiri atas 56,7% laki-laki (51,1%) dan  rentang usia 1 bulan hingga 17 tahun. Tindakan laparatomi dengan berbagai indikasi dijalani 47,8% subjek. Hampir semua subjek (9 3,3%) mendapat cairan hipotonik pasca operasi. Insiden hiponatremia pasca operasi 28,9%, 11,1% di antaranya hiponatremia sedang-berat. Rerata kadar natrium pasca operasi (130,1±4,1) mEq/L, rerata total cairan (79,8±27,4) mL/kg. Pada 30,9% subjek yang mendapatkan cairan hipotonik pasca operasi mengalami kejadian hiponatremia, rerata lama rawat 5,6±4 hari. Terdapat 1/26 subjek yang mengalami komplikasi berupa kejang dan edema otak.Kesimpulan. Insiden hiponatremia pasca tindakan operasi mayor di ruang rawat intensif hampir mencapai 30% dan sebagian besar mendapat cairan hipotonik pasca operasi. Penelitian lebih lanjut perlu dilakukan untuk mengevaluasi pemberian cairan pasca operasi yang tepat untuk mencegah hiponatremia. 
Fungsi Ginjal Pasien Thalassemia Mayor yang Mendapatkan Kelasi Besi Oral Teny Tjitra Sari; Aulia Fitri Swity; Hikari Ambara Sjakti; Eka Laksmi Hidayati; Dian Puspita Sari
Sari Pediatri Vol 20, No 4 (2018)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (129.396 KB) | DOI: 10.14238/sp20.4.2018.242-8

Abstract

Latar belakang. Peningkatan angka kelangsungan hidup pasien thalassemia menyebabkan terdeteksinya berbagai penyakit komorbid termasuk komplikasi pada ginjal. Anemia kronis, kelebihan besi, dan pemakaian kelasi besi, terutama kelasi besi oral diduga berpengaruh pada fungsi ginjal. Berbagai derajat disfungsi tubular dan abnormalitas laju filtrasi glomerulus (LFG) dideteksi dengan berbagai macam pemeriksaan. Tujuan. Membandingkan laju filtrasi ginjal (tubulus dan glomerulus) pada pasien thalassemia yang mendapatkan kelasi besi oral.Metode. Penelitian potong lintang ini dilakukan di Pusat Thalassemia RS. Cipto Mangunkusumo Jakarta pada bulan Maret – Juli 2017. Kriteria inklusi adalah pasien thalassemia major berusia <18 tahun, dan telah mendapatkan kelasi oral minimal selama 1 tahun. Kriteria eksklusi adalah pasien telah memiliki penyakit atau kelainan ginjal sebelumnya dan menggunakan kelasi besi kombinasi. Pasien menjalani pemeriksaan hematologi, kreatinin serum, feritin serum, dan pengambilan urin pagi sewaktu untuk pemeriksaan kadar kalsium dan kreatinin urin sewaktu.Hasil. Penurunan nilai LFG pada 15 pasien deferipron (DFP) 53,6%, tetapi masih dalam batas normal, sedangkan 12 pasien deferasirox (DFX) 46,2%. Tidak ada perbedaan bermakna antara fungsi tubular ginjal yang dinilai berdasarkan rasio kalsium kreatinin urin pada pasien thalassemia yang mendapatkan DFP dibandingkan dengan DFX. Terdapat 1 (3,6%) pasien dengan hiperkalsiuria pada kelompok DFP dan 7 pasien (12,9%) dengan hiperkalsiuria pada kelompok DFX.Kesimpulan. Terdapat penurunan fungsi ginjal pada pasien yang mendapat kelasi besi oral, walaupun hal ini tidak bermakna. Pemeriksaan fungsi tubular maupun glomerular ginjal pasien thalassemia mayor perlu dinilai secara berkala, mengingat penggunaan kelasi besi jangka panjang dan cukup tingginya angka kejadian penurunan LFG dan hiperkalsiuria. Pemeriksaan rasio kalsium kreatinin urin maupun LFG perlu diukur pada saat pasien kontrol bersamaan dengan pemeriksaan kreatinin serum.
Pengalaman Transplantasi Ginjal pada Anak di Jakarta Sudung O. Pardede; Eka Laksmi Hidayati; Cahyani Gita Ambarsari; Henny Adriani Puspitasari; Partini P. Trihono; Taralan Tambunan
Sari Pediatri Vol 21, No 1 (2019)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (98.256 KB) | DOI: 10.14238/sp21.1.2019.44-9

