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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
Incidence and risk factors of nephritis in childhood Henoch-Schonlein purpura Yaulia Yanrismet; Eka Laksmi Hidayati; Zakiudin Munasir; Klara Yuliarti; Afifa Fahriyani
Paediatrica Indonesiana Vol 63 No 4 (2023): July 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.4.2023.304-14

Abstract

Background Henoch-Schönlein Purpura (HSP) is the most common systemic vasculitis disease in children. It is characterized by involvement of the skin, joints, gastrointestinal tract, and kidney. Kidney manifestations may progress to severe nephritis, even lead to end-stage kidney disease. Objective To identify the incidence and risk factors of nephritis in childhood HSP. Methods A retrospective cohort study was performed to evaluate clinical, demographic, laboratory, and therapeutic parameters of HSP patients aged 0-18 years between 2011-2019 at Dr. Cipto Mangunkusumo Hospital, Jakarta. Diagnoses of HSP were made according to the 2008 EULAR/PRES/PRINTO criteria. Wefollowed subjects’ medical records for at least 3 months after disease onset to observe incidence and risk factors of Henoch-Schönlein nephritis (HSN).Results There were 112 HSP patients (aged 2-17 years) included in this study. HSN was found in 40 out of 112 patients (35.7%). Nephritis developed within the first 4 weeks for a majority of cases. Multivariate analysis showed that persistent purpura (OR 3.306; 95%CI 1.315 to 8.315; P=0.011) and acute phase leukocytosis(OR 2.585; 95%CI 1.047 to 6.385; P=0.039) were significantly associated risk factors for HSN. We found that corticosteroid use did not reduce the risk of HSN. The accumulation of several risk factors was associated with the likelihood of developing HSN. Conclusion Persistent purpura and acute phase leukocytosis are independent risk factors for HSN. Therefore, blood tests are needed to estimate the risk of HSN. Early corticosteroid therapy do not reduce the risk of kidney impairment.