Hubungan N-Acetyl-Β-D-Glucosaminidase Urin dengan Proteinuria Kualitatif pada Anak dengan Sindrom Nefrotik

Abstract

Background. N-Acetyl-β-D-Glucosaminidase (NAG) was increased in the presence of proximal tubular damage. Urinary NAG level related with severity of proteinuria in patients with nephrotic syndrome. Increasing level of urinary NAG indicated that tubular damage has occurred. The level found higher in steroid resistant than steroid sensitive nephrotic syndrome. Objective. To assess the relationship between urinary NAG and qualitative proteinuria in NS and also investigate variations in urinary NAG level excretion between steroid sensitive,(group I), steroid resistant (group II) and control. Methods. A cross sectional study was conducted in Haji Adam Malik Hospital from October 2013 to February 2014. Twenty two children with NS were included and 22 healthy children as control. The patients were divided according to their response to corticosteroid, group I 16 children and group II 6 children. The NAG level and qualitative proteinuria were measured. and NAG expressed as a ratio over urinary creatinine (Cr). Pearson correlation was performed to find the association between NAG and proteinuria. Kruskal Wallis test was performed to assess variations in NAG level among group I, II and control. Results. Correlation between urinary NAG and proteinuria in all NS with r=0.159 and P=0.479. Urinary NAG was significantly higher in group steroid resistant, followed by group steroid sensitive and control group with mean SD 79.92±92.45, 62.99±78.29 and 22.54±39.40 respectively. Conclusion. Increasing NAG level was not significantly correlated with qualitative proteinuria level. Urinary NAG level was found higher in steroid resistant than steroid sensitive NS and contro

Latar Belakang. N-Acetyl-β-D-Glucosaminidase (NAG) meningkat apabila terjadi kerusakan di tubulus proksimal ginjal. Eksresi NAG dilaporkan sejalan dengan eksresi protein urin. Peningkatan eksresi NAG pada pasien sindrom nefrotik dijumpai lebih tinggi pada sindrom nefrotik yang resisten steroid. Tujuan. Mencari korelasi antara NAG urin dan proteinuria kualitatif dan juga meneliti variasi kadar NAG urin antara kelompok sensitif steroid,resisten steroid dan control. Metode. Studi potong lintang dilakukan di RSUP Haji Adam Malik mulai bulan Oktober 2013 sampai Februari 2014. Duapuluh dua anak dengan diagnosis Sindrom Nefrotik dan 22 anak sebagai kontrol. Pasien dibagi kelompok sesuai respon terhadap steroid, kelompok pertama adalah 16 orang anak yang sensitif terhadap steroid dan kelompok kedua adalah 6 orang anak yang resisten steroid. Kadar N AG diekspresikan sebagai rasio dengan kreatinin urin. Korelasi Pearson dipakai untuk mencari hubungan antara NAG urin dan proteinuria. Uji Kruskal Wallis dilakukan untuk mencari kadar NAG urin pada kelompok I, II dan kontrol. Hasil. Tidak dijumpai hubungan antara kadar NAG urin dan proteinuria kualitatif dengan r=0.159 dan P=0.479. Kadar NAG secara signifikan lebih tinggi pada sindrom nefrotik yang resisten steroid, diikuti kelompok sensitif steroid dan kontrol dengan rerata 79.92±92.45, 62.99±78.29 and 22.54±39.40 secara berurutan.. Kesimpulan. Peningkatan kadar NAG urin tidak berhubungan dengan proteinuria kualitatif. Kadar NAG urin ditemukan lebih tinggi pada sindrom nefrotik resisten steroid dibandingkan sensitive steroid dan kontrol..