Oleh Admin Kalbe Medical pada April 12, 2017 07:30

Benarkah Efek Samping HES pada Ginjal?

Efek samping dari pemberian HES (Hydroxyethyl Starch) yang paling dikhawatirkan ialah penurunan fungsi ginjal. Efek samping tersebut diperkirakan memiliki mekanisme berupa terjadinya nephrosis like lesion dan tubular obstruction setelah pemberian HES. Untuk yang pertama, yaitu nephrosis like lesion, hal ini ternyata merupakan mekanisme yang masih kontroversial. Awalnya pada tahun 1993, mekanisme ini memang telah dibuktikan oleh Legendre, et al, pada hasil biopsi pasien-pasien pasca-transplantasi ginjal yang mendapatkan terapi HES. Namun, hal ini dibantah oleh hasil studi Coronel, et al, yang menyatakan tidak terdapat peningkatan kejadian nephrosis like lesion pada pasien-pasien pasca-transplantasi ginjal pada kelompok pasien yang diberikan HES dibandingkan yang tidak mendapatkan HES. Pada studi yang dilakukan Legendre, et al, ataupun Coronel, et al, keduanya tidak menemukan HES pada vakuola ginjal. Hal ini tentunya akan mempersulit pembuktian dari mekanisme kedua, yaitu tubular obstruction, akibat pemberian HES.

Studi yang berjudul “administration of HES in elderly patients undergoing hip arthroplasty under spinal anesthesia is not associated with an increase in renal injury”  membandingkan fungsi ginjal pada pasien-pasien usia (>65 tahun) lanjut yang menjalani hip arthroplasty yang mendapatan HES dengan yang mendapatkan ringer’s lactate. Studi ini menggunakan tolak ukur berupa tekanan darah, konsentrasi neutrophil gelatinase–associated lipocalin (NGAL), IL 18, β2 mikro-albumin dan albumin pada urin, serta kreatinin, NGAL, dan IL018 pada plasma. Sampel diambil sebelum, selama, dan setelah operasi.


NGAL merupakan protein kecil yang difiltrasu pada glomerulus dan reabsorbsi pada tubulus proksimal. Kadarnya akan naik 6 jam setelah terjadi cedera renal. Interleukin 18 diproduksi oleh tubulus proksimal dan merupakan faktor proinflamatori yang dapat terdeteksi pada urin pada tahap awal acute kidney injury (AKI). Spesifisitas dan sensitifitas IL-18 untuk mendiagnosis AKI mencapai 90%.


Pada hasil studi ini didapatkan bahwa tidak terdapat perbedaan pada berbagai tolak ukur yang ada pada kelompok yang mendapatkan HES dibandingkan kelompok yang mendapatkan ringer’s lactate. Dengan demikian, dapat disimpulkan bahwa penggunaan HES sebanyak 500 mL pada pasien lanjut usia yang merupakan populasi dengan risiko tinggi terjadinya AKI, tidak menyebabkan terjadinya AKI.


Image : Ilustrasi
Referensi:
1.Berlot G, Delooz H, Gullo A. Trauma operative procedures. Milano: Springer; 1999 .p. 86-8.
2.Zhang Y, Yu Y, Jia J, Yu W, Xu R, GEng L, et al. Administration of HES in elderly patients undergoing hip arthroplasty under spinal anesthesia is not associated with an increase in renal injury. BMC Anesthesiol. 2017;17(1):29. doi: 10.1186/s12871-017-0320-8.

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