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All Journal Jambi Medical Journal : Jurnal Kedokteran dan Kesehatan Jurnal Kedokteran Diponegoro International Journal of Integrated Health Sciences Majalah Kedokteran Bandung Sari Pediatri Paediatrica Indonesiana Indonesian Journal for Health Sciences (IJHS) Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia Journal Integration of Management Studies
Ahmedz Widiasta
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Umum Pusat Dr. Hasan Sadikin, Bandung
Biochemistry, Genetics & Molecular Biology Decision Sciences, Operations Research & Management Education Health Professions Medicine & Pharmacology Nursing Public Health

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Length of Stay Children Hospitalized with Chronic Kidney Disease Based on Etiology and Stage in Dr. Hasan Sadikin Hospital Bandung Angelreika Libowo; Ahmedz Widiasta; Dedi Rachmadi
International Journal of Integrated Health Sciences Vol 8, No 1 (2020)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/ijihs.v8n1.1880

Abstract

Objectives: This study aims to describe the LOS children hospitalized with CKD based on the etiology and stage at Dr. Hasan Sadikin General Hospital, Bandung in 2016–2018.Methods: This was a retrospective study with a cross-sectional design from June–October 2019. The inclusion were all medical records of pediatric inpatient diagnosed with CKD and exclusion criteria were incomplete medical record data and hospital readmission patients. The variables studied were CKD etiology, CKD stage, and length of stayResults: From 103 patients, the etiologies found were steroid-resistant nephrotic syndrome (SRNS) (58.25%), congenital anomalies of kidney and urinary tract (9.71%), urinary tract infection (5.83%), and chronic glomerulonephritis (21.36%). The mean LOS was 19 days. The longest LOS found in CKD stage 5 patients caused by SRNS (141 days). Meanwhile, the shortest LOS was found in CKD stage 2 patients caused by chronic glomerulonephritis and CKD stage 5 patients were caused by SRNS who died (1  day). Conclusion: Pediatric patients with CKD stage 5 with SRNS has the potential to have a longer LOS than other etiologies.
Subclinical hypothyroidism in pediatric nephrotic syndrome: the correlations with albumin, globulin, and proteinuria Erni Nuraeni; Faiisal Faisal; Ahmedz Widiasta; Novina Novina
Paediatrica Indonesiana Vol 60 No 2 (2020): March 2020
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (218.05 KB) | DOI: 10.14238/pi60.2.2020.91-5

Abstract

Background Nephrotic syndrome causes loss of medium-sized plasma proteins and binding proteins, resulting in thyroid hormone deficiency. Objective To assess for potential correlations between subclinical hypothyroidism in pediatric nephrotic syndrome with albumin, globulin, and proteinuria. Methods This cross-sectional study was conducted in the Department of Pediatrics, Hasan Sadikin General Hospital, Bandung, West Java. All types of nephrotic syndrome patients aged 1 month to < 18 years were included. Blood and urine specimens were collected from the patients for albumin, globulin, thyroid function (T3, fT4 and TSH), and proteinuria tests and analyzed with standard techniques. Results There were 26 subjects, 20 males and 6 females. Ten subjects developed subclinical hypothyroidism, with mean albumin and thyroid-stimulating hormone (TSH) levels of 0.92 g/dL and 6.9 mIU/L, respectively. There was a negative correlation between albumin level and subclinical hypothyroidism (rpb=-0.702; P<0.001) and a positive correlation between proteinuria and subclinical hypothyroidism (r=0.573; P=0.003). Univariate logistic regression analysis revealed that globulin had no impact on the presence of subclinical hypothyroidism, but albumin and proteinuria did have such an impact. The odds ratios of albumin and proteinuria with subclinical hypothyroidism were 27.00 (95%CI 1.69 to 17.7) and 19.80 (95%CI 1.94 to 201.63), respectively. Conclusion Subclinical hypothyroidism correlates with serum albumin level and proteinuria in nephrotic syndrome patients. Tha low serum albumin level has a high likelihood of subclinical hypothyroidism.
Kualitas Hidup Anak dengan Penyakit Ginjal Kronik di Rumah Sakit Umum Pusat Hasan Sadikin Bandung Fairuz Sani; Rodman Tarigan; Ahmedz Widiasta
Sari Pediatri Vol 24, No 1 (2022)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp24.1.2022.31-5

