EVALUATION OF CYCLOPHOSPHAMIDE'S EFFECTIVENESS AND SAFETY IN TREATING PEDIATRIC PATIENTS WITH STEROID-RESISTANT NEPHROTIC SYNDROME AT A GENERAL HOSPITAL IN BANDUNG

• Main Author: Magdalena Carissa B., Maria
• Format: Final Project
• Language: Indonesia
• Online Access: https://digilib.itb.ac.id/gdl/view/85406
• Institution: Institut Teknologi Bandung

Steroid-resistant nephrotic syndrome (SRNS) is a condition in patients with nephrotic syndrome who do not achieve remission (reduction/elimination of disease symptoms) on treatment with prednisone. Among the various treatment options for SRNS patients, cyclophosphamide was the most widely used drug in Indonesia due to its full coverage by national health insurance. On the other hand, Kidney Disease Improving Global Outcomes (KDIGO) did not recommend that cyclophosphamide for SNRS patients because it is considered ineffective and has the potential risk of infertility. Therefore, cyclophosphamide requires further evaluation. This study aims to evaluate the effectiveness and safety of cyclophosphamide and determine the influence of patient characteristics on the response to therapy. This research was a descriptive observational study utilized medical records from patients who started therapy between January 2022 and completed the therapy cycle by April 2024 at Dr. Hasan Sadikin Hospital (RSHS). A total of 83 patient were included in the study. Data collected included patient demographic information, 24-hour urine protein test or morning spot urine protein-creatinine ratio (uPCR) and drug side effects. Binary logistic regression was used to analyze the influence of patient characteristics on therapy response. Total remission was achieved in 27 patients (32.53%), partial remission was achieved in 40 patients (48.19%), and 16 patients (19.28%) did not achieve remission. The average duration (mean ± SD) to achieve complete remission was 4 ± 1.98 months. Statistical analysis showed a relationship between hypoalbuminemia and response to therapy (P=0,036), but no relationship was found between gender, age of onset at SNSRS, edema, hematuria, blood pressure, kidney function, and type of resistance to response to therapy. The most common side effects were nausea (68,67%), vomiting (27,71%), and hair loss (20,48%). From this study, it can be concluded that the response of SNRS patients to cyclophosphamide therapy was effective in inducing remissions in many SNRS patients, but did not achieving the desired complete remission in all cases. The patient characteristic that influenced the response to therapy was hypoalbuminemia status and the most common side effects were nausea, vomiting, and hair loss.