FEBRINA PRITAYUNI PERMATASARI, 051415153022 (2017) ANALISIS PENGGUNAAN PREDNISON DOSIS TINGGI JANGKA PANJANG TERHADAP PERUBAHAN KADAR OSTEOCALCIN PADA PASIEN SINDROM NEFROTIK ANAK (Penelitian Dilaksanakan di SMF Ilmu Kesehatan Anak Divisi Nefrologi RSUD Dr. Soetomo Surabaya). Thesis thesis, Universitas Airlangga.

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Abstract

Nephrotic syndrome (NS) patients are treated with high dose and longterm prednisone therapy which may decrease the function of osteoblasts and lead to suppression of bone formation. These effects cause reduce osteocalcin level. Objectives : To analyze osteocalcin levels in induction and alternate phase, associated with clinical manifestation. Method : This prospective longitudinal study was approved by the Ethics Committe of Dr. Soetomo Teaching Hospital Surabaya. Data was collected from May to October 2016. Osteocalcin levels were measured before and after induction phase and four weeks after alternate phase. Venous blood samples were obtained in the morning at 08.00-09.00 am. This study protocol was approved by the Ethics Committe of Dr. Soetomo Teaching Hospital Surabaya. The parents of the patients signed informed consents for this study. The collected data were analyzed using student’s “t” test to compare the parametric data of two groups and pearson correlation to correlate two quantitative variables Result : 15 patients were included in this study (60% boys). Majority of their age was 6 - <12 years and 40% were dependent steroid NS. There were no correlation between history of prednisone and calcium supplementation with osteocalcin levels before induction phase. Seven from 15 patients had osteocalcin levels before induction phase which had higher than reference value (45–105 ng/mL). Suppression of osteocalcin levels in induction phase was 53.33%. After alternate phase osteocalcin levels increased 175.82%. Clinical manifestation as bone pain/cramps only appeared 33% in induction phase and 20% in alternate phase. Average suppresion of osteocalcin levels in group with induction phase duration therapy ≥ 28 days and without calcium supplementation was higher than 21-27 days and with calcium supplementation (-56.752±58.674 and -64.467±67.921 vs -25.434 ±51.932 and -30.376±43.166) ng/mL, respectively. Osteocalcin levels increased in patients with ≤ 14 days and > 14 days alternate phase also in patients with and without calcium supplementation. The result of analysis showed there were no significant difference among all groups (p > 0.05). Correlation between cummulative dose, duration therapy of calcium supplementation, calcium and phosphate levels with osteocalcin levels were insignificant (p > 0.05). Conclusion : Suppresion of osteocalcin levels was reversible after alternate phase. It shows that tappering off regimen is important. Clinical sign as pain bone/cramps almost showed no manifest in all of these patients.

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