Abstract

Latar belakang. Penyakit ginjal kronik (PGK) dapat mengakibatkan kualitas hidup anak penderita menjadi menurun baik secara fisik, emosional, sosial, maupun prestasi belajar. Terdapat sekitar 52 kasus PGK per tahunnya yang terjadi di Rumah Sakit Hasan Sadikin Bandung.Tujuan. Mengetahui kualitas hidup anak pasien penyakit ginjal kronik di RSUP Dr. Hasan Sadikin Bandung.Metode. Penelitian menggunakan metode deskriptif kategorikal dengan rancangan potong lintang (Cross-sectional) pada periode Juli – Agustus 2019. Subjek penelitian terdiri atas seluruh pasien anak berusia 2-18 tahun dan orangtua pasien dengan PGK. Sampel penelitian diperoleh dengan metode konsekutif. Subjek diekslusi apabila pasien anak PGK sedang mengalami eksaserbasi akut dan pasien atau orangtua pasien yang tidak kooperatif. Data diperoleh menggunakan kuesioner PedsQL 4.0 Generic Core Scales.Hasil. Sebanyak 60% anak dengan PGK di RSUP Dr. Hasan Sadikin Bandung memiliki kualitas hidup yang buruk berdasarkan self-report dengan rata-rata skor total yaitu 56,85 ± 7,53. Berdasarkan parent-report, kualitas hidup anak dengan PGK termasuk ke dalam kategori yang buruk dengan rata-rata skor total sebesar 69,43±17,07.Kesimpulan. Sebagian besar anak dengan PGK yang ada di RSUP Dr. Hasan Sadikin Bandung memiliki kualitas hidup yang buruk. Skor total terendah terdapat pada pasien anak dengan PGK yang sudah memasuki derajat akhir (PGK 5).
Clinical Profile of Pediatric Patients with Steroid-resistant Nephrotic Syndrome Treated by Cyclophosphamide, Cyclosporin A, Mycophenolate Mofetile and Tacrolimus in Hasan Sadikin General Hospital Widiasta, Ahmedz; Jambak, Muhammad Khalid; Sekarwana, Nanan
Jurnal Kedokteran Diponegoro (Diponegoro Medical Journal) Vol 13, No 2 (2024): JURNAL KEDOKTERAN DIPONEGORO (DIPONEGORO MEDICAL JOURNAL)
Publisher : Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/dmj.v13i2.41983

Abstract

Background: Steroid-resistant nephrotic syndrome is a major cause of chronic kidney disease in children and adolescents. These diseases require appropriate management, while in some developing countries; the availability of agents recommended by international guidelines is very limited. Research objectives: To determine and describe the patient profiles of pediatric Steroid Resistant Nephrotic Syndrome (SRNS) that use Cyclophosphamide (CPA), Cyclosporine(CyA), Tacrolimus, and Mycofenolat Mofetil (MMF) in Dr. Hasan Sadikin Hospital (RSHS), Bandung as a tertiary hospital in West Java, Indonesia. Methods and materials: This research used a retrospective study with crosssectional study design, total sampling method and medical record of pediatric (1-18 years old) patients from January 1st 2017–September 31st 2019 who were diagnosed as SRNS. Results : From 99 subjects that belonged to inclusion criteria, 35.4% pediatric SRNS patients were in the age group 6-10 years and 60.6% were males. Laboratorium profiles showed among all population, ureum <100 mg/dL were found as high as 97%, creatinine 0.3-1.0 mg/dL (71.7%) albumin >2,5 gr/dL (51.5%), negative hematuria (68.7%) , protein dipstick < 3 (50.5%), and LFG > 90 mL/min/1.73 m2 (79.8%).. The patients generally had use CPA (87.9%) and remission <6 month (51.5%). Conclusion: Profiles of pediatric patients are important to diagnose and prognose SRNS. By using these approaches, it is feasible to access and detect the most effective treatment for SRNS.
The Art of Management of Children with Steroid-Resistant and Cyclophosphamide-Resistant Nephrotic Syndrome in Indonesia Widiasta, Ahmedz; Ilman, Muhammad; Rachmadi, Dedi
Jambi Medical Journal : Jurnal Kedokteran dan Kesehatan Vol. 12 No. 2 (2024): JAMBI MEDICAL JOURNAL: Jurnal Kedokteran dan Kesehatan
Publisher : FAKULTAS KEDOKTERAN DAN ILMU KESEHATAN UNIVERSITAS JAMBI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22437/jmj.v12i2.29348

