,

! i,lr,.-1,.

PEMAKAIAN ASAM FOLAT

PADA GAGAL GINJAL KRONIK
Suhardi D A'
-
HiPertensi