Abstract

Latar belakang.Transplantasi ginjal merupakan terapi yang efektif untuk penyakit ginjal kronik (PGK) stadium 5 atau gagal ginjal terminal. Transplantasi ginjal di dunia pertama kali dilakukan pada tahun 1950an. Di Indonesia, transplantasi ginjal pada orang dewasa telah dilakukan pada tahun 1977 dan semakin berkembang dan telah dilakukan di beberapa kota di Indonesia. Transplantasi ginjal pada anak pertama kali dilakukan di Rumah Sakit Dr. Cipto Mangunkusomo pada bulan Maret 2013, terhadap seorang anak lelaki berusia 13 tahun dengan gagal ginjal terminal yang disebabkan sindrom nefrotik, dengan ginjal yang diperoleh dari non-related living donor. Ini merupakan transplantasi ginjal yang pertama kali dilakukan pada anak di Indonesia.Tujuan. Melaporkan data tentang kegiatan transplantasi ginjal yang dilakukan di Jakarta.Metode. Penelitian ini merupakan penelitian retrospektif yang mengambil data dari catatan medis. Hingga tahun 2018 telah dilakukan 11 kali transplantasi ginjal pada 10 orang anak terdiri atas 9 laki-laki dan 1 perempuan, dengan 1 kasus re-transplan. Rentang usia adalah 8-18 tahun, dengan penyakit dasar terdiri atas sindrom nefrotik (3 anak), dan ginjal hipoplasia (7 anak). Donor untuk kesebelas transplan anak tersebut terdiri atas 4 non-related living donor dan 7 orang related living donor, yaitu 5 orang donor ayah dan 2 orang donor ibu. Hasil. Di antara 10 pasien transplan, 3 orang menggunakan biaya pribadi atau asuransi swasta dan 8 orang dengan biaya dari Badan Penyelenggara Jaminan Sosial (BPJS). Hingga bulan Agustus 2018, di antara kesepuluh anak tersebut, 7 orang hidup dan di antaranya 2 orang mengalami rejeksi pada tahun ke-3 (1 orang konversi kembali ke hemodialisis dan 1 orang telah menjalani re-transplan). Tiga pasien meninggal akibat infeksi berat.Kesimpulan. Transplantasi ginjal di Rumah Sakit Dr. Cipto Mangunkusomo dimulai pada tahun 2013, dengan donor hidup yang sebagian besar berasal dari orangtua, dengan pembiayaan sebagian besar menggunakan BPJS.
Luaran Jangka Panjang Transplantasi Ginjal pada Anak Eka Laksmi Hidayati
Sari Pediatri Vol 23, No 5 (2022)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp23.5.2022.346-52

Abstract

Transplantasi ginjal merupakan pilihan utama terapi pengganti ginjal pada pasien dengan penyakit ginjal kronik stadium 5. Beberapa faktor pada periode pratransplantasi, perioperatif, dan pascatransplantasi ikut memengaruhi luaran jangka panjang pada pasien anak yang menjalani transplantasi ginjal. Faktor-faktor pratransplantasi yang memengaruhi, antara lain, etiologi dasar penyakit ginjal kronik, kondisi fisis sebelum transplantasi, status urodinamik, jenis donor, usia resipien, serta kesesuaian HLA antara resipien dan donor. Teknik pembedahan, kecukupan perfusi darah, dan cold ischemia time selama operasi berperan penting dalam keberhasilan transplantasi. Setelah menjalani prosedur transplantasi, penggunaan obat-obatan imunosupresan jangka panjang secara optimal merupakan kunci keberhasilan transplantasi. Pemantauan secara ketat terhadap kepatuhan terapi, reaksi penolakan organ, infeksi, keganasan, kelainan metabolik, dan gangguan kardiovaskular, dibutuhkan untuk memastikan keberhasilan transplantasi dan mendeteksi adanya komplikasi terkait prosedur transplantasi.
Natural course of gastroesophageal reflux disease during infancy - six-month follow-up Eka Laksmi Hidayati; Agus Firmansyah; Alan R. Tumbelaka
Paediatrica Indonesiana Vol 47 No 5 (2007): September 2007
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (363.422 KB) | DOI: 10.14238/pi47.5.2007.211-5