Abstract

Background: Steroid resistant nephrotic syndrome (SRNS) in Indonesia contributes to chronic kidney disease (CKD). Method: Data from several teaching hospitals in Indonesia states that the incidence of CKD which originates from inadequate therapy nephrotic syndrome and steroid resistant nephrotic syndrome is around 60 – 70%. Result: This figure is much higher than in developed countries. One of the causes is that the main treatment for SRNS is with a calcineurin inhibitor, namely cyclosporin A, which is not yet available. This case report discuss the management of SRNS with cyclosporine A as an effort to prevent CKD at one of the provincial referral hospitals in Indonesia. Conclusion: Administration of CyA is the therapy of choice for SNRS, because it has a higher remission rate than CPA. The speed of achieving remission was also higher in CyA than CPA. There are several obstacles in providing CyA to pediatric SNRS patients in Indonesia currently, the main obstacle is cost. Keywords: Children; Chronic Kidney Disease ;  Steroid Resistant Nephrontic Syndrome; Intensive Care; Cyclosporine
Tacrolimus Therapy Among Steroid-Resistant Nephrotic Syndrome Children: A Preliminary Study in West Java, Indonesia Widiasta, Ahmedz; Wahyudi, Kurnia; Rachmadi, Dedi
International Journal of Integrated Health Sciences Vol 12, No 2 (2024)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/ijihs.v12.n2.3663

Abstract

Objective: To explore the outcomes of Tac therapy for Steroid-Resistant Nephrotic Syndrome (SRNS) and its implication in reducing the number of CKD events.Methods: An open, prospective, cohort study was conducted at a tertiary hospital in Bandung, West Java, Indonesia. Children (age 1–18 years old) with steroid and cyclophosphamide resistant nephrotic syndrome were enrolled in this study. Blood pressure, urinary protein, serum ureum, and creatinine levels were measured every month, Tac and soluble urokinase plasminogen activator receptor (supaR) levels were assessed at the 0, third, and sixth months.Results: Ten of fifteen subjects enrolled in this study got better within 3–6 months with a trend of decreasing suPAR level and proteinuria, as well as stable blood pressure and serum creatinine and ureum level. During treatment, no side effects of the subjects were found with the Tac level maintain safely.Conclusion: Tac is an effective and safe agent in treating SRNS, especially for those do not respond well to an alkylating agent.
ALKYLATING AGENT TREATMENT IN CHILDREN WITH STEROID-RESISTANT NEPHROTIC SYNDROME IN WEST JAVA Widiasta, Ahmedz; Rachmadi, Dedi; Hilmanto, Dany
Indonesian Journal for Health Sciences Vol 9, No 1 (2025): March
Publisher : Universitas Muhammadiyah Ponorogo

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24269/ijhs.v9i1.8383

Abstract

Objective: to evaluate SRNS therapy in children. Steroid-resistant nephrotic syndrome (SRNS) is one of the most common causes of chronic kidney disease in children. Kidney Disease Initiative for Global Outcome (KDIGO) no longer recommends an alkylating agent (AA) as the treatment protocol for SRNS, still in some developing countries, such as Indonesia, there are some limitations in obtaining immunosuppressive agents other than AA. Method: Data were collected from the medical records of SRNS children with SRNS aged between 1 and 18 years from January 2016 to December 2021. The data included time to remission, adverse effects, and relapse-free period after receiving AA treatment based on the lesion type.  Results: Among the 369 patients enrolled from January 2016 to December 2018, 244 patients (66.12%) had remission with AA, and 125 patients experienced persistent proteinuria. Most of them had remission during the fifth to seventh cycles of intravenous AA (after 6 – 8 months). None of the patients experienced severe adverse effects of AA. Only a small proportion of patients had chronic kidney disease (CKD) stage II–V during follow-up. Conclusions: AA is still effective in treating SRNS in children, with only a few and less harmful adverse effects
Comparison Of Steroid-Resistant Nephrotic Syndrome Therapy In Children Using Alkylating Agents, Calcineurin Inhibitors, And Monoclonal Antibodies: A Cost-effective Perspective Widiasta, Ahmedz; Rahadi, Raden Aswin; Bagaskara, Danang Pangestu Gusti; Rachmadi, Dedi; Hilmanto, Dany
Journal Integration of Management Studies Vol. 3 No. 1 (2025)
Publisher : Integrasi Sains Media

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58229/jims.v3i1.293

Abstract

Chronic kidney disease (CKD) poses significant medical and economic challenges, particularly in pediatric patients, with steroid-resistant nephrotic syndrome (SRNS) being a major contributor. Despite the financial support provided by Indonesia’s BPJS health insurance system, the rising prevalence of SRNS necessitates a reassessment of treatment strategies. This study retrospectively analyzed pediatric SRNS cases at Hasan Sadikin General Hospital, Bandung, from 2010 to 2019, focusing on the effectiveness and cost-efficiency of different treatment regimens, including calcineurin inhibitors (CNIs) and cyclophosphamide (CPA). Among 2,590 SRNS cases, CPA achieved a remission rate of 48.75%, whereas CNIs demonstrated superior efficacy, with tacrolimus (96.87%) and cyclosporine A (75.61%) achieving significantly higher remission rates in 2018–2019. Although CNIs incurred higher initial costs, they were more cost-effective in the long term. Rituximab (RTX) emerged as a promising alternative, with a 90% remission rate, offering potential savings by reducing disease progression and preventing more expensive treatments associated with advanced CKD. These findings highlight the necessity for a strategic shift in SRNS treatment protocols, emphasizing not only immediate costs but also long-term health outcomes and financial sustainability. Integrating RTX into standard treatment guidelines could enhance patient prognosis while optimizing healthcare expenditures. However, further research is needed to evaluate the long-term health impacts, expand the demographic scope, and refine cost-effectiveness analyses. A comprehensive approach to SRNS management, prioritizing both clinical efficacy and economic viability, is crucial to improving pediatric CKD outcomes and ensuring the sustainability of national healthcare resources.
Acid-Base and Electrolytes Profile in Critically Ill Pediatric Patients Admitted to Pediatric Intensive Care Unit (PICU) Khairunnisa, Alya Roosrahima; Peryoga, Stanza Uga; Widiasta, Ahmedz
Majalah Kedokteran Bandung Vol 57, No 1 (2025)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v57.3854

Abstract

Critically ill pediatric patients are known to experience more frequent episodes of acid-base and electrolyte imbalances when compared to adults, which can significantly impact morbidity and mortality with higher mortality rates and longer hospital stays. Data on the profile of acid-base and electrolyte imbalances in critically ill pediatric patients is very limited in Indonesia. This study was conducted to describe the electrolytes and acid-base profile of critically ill pediatric patients admitted to the Pediatric Intensive Care Unit (PICU). This was a cross-sectional study using secondary data from medical records of critically ill pediatric patients aged 1 month to 18 years admitted to the PICU of Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, from January 1 to December 31, 2021. Results indicated that 131 (50.8%) of 258 patients experienced electrolytes and acid-base imbalances. The majority of patients were boys (53.0%) and infants (32.8%). The most common primary diagnosis was respiratory (28.2%), central nervous system (19.8%), and gastrointestinal disorders (15.3%). A total of 366 electrolyte imbalance events and 111 acid-base imbalance events were recorded. The most common electrolyte imbalance events were hyponatremia (75.6%), hypocalcemia (48.9%), and hypokalemia (42.7%), respectively, while the most frequent acid-base imbalance events were respiratory alkalosis (33.6%) and metabolic acidosis (21.4%). Electrolyte and acid-base imbalances are common among critically ill pediatric patients in PICU. Thus, early evaluation and recognition of acid-base and electrolyte imbalances are crucial in order to prevent poor outcomes in these patients.
Stem Cell As A Promising Modality In Chronic Kidney Disease Children Future Treatment Widiasta, Ahmedz
Jambi Medical Journal : Jurnal Kedokteran dan Kesehatan Vol. 13 No. 1 (2025): JAMBI MEDICAL JOURNAL: Jurnal Kedokteran dan Kesehatan
Publisher : FAKULTAS KEDOKTERAN DAN ILMU KESEHATAN UNIVERSITAS JAMBI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22437/jmj.v13i1.29561

Abstract

Background: End-stage kidney disease (ESKD) is the origin of chronic kidney disease (CKD), both in adults and children. The progression of CKD to ESKD often cannot be prevented, even with sophisticated and up-to-date medicines. Method: Data search was conducted by searching for articles in electronic databases, namely PubMed, ScienceDirect, Scopus, Cochrane and Google Scholar. Result: Based on the pathophysiology, the transformation from CKD to ESKD involves a process of fibrosis in the kidneys, which is extensive and persistent. Several studies in experimental animals have found that treatment with stem cells in liver cells can repair cells that have experienced fibrosis, this may be analogous to fibrosis in the kidneys. Through this library extract, we will discuss stem cells, as well as how to treat stem cells for CKD and ESKD in the future. Conclusion: There are various variations in research results on the effectiveness of stem cell therapy in CKD patients. This occurs because of differences in the baseline clinical entity of CKD. Research on stem cell therapy in children has not been well published.
Co-Authors Angelreika Libowo Bagaskara, Danang Pangestu Gusti Dany Hilmanto Dedi Rachmadi Dedi Rachmadi Erni Nuraeni Faiisal Faisal Fairuz Sani Jambak, Muhammad Khalid Khairunnisa, Alya Roosrahima Kurnia Wahyudi, Kurnia Muhammad Ilman, Muhammad Nanan Sekarwana Novina Novina Rahadi, Raden Aswin Rodman Tarigan Stanza Uga Peryoga