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All Journal Jurnal Penyakit Dalam Indonesia
Wardhani, Ariani Intan
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Medicine & Pharmacology

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Profilaksis vs. Terapi Preemtif Penyakit Cytomegalovirus (CMV) pada Pasien Transplantasi Ginjal Risiko Tinggi: Suatu Laporan Kasus Berbasis Bukti Wardhani, Ariani Intan; Tunjungputri, Rahajeng N.; Tetrasiwi, Erpryta Nurdia; Marbun, Maruhum Bonar
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 3
Publisher : UI Scholars Hub

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Kidney transplant recipients require the use of immunosuppressive agents to prevent multiple organ rejection. Administration of immunosuppressive agents triggers an increased risk of impaired immunity and microbial infections, one of which is cytomegalovirus (CMV). Prevention of cytomegalovirus infection can be given as a prophylaxis or preemptive therapy. However, the efficacy of choosing prophylaxis or preemptive therapy is still under debate, thus we conducted this study to identify current approach in preventing CMV disease in clinical practice. A literature search was carried out using the PubMed, Cochrane Library, Embase and Scopus databases with the keywords “high risk kidney transplant”, “prophylaxis”, “preemptive” and “CMV infection disease”. Inclusion criteria were only studies in adult kidney transplant patients as a population. , prophylaxis as intervention, preemptive therapy as comparison, and cytomegalovirus infection as outcome. The exclusion criteria of this study were the study articles that were not in Bahasa Indonesia or English, case reports and studies with subjects <18 years old. Critical review using Oxford Center for Evidence Based Medicine (CEBM) Critical Appraisal Tools for Prognostic Study And Systematic Review. The total number of articles identified based on the keywords used is 115 articles. Eliminating duplication with EndNote resulted in 92 articles. Furthermore, exclusion was carried out based on title and abstract so that 29 articles were filtered for which the full text was available. Of these, 23 articles did not have appropriate research questions, 3 studies did not have appropriate patient populations, and 3 articles with types that did not meet the inclusion criteria of this study. As a result, there were 4 articles that can be used in this report. Based on those four articles, it can be concluded that prophylaxis is more effective in preventing CMV disease but had more side effects, when compared to preemptive therapy. However, there was no difference in long term outcome between kidney transplant patients with CMV prophylactic or preemptive therapy.
Polisitemia Sekunder pada Pasien Laki-Laki Muda dengan Sindrom Nefrotik Wardhani, Ariani Intan; Nugroho, Pringgodigdo; Rinaldi, Ikhwan; Sarasawati, Meilania; Miranda, Monik Ediana; Harahap, Agnes Stephanie
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

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Polycythemia is a condition characterized by an abnormal increase in the total red blood cell mass and is classified into primary and secondary polycythemia. Secondary polycythemia occurs as a physiological response to tissue hypoxia or increased erythropoietin production, without intrinsic abnormalities in erythroid progenitor cells. This condition is rare, particularly when associated with nephrotic syndrome. This report aims to describe a case of secondary polycythemia associated with focal segmental glomerulosclerosis (FSGS). A 20-year-old man presented with generalized edema for five months prior to admission, accompanied by foamy urine. Physical examination revealed peripheral edema and minimal ascites. Laboratory investigations demonstrated massive proteinuria and elevated hemoglobin levels. Renal biopsy confirmed the diagnosis of FSGS, while bone marrow biopsy showed normocellular findings without evidence of malignancy or fibrosis. The patient was treated with methylprednisolone, ramipril, and simvastatin, and underwent four sessions of phlebotomy along with antiplatelet therapy. Following treatment, there was improvement in hemoglobin levels, proteinuria, and blood pressure control. Secondary polycythemia has been reported to be associated with various parenchymal kidney diseases, including FSGS. The proposed mechanisms include increased erythropoietin production due to renal ischemia or dysregulation of erythropoiesis feedback mechanisms. Phlebotomy is an important therapeutic intervention to prevent complications related to hyperviscosity and thromboembolism and has been shown to result in clinical improvement. This case illustrates a rare occurrence of secondary polycythemia in a patient with nephrotic syndrome due to FSGS. Accurate diagnosis and comprehensive management, including phlebotomy, can lead to meaningful clinical improvement. This report is expected to contribute to the literature on the diagnosis and management of secondary polycythemia in kidney disease.
Co-Authors Agnes Stephanie Harahap Ikhwan Rinaldi Maruhum B.H. Marbun Miranda, Monik Ediana Pringgodigdo Nugroho, Pringgodigdo Sarasawati, Meilania Tetrasiwi, Erpryta Nurdia Tunjungputri, Rahajeng N.