Abstract

Background Very few data have been published about the naturalcourse of gastro-esophageal reflux (GER) symptoms duringinfancy; further, no risk factors of GER disease (GERD) have beenidentified.Objectives To determine the prevalence and natural course ofregurgitation in infancy and factors of gastroesophageal refluxdisease.Methods A cohort of 223 healthy infants who attended IntegratedHealth Services run by local housewife (Posyandu) of Ciputat –suburb of Jakarta – between March and November 2005.Information on subjects’ history of regurgitation and other reflux-related symptoms was obtained by interviewing mother and diaryrecord. Subjects were followed up to age of 1 year irrespective ofthe clinical status.Results At 6 months of age most infants (56.5%) had regurgitation1 to 3 days per week and only 2.7% infants regurgitated daily.Regurgitation 1 to 3 episodes per day was found in 92.8% ofsubjects. The proportion of infants regurgitation decreasedgradually with age; the proportion for the consecutive 6 to 11month was 100%, 65.5%, 33.6%, 14.3%, 3.6% and 1.3%,respectively. At the age of 1 year no infants was found to beregurgitated. Related symptoms included hiccup (58.3%),vomiting (23.3%) and back arching (2.2%). Feeding problemoccurred in 34.1% infants and occurred more likely in infantswho regurgitate daily compared to 4 – 6 day per week (OR 3.5;95%CI 2.2;5.6) and 1 – 3 day per week (OR 1.8; 95%CI 0.6;0.9).Conclusions Regurgitation in infancy disappears spontaneouslywith age. Reflux-related symptoms are hiccup, vomiting and backarching. Feeding problem occurs most likely in infants whoregurgitate daily.
Comparison of oral and intravenous cyclophosphamide in children with steroid-resistant nephrotic syndrome Eka Laksmi Hidayati; Sudung O. Pardede; Partini P. Trihono
Paediatrica Indonesiana Vol 51 No 5 (2011): September 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi51.5.2011.266-71

Abstract

Background There are variations in remission rates following treatment of steroid-resistant nephrotic syndrome (SRNS) with cyclophosphamide.Objective To compare the efficacy of oral versus intravenous cyclophosphamide (CPA) in the management of pediatric SRNS.Methods This was a prospective study of 41 children with SRNS treated with CPA. One group received oral CPA at a dose of 2 mg/kg body weight/day for 8-12 weeks, while the other group received intravenous CPA at a dose of 500mg/m2 body surface area (BSA) monthly for 6 months. All patients were concomitantly treated with prednisone on alternate days. The primary outcome was the number of patients attaining remission.Results The study was comprised of 20 children receiving oral CPA and 21 children receiving intravenous CPA. There were 29 boys and 12 girls. The mean age of children at the onset of nephrotic syndrome (NS) was 47 ± 40 months old (range 12 months – 13 years), and the mean duration of NS before initiation of CPA therapy was 15 ± 28 months (range 1 – 129 months). Remission was achieved in 29 (70.7%) patients, with no difference between oral and intravenous route of CPA administration. The mean time to achieve remission was 22.7 weeks (about 5 months). The oral route group required less time in achieving remission than the intravenous route group. No association was found between remission and other factors, such as onset of steroid resistance, route of CPA, hypertension and hematuria. Side-effects included infection, anemia, nausea/vomiting, and alopecia. None of the patients required discontinuation of the medication.Conclusion Oral CPA was as effective as intravenous CPA for children with steroid-resistant nephrotic syndrome. [Paediatr Indones. 2011;51:266-71].
Admission characteristics of pediatric chronic kidney disease Eka Laksmi Hidayati; Partini Pudjiati Trihono
Paediatrica Indonesiana Vol 51 No 4 (2011): July 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi51.4.2011.192-7

Abstract

Background Chronic kidney disease (CKD) in children is a potentially fatal disease if left untreated. Early detection and treatment are important to slow progression to end-stage renal disease requiring dialysis.Objective We aimed to find characteristics of CKD patients at admission and evaluate factors associated with end-stage CKD (stage 5).Methods Our cross-sectional study was based on medical records of CKD patients aged less than 18 years in Cipto Mangunkusumo Hospital, Jakarta, from January 2007 to December 2009. Diagnosis and stages of CKD were based on the Kidney Disease Outcomes Quality Initiative (K/DOQI) criteria. Data on disease etiology, symptoms, nutritional status and laboratory tests were collected. Bivariate and multivariate analyses were performed to examine the association between end-stage CKD and its possible risk factors.Results Of the 142 cases eligible for analysis, 55% were boys. Subjects’ median age was 73.5 months (interquartile range of 23.5-122.5 months). Edema and recurrent fever were the two most frequent symptoms of CKD if diagnosed at stages 2-4, while breathlessness was the most frequent symptom of CKD if diagnosed at stage 5. The most common etiologies were glomerulonephritis (49.3%) and anomalies of the kidney and urinary tract (32.4%). Of our CKD subjects, 21.8% were in stage 5. Independent predictors of stage 5 CKD at presentation were hypertension (OR 3.88; 95% CI 1.17 to 12.87; P=0.026), urea level > 60 mg/dL (OR 39.11; 95%CI 4.86 to 314.74; P<0.001) and non-glomerulonephritis as the etiology (OR 6.51; 95%CI 2.12 to 19.92; P<0.001).Conclusion Glomerular disease was the most common cause of CKD in our study. Stage 5 CKD was present in 21.8% of subjects at admission and could be predicted by the presence of hypertension, high serum urea level, and non-glomerular disease as the etiology.
Effects of probiotic on gut microbiota in children with acute diarrhea: a pilot study Dion Darius Samsudin; Agus Firmansyah; Eka Laksmi Hidayati; Irene Yuniar; Mulya Rahma Karyanti; Rosalina Dewi Roeslani
Paediatrica Indonesiana Vol 60 No 2 (2020): March 2020
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (483.346 KB) | DOI: 10.14238/pi60.2.2020.83-90

Abstract

Background Acute diarrhea is a common health problem in Indonesia. During acute diarrhea, changes in gut microbiota are marked by decrease beneficial microbes Bifidobacterium and Lactobacillus, and increased pathogenic bacteria Enterobacter and Clostridium. Such microbial imbalances are known as dysbiosis. Treatment with probiotics may help repair dysbiosis, quicken healing time, and decrease complications. Objective To assess for dysbiosis during acute diarrhea, and determine if it can be normalized by probiotic treatment. Methods This placebo-controlled, unblinded clinical trial was performed in Budhi Asih District Hospital, Jakarta, from January to March 2018. Twenty-four children age 6-24 months with acute diarrhea and 12 healthy children were enrolled. First fecal specimen was collected for all subjects and analyzed using non-culture real time PCR to count the population of Lactobacillus, Bifidobacterium, Enterobacter, Clostridium, and all bacteria. Children with diarrhea were assigned to probiotic or placebo treatment for 5 days and the second fecal specimen was analyzed two weeks after the diarrhea subsided. Results Prior to treatment, significant higher amounts of Lactobacillus were observed in children with acute diarrhea than in healthy controls [median (interquartile range/IR): 1.52x103 (1.22x104) vs. 6.87x10 (2.41x102), respectively; proportion in percentage (from total bacteria population): 0.044% vs. 0.003%, respectively]. However, median (IR) Clostridium was significantly higher in healthy controls than in children with acute diarrhea [2.37x102 (4.64x103) vs. 4.67 (1.50x102), respectively (P<0.05), with proportion of 0.01% vs. 0.0001%, respectively]. Children who received probiotics had significantly higher count of Bifidobacterium compared to the placebo group [1.94x104 (4.97x104) vs. 1.74x103 (2.08x107), respectively, with proportion of 0.394% vs. 0.081%, respectively]. Conclusion This pilot study do not find evidence of dysbiosis in children with acute diarrhea. Group who received probiotic had higher Bifidobacterium count compared towards those who received placebo.
Mesenchymal stem cells therapy in children with end-stage kidney disease Eka Laksmi Hidayati; Reza Fahlevi; Henny Adriani Puspitasari; Anisa Rahmadhany; Sudung Oloan Pardede
Paediatrica Indonesiana Vol 62 No 3 (2022): May 2022
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi62.3.2022.217-22

Abstract

Chronic kidney disease (CKD) is a major health problem worldwide, with increasing incidence and prevalence. While the incidence of CKD in children is relatively low, CKD contributes to major health problems and has many long-term effects.1 Chronic kidney disease is characterized by a gradual decline in kidney function over time. The Kidney Disease Improving Global Outcomes (KDIGO) report defined CKD as an abnormality of renal structure or function with decreased glomerular filtration rate (GFR) that lasts more than three months. Chronic kidney disease is classified into 5 stages based on the GFR value.2 Patients with stage V CKD transition from progressive disease to irreversible, terminal, end-stage kidney disease (ESKD). To date, the standard of ESKD management has been kidney replacement therapy, consisting of hemodialysis (HD), peritoneal dialysis (PD), and/or kidney transplantation. Complexity and cost of kidney care have obvious consequences on the availability of kidney replacement therapy for children, especially in developing countries. Dialysis provides only partial replacement of renal functions, especially clearance and fluid balance, but does not cure the disease. Kidney transplantation is a curative management, but donor availability for pediatric patients remains challenging
Nutritional Status in Children with End-Stage Kidney Disease Undergoing Hemodialysis and Other Related Factors Namira Metasyah; Eka Laksmi Hidayati
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 2 No. 3 (2023): APGHN Vol. 2 No. 3 August 2023
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.2.3.2023.13-24

Abstract

Background: Chronic kidney disease causes several changes in the body's function in metabolizing nutrients. This has led to the discovery of cases of malnutrition in chronic kidney disease patients, especially in ESRD patients undergoing hemodialysis. This certainly needs to be a concern because nutrition is very important for children's growth. Therefore, this study was conducted to find out the effect of hemodialysis and other influencing factors on the nutritional status of children. Methods: The study was conducted with a cross- sectional design by taking secondary data in the form of disease stage, duration of disease, primary etiologic factors, and comorbidities from medical records. Data on the nutritional status of children was obtained by measuring weight and height, and upper arm circumference and then entered into the WHO Anthro application. Demographic data, such as the education level of the father & mother, family economic status, age, and gender were obtained by filling out the Case Report Form (CRF). Twenty respondents met the inclusion and exclusion criteria of this study. Results: The average nutritional status assessment seen from the body mass index according to age showed results of -2 SD < x < 1 SD with good nutrition interpretation and x <-2 SD (short stature) in terms of height according to age. Based on bivariate analysis, there was no significant effect between duration of hemodialysis, frequency of hemodialysis, etiology, age, sex, and comorbidities (p>0.05) in children with chronic kidney failure who were undergoing hemodialysis on their nutritional status. Conclusion: The nutritional status of CKD children undergoing hemodialysis was assessed based on body mass index and height according to age. The average results were good nutrition but with short stature. There was no effect of duration, frequency, etiology, age, gender, and comorbidities in children with chronic kidney failure undergoing hemodialysis on their nutritional status.
Co-Authors Afifa Fahriyani Agus Firmansyah Alan R. Tumbelaka Anisa Rahmadhany Aulia Fitri Swity Bambang Supriyatno Beatrix Siregar Cahyani Gita Ambarsari Cut Nurul Hafifah Dewi Sukmawati Dewi Wulandari Dian Puspita Sari Dion Darius Samsudin Edwin Kinesya Evita Kariani B. Ifran Ghina Rania Henny Adriani Puspitasari Henny Adriani Puspitasari Henny Adriani Puspitasari Henny Adriani Puspitasari Hikari Ambara Sjakti, Hikari Ambara Irene Yuniar, Irene Mulya Rahma Karyanti, Mulya Rahma Namira Metasyah Nathanne Septhiandi Novie Amelia Oke Rina Ramayani Partini P. Trihono Partini P. Trihono Partini Pudjiastuti Trihono Partini Pudjiastuti Trihono Partini Pudjiati Trihono Piprim B Yanuarso Reza Fahlevi Reza Fahlevi Rismala Dewi Rosalina Dewi Roeslani Sudung O Pardede, Sudung O Sudung O. Pardede Sudung Oloan Pardede Sudung Oloan Pardede Sudung Oloan Pardede Taralan Tambunan Teny Tjitra Sari Yaulia Yanrismet Yuliarti, Klara Zakiudin Munasir