NANI WIJAYANTI D.N., 051415153010 (2017) ANALISIS KADAR KORTISOL SETELAH PEMBERIAN PREDNISON DOSIS TINGGI JANGKA PANJANG PADA PASIEN ANAK SINDROMA NEFROTIK SENSITIF STEROID (Penelitian dilakukan di SMF Ilmu Kesehatan Anak Divisi Nefrologi RSUD Dr. Soetomo Surabaya). Thesis thesis, Universitas Airlangga.

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Abstract

Background : Steroid Sensitive Nephrotic syndrome (SSNS) is a glomerular disease characterized by heavy proteinuria due to immune system disorder which response to corticosteroid as immunosuppressant. This syndrome is commonly treated with high-dose of prednisone with the long-term use could develop HPA axis suppression indicated by the decrease of cortisol levels. Therefore, to monitor the cortisol levels is necessary. Objectives : to analyze cortisol levels in induction and alternate phase, associated with clinical manifestation in developing adrenal suppression. Methode : An observational, longitudinal study which had been approved by the ethical commitee from Dr. Soetomo Teaching Hospital Surabaya was conducted from June to October 2016. Cortisol levels were measured before induction phase (t=0), after induction phase (t=1), and after alternate phase (t=2). Venous blood samples were obtained in the morning at 08.00-09.00 am. The data were analyzed using student’s t-test to compare of the parametrics data of two groups. Results : 15 patients were included, but 6 patients were exclude because of cross-reactivity with prednisone when using Advia Centaur Cortisol Assay. 9 patients (55.56% boys) had mean age 6 - < 12 years old (55.56%) and 33.33% were initial attack and dependent steroid NS. There were no correlation between history of prednisone exposure and cortisol levels before induction phase (t=0). Eight from 9 patient had normal cortisol levels at baseline (t=0). The decrease cortisol levels in induction phase was 72.92% (11.79 ± 10.66 mcg/dL to 1.75 ± 1.08 mcg/dL) (p=0.024). After alternate phase cortisol levels increased 417.60% (1.75 ± 1.08 mcg/dL to 5.95 ± 3.33 mcg/dL (p=0.007). There were no difference of the mean decrease of cortisol levels in group with induction phase duration therapy > 28 and 21-28 days. Cortisol levels in patients with ≤ 14 days and > 14 days alternate phase were higher than in induction phase. The result of analysis showed there were no significant difference among all groups (p > 0.05). Clinical Manifestation as nausea/vomiting and abdominal distention only appeared in 11.11% patients in induction phase but not in alternate phase. Conclusions : HPA axis suppression could develop after induction phase which was indicated by low cortisol levels. High dose and long term prednisone exposure decreased cortisol levels reversibly. Clinical manifestation of adrenal suppression as weakness, nausea/vomiting, acute dehydration, and abdominal distention almost did not manifest in all of these patients.

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