Garuda - Garba Rujukan Digital

M. P. Damanik

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Author-ID : 3452957

Health Professions Medicine & Pharmacology

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Effect of enalapril in children with steroid resistant primary nephrotic syndrome L. P. Primi Atmikasari; M. P. Damanik; Tonny Sadjimin
Paediatrica Indonesiana Vol 47 No 2 (2007): March 2007
Publisher : Indonesian Pediatric Society

Background A significant proportion of children with nephrotic syndrome become steroid dependent or steroid resistant who need further medication with cytostatic or other immunosuppressive drugs such as cyclophosphamide or chlorambucil. Unfortunately studies show that the drugs give no good results and cause adverse effects.Objective To establish the effect of enalapril in decreasing proteinuria in children with steroid resistant nephrotic syndrome.Methods We conducted a clinical trial in Nephrology Division, Pediatrics Department, Dr. Sardjito General Hospital from January 2004 to October 2005. Subjects were randomized to either receive prednisone and enalapril (Enalapril Group) or prednisone and cyclophosphamide (CPA Group). The main parameter was proteinuria level, which was examined at the beginning of the study and then every two weeks for eight weeks.Results Remission rate in enalapril group was 96% whereas in CPA group was 82% (P=0.09). Proteinuria level reduction in Enalapril Group from the beginning until the end was 606.92 mg/dl (99%) whereas in CPA Group the reduction was 712.97 mg/dl (91%). Statistically, there was no significant difference in the average decrease of proteinuria level between both groups (P=0.30). Odds ratio for overall adverse events in combined prednisone and enalapril therapy group compared to combined prednisone and cyclophosphamide therapy group was 0.29 (CI 95% 0.17;0.41).Conclusion Combined prednisone and enalapril has similar effect tocombined prednisone and cyclophosphamide in children with steroidresistant nephrotic syndrome. Overall adverse events in combinedprednisone and enalapril group was lower than that in combinedprednisone and cyclophosphamide group.

Results of proteinuria measurement using semiquantitative dipstick in children with fever or nephrotic syndrome Chatidjah Alaydrus; Yati Soenarto; M. P. Damanik
Paediatrica Indonesiana Vol 48 No 1 (2008): January 2008
Publisher : Indonesian Pediatric Society

Background Proteinuria is a major determinant of the progressionof renal disease. Quantitative measurement of proteinuria withina 24-hour period of urine collection was the accepted method ofevaluation, but is tedious and prone to error in the absence of areliable collection. We evaluated the diagnostic value of AUTIONSticks 10 TA to diagnose proteinuria in children with fever andnephrotic syndrome.Methods This study was conducted at the pediatric ward of SardjitoHospital. Proteinuria levels were measured using semiquantitativedipstick methods with AUTION Sticks 10 TA using a 24-hoururine sample collected at the first examination until the followingday. Proteinuria level was also measured by Esbach method as goldstandard.Results A total of 120 children aged 16 years old were recruited. Inthe fever group, AUTION Sticks 10 TA couldnâ€™t be used for thediagnostic test. AUTION Sticks 10 TA +2 to diagnose intermediateproteinuria produced a sensitivity of 60%, a specificity of 89%, apositive predictive value of 43% , a negative predictive value of94%, a positive likelihood ratio of 5.4, a negative likelihood ratio of0.45. To diagnose nephrotic proteinuria, AUTION Sticks 10 TA+3/+4 produced a sensitivity of 90%, a specificity of 91%, a positivepredictive value of 96%, a negative predictive value of 77%, apositive likelihood ratio of 10, a negative likelihood ratio of 0.11.Conclusion AUTION Sticks 10 TA +2 is sufficiently accuratefor a diagnostic test of intermediate proteinuria (Esbach value)while +3/+4 is sufficiently accurate for a diagnostic test ofnephrotic proteinuria (Esbach value) in children. In the fevergroup, dipstick result can not explain the Esbach value.

Relapse episodes in childhood primary nephrotic syndrome treated by alternate or three consecutive daily dose prednisone therapy Denny Sujatno; M. P. Damanik; Purnomo Suryantoro
Paediatrica Indonesiana Vol 48 No 6 (2008): November 2008
Publisher : Indonesian Pediatric Society

Background Prednison is still the drug of choice for the treatmentof nephrotic syndrome, especially for those with minimal change.Methods of treatment to optimize the effectiveness and efficacyare still in discussion.Objectives To evaluate the episode of relapsing minimal changenephrotic syndrome patients who received prednisone therapy byalternate or by three consecutive dose methods.Methods We performed a retrospective cohort study using medicalrecords of the patients with primary nephrotic syndrome admittedto Division of Nephrology, Sardjito Hospital, Yogyakarta fromJanuary 1995 to January 2005. Subjects were divided into twogroups, the first group treated with alternate days while thesecond group with three consecutive days prednisone program.Evaluation had been done to compare both treatment program(alternate days or consecutive days).Results Relapse episodes after six month recovery periods withalternate days treatment was 33% while those with consecutivedays was as high as 83% (P>O.Ol).Conclusion Alternate dose group has a lower relapse eventcompared to three consecutive dose group in children withnephrotic syndrome.

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