RESIKO
PERTUMBUHAN JANIN TERHAMBAT TERHADAP GANGGUAN FUNGSI GINJAL JANIN &
KELANJUTANNYA SETELAH KELAHIRAN
Abstrak
Tujuan
Mengetahui besar volume ginjal dan fungsinya pada janin PJT dan normal intra
uterine dan segera setelah lahir
Metode
Telah
dilakukan penelitian studi kohort terhadap 20 janin PJT sampai 36 minggu
dibandingkan dengan janin normal dengan melakukan pemeriksaan volume ginjal,
volume sekresi urin, indek cairan amnion dan pemeriksaan arus darah
umbilikalis.
Setelah lahir
pada hari ke 7 dilakukan pemeriksaan mikroalbumin, kreatinin dan cystatin-c
darah
Sampel
penelitian ini berasal dari Rs. H. Adam Malik dan Rs. Pirngadi serta praktek
dokter obstetric dan ginekologi
Hasil
Rerata volume ginjal kiri janin PJT 6,47 ml dengan
SD 1,85 dan pada janin normal 11,09 ml dengan SD 2,91 secara statistik dengan
uji Mann-Whitney berbeda bermakna dengan p 0,001, rerata volume ginjal kanan
janin PJT adalah 6,07 ml dengan SD 1,9 sedang janin normal 10,75ml dengan SD
3,35 yang secara statistic berbeda bermakna.
Rerata volume
urine janin PJT tiap jam adalah 8,21cc SD3,48 dan janin normal 19,23 cc SD 5,79
yang secara statistic berbeda bermakna. Meskipun belum mencapai oligohidramnion
namun jumlah air ketuban janin PJT lebih sedikit dibanding janin normal,
masing-masing 6,57 SD 2,28 dibanding normal 11,85 SD 2,53 dan secara statistic
berbeda bermakna dengan p 0,001.
Rerata arus
darah umbilikalis janin PJT RI 0,85 SD 0,72; SD rasio 3,38 SD 0,67 dan PI 1,25
SD 0,21 sedang janin normal RI 0,59 SD 0,07; SD rasio 2,56 SD 0,46 dan PI 0,89 SD 0,26 dan secara statistic arus
darah arteri umbilical janin PJT dan normal berbeda bermakna.
Setelah lahir
pada hari ke 7 dilakukan pemeriksaan mikroalbumin urin janin PJT 15,83 mg/ml SD
31,32 sedang janin normal 1,9 mg/ml SD 0,97 secara statistic berbeda bermakna
dengan p 0,001. Sedang kadar kreatinin urin janin PJT 17,19 mg SD 9,84 dan
janin normal 8,22 mg SD 2,85 kadar kretinin ini berbeda bermakna. Didapati
kadar albumin/kreatinin rasio janin PJT 198,0 µg/ml SD 627,63 sedang janin
normal 24,75 µg/ml sd 14,07 dan hal ini berbeda bermakna.
Pada
pemeriksaan Cystatin-C darah didapati pada janin PJT 1,47 mg/ml SD 0,28 dan
pada janin normal 1,45 mg/ml SD 0,19 secara statistic tidak berbeda bermakna
Kesimpulan
Didapat volume ginjal kiri dan kanan janin PJT lebih
kecil dibanding janin normal begitu juga sekresi urin janin PJT lebih sedikit
dibanding janin normal diikuti dengan volume indek cairan amnion janin PJT
lebih rendah dibanding janin normal.
Arus darah arteri
umbilikalis janin PJT lebih lambat dibanding janin normal dan secara statistic
berbeda bermakna.
Terjadi
gangguan fungsi ginjal janin PJT segera setalah lahir dengan terjadinya
mikroalbuminuria, peningkatan albumin/kretinin rasio dan peningkatan kadar
kreatinin urin.
TRANSLATION
THE RISK OF INTRAUTERINE GROWTH RESTRICTION (IUGR) ON THE RENAL IMPAIRMENT & ITS SUBSEQUENT BIRTH OUTCOME
Abstract
Objective
To
determine the volume and function of kidney of Intrauterine Growth Restriction
(IUGR) fetuses and normal intrauterine fetuses subsequently after birth.
Methods
A cohort research was conducted on
20 IUGR fetuses up to 36 weeks compared with normal fetuses by examining the
volume of kidney and secretion of urine, amniotic fluid index and umbilical
blood flow.
On day 7 after
birth, examination was performed on microalbumin, creatinine and Cystatin-c
Test
The research
samples were derived from RS. H. Adam Malik, RS. Pirngadi and obstetrician and
gynecologist practices.
Results
The mean volume
of the left kidney of IUGR fetuses was 6.47 ml with SD 1.85 and in normal
fetuses were 11.09 ml with SD 2.91 using Mann-Whitney test was statistically
different at p 0.001, the mean volume of the right kidney of IUGR fetuses was
6,07 ml with SD 1.9 whereas normal fetuses was 10,75ml with SD 3.35. it was
statistically different.
The mean of
urine volume per hour of IUGR fetuses was 8,21cc with SD 3,48 and normal
fetuses was 19.23 ml, SD 5.79 ml and it was statistically different. Although it had not
reached oligohydramnios but the amount of amniotic fluid of IUGR fetuses was
less than the normal fetuses 6.57 ml with SD 2.28 ml compared with that of the normal ones
11.85 with SD 2,53 ml and it was statistically different with p =
0.001.
The mean of umbilical blood flow of IUGR fetuses Resistance Index (RI) was 0.85, SD 0.72; SD ratio 3.38, SD 0.67 and PI 1.25, SD 0.21 whereas normal fetuses was RI 0.59 SD 0.07; SD
ration2.56, SD 0.46 and PI 0.89,
SD 0.26. Umbilical artery blood flow between normal fetuses and IUGR
fetuses was statistically different.
On day 7 after
birth, microalbumin urine of the examination of IUGR fetuses was 15.83 mg/ml,
SD 31.32 but the normal ones was 1.9 mg/ml, SD 0.97 and it was statistically
different with p = 0.001. Whereas the mean creatinine urine level of IUGR
fetuses was 17.19 mg, SD is 9.84 and normal fetuses was 8.22 mg, SD 2.85. These
creatinine levels were statistically different. It was found that the level of
albumin/creatinine ratio of IUGR fetuses was 198.0 µg/ml, SD 627.63 whereas the
normal fetuses was 24.75 ug/ml, SD is 14.07 and it was statistically different.
On examination
of blood Cystatin-C it was found that
IUGR fetuses was 1.47 mg/ml and SD was 0.28 and in normal fetuses was 1.45 mg/ml,
SD 0.19, it was not statistically different.
Conclusions
it was obtained that the volume of
left and right kidneys of IUGR fetuses was smaller than normal fetuses as well
as urine secretion of IUGR fetuses was less than
the urine secretion of normal fetuses. Meanwhile, the volume of
amniotic fluid index of IUGR fetus was also lower than that of the normal ones.
Fetal umbilical
artery blood flow of IUGR fetuses was slower than that of the normal ones and
it was statistically a significant difference.
Impairment of
renal function occured immediately after the IUGR fetus was born with the onset
of microalbuminuria, the increase of albumin/creatinine ratio and urinary
creatinine level.
