Questioning Patients With Acute Kidney Disorders At RSCM And Messages For Parents To Overcome Fever Children

Illustration. Cases of mysterious acute kidney failure increased dramatically during the period January to October 2022. (Unsplash / Robina Weermeijer)

JAKARTA Blocks are body organs that function, including removing toxins, excessive salt levels, water and excess minerals, and waste that contains nitrogen (urea). Blood flows waste to the kidneys to be disposed of in the form of urine.

Judging from its function, if the kidneys are disturbed, the waste from the body's metabolism can certainly accumulate in the blood and cause health problems and can even have an impact on death.

Cases of kidney failure or kidney failure are not new cases. However, it is a concern, when the number of sufferers increases dramatically in Indonesia. This is why it is called an artificial progressive acute kidney disorder.

Akut means sudden, progressive means fast, artificially not as usual. Unlike in the text of the book, oddly basically," said RSCM Director dr. Lies Dina Liastuti during a press conference on August 20, 2022.

Data from Cipto Mangunkusumo Hospital (RSCM) as a referral hospital for kidney disorders said the increase in cases occurred in August 2022, from only 1 patient in the previous month to 8 patients. Then, it increased again to 20 cases in September 2022 and 11 cases in October 2022.

So, during the January-October 2022 period, there were 49 patients with acute kidney disorders at RSCM aged between 8 months to 8 years. They are referral patients who arrived at RSCM who are in a condition of not being able to urinate.

11 patients are still being treated: 10 are still in PICU, and 1 is still in the ER because it has just entered. The death rate is 63 percent," said dr. Lies.

Judging from the patient's clinical history, children with acute kidney disorders who enter RSCM do not have comorbidities. In general, it is preceded by symptoms of fever, digestive tract disorders (diarrhea), respiratory tract disorders, and without an episode of dehydration.

That, said dr. Lies, is different from the clinical history of disorders or regular kidney failures whose causes are known to be due to lack of fluids, infections due to viruses or bacteria, systemic inflammation, congenital disorders, and poisoning of harmful substances.

Even when medical tracing is carried out, there is no condition of lack of fluids/dehydration, examination of the kidney ultrasound does not show congenital abnormalities. We look for infections, neither viruses nor germs specifically. We look for the direction of Covid, nor do we. We look for whether the effect of vaccination is not true, there is no effect from the vaccine, the children have not reached the vaccine stage," said dr. Lies.

In fact, the RSCM doctor also had time to try to give a immune-boosting drug, IVIG Gammaraas so that the body is strong, but it turns out that it can't give maximum results. Some are good, some are not.

Finally, get information from the case in Gambia regarding chemical compounds on drugs. On that basis, we start thinking maybe there is also something in that direction. Why because the trip is not the same as the usual kidney failure disease, Dr. Lies added.

Then, the Ministry of Health took a policy by temporarily stopping the administration of a number of drugs. Doctor Lies did not clearly describe either policies or drug matters because it was not his authority.

What is certain, he said, is just to determine whether it is true due to the impact of drugs.

So, it's not an accusation that drugs are dangerous. We learned from the case of acute kidney disorders in Gambia which stopped the use of a number of mild drugs for 2 weeks. Apparently, the results were significant. If we have stopped for some time but cases are still soaring, that doesn't mean that's not the cause," explained dr. Lies.

For the community, dr. Lies suggests that it is not easy to give medicine to children when they have a fever. First, anticipate by providing sufficient fluids and doing compresses. Then, come to health services to ask for the best advice regarding the drugs that will be taken to the doctor.

Chairman of the Central Board of the Indonesian Pediatrician Association (IDAI) Piprim Basarah Yanuarso also suggested the same thing. Fever in children is something natural. Body mechanism in removing incoming pathogens.

Not all conditions require paracetamol. Pilek cough or what is commonly called a cold, for example, is a condition that is categorized as a self-limiting disease or can recover by itself even without medication.

"You don't always have to be given medicine, let alone any medicine in the shop. If you want to try a warm water compress first. But if you want to use paracetamol, that's okay too. Don't panic, please give paracetamol, if you have a fever, it's okay to give paracetamol, but you need to be vigilant and consult a doctor, do you really need paracetamol," he explained during the IDAI liveinstagram on October 18, 2022.

If the child has a fever, according to dr. Andi Khomeini Takdir, parents must also defecate. Prepare a thermometer to measure the child's body temperature. When the body temperature is still around 37.5-37.9 degrees Celsius, parents must first focus on fluid intake for their children by increasing drinking water.

However, when the body temperature does not decrease or still ranges from 37.9-38.5 degrees Celsius, immediately do a compress using warm water.

With a small towel soaking in warm water with a temperature of about 37 degrees, peras, and attaching it to several parts of the child's body. It can be on the head, stomach, or armpits. It can be done many times, but fluid intake is also maintained," said Andi, a researcher from the Faculty of Medicine at the University of Indonesia to VOI, Saturday (22/10).

This refers to the concept of heat propagating through conduction and convection. When a warm towel sticks, it widens the blood vessel tissue under the skin and conducts heat into the towel.

However, if the treatment is not able to reduce the child's body temperature, or the child's body temperature rises to above 38.5 degrees, it should immediately go to the nearest health service.

According to dr. Andi Khomeini, apart from body temperature, parents must also understand the condition of the child. This is because the condition of the child's immune system is different. Some are just hot and they are lazy, look weak, some are still active.

Likewise the period of fever experienced. Is it only certain moments or all day long.

So, the benchmark is two things, the body temperature and condition of the child. Parents must be wise in making the best decisions for their children, " dr. Andi emphasized.