COMPARISON OF URINE PROTEIN EXCRETION IN CHILDREN WITH DENGUE VIRUS INFECTION WITH OR WITHOUT SHOCK

TESIS

Abstract

By : Ni Made Dwiyathi Utami

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Faculties : Fakultas Kedokteran

Department : PS. ILMU KESEHATAN ANAK

ABSTRACT COMPARISON OF URINE PROTEIN EXCRETION IN CHILDREN WITH DENGUE VIRUS INFECTION WITH OR WITHOUT SHOCK Dengue virus as the cause of dengue fever with the incidence rate in Denpasar on 2015 was 178.7 per 100.000 populations. Mortality rate increased 5% in case of dengue shock syndrome. An accurate assessment of the risk of shock is an important key to prevent of shock in patients with dengue hemorrhagic fever. Hematological parameters such as increased hematocrit, and platelet decline has long been known as a prognostic factor of the shock. Urine abnormality can be a parameter of the severity of dengue infection. Research on proteinuria is still a controversy. Research in adult said that proteinuria higher in patients with dengue hemorrhagic fever than patients with dengue infection. Researches are limited in pediatric field. Nephrotic range proteinuria that can occured in dengue virus infection with a shock that could become acute renal failure with mortality reached 60%. This condition will affect the procedure for administration of fluids in dengue shock syndrome. This study was a cross sectional study using consequtive sampling method. Samples are children aged 6 month to 12 years who were treated with dengue virus infection with less or without shock and no renal abnormalities. From the results, subjects were not different in characteristics of both genders, satus nutrition, weight, height, body surface area. The difference was found in a state of fever before admission, diuresis decreased, and an increase in hematocrit. The median value of urine creatinine ratio of protein versus the higher shock condition 0.3 (IQR=-0.12 to 0.72) compared with those without shock 0.18 (IQR=0.02 to 0.34), p=0.01. Nephrotic type proteinuria entirely experienced by patients who experienced shock of OR=3.52; 95%CI (1.58 to 7.85); p=0.002. Albumin level had significant effect on proteinuria rather than shock in dengue infection with F=4.22; p=0.042; R2=0.04. Based on the results of this study conclude urine protein excretion were higher in dengue virus infection with shock rather than without shock, and shock conditions tend to cause nephrotic type of proteinuria. Hipoalbumin more significant cause proteinuria compared than shock conditions. It describes the mechanism of proteinuria occurring in dengue viral infection is greater because of viral nephropathy due to NS1 antigen reactions in renal endothelial glycocalix.

Keyword : Keywords: dengue virus infection, shock, proteinuria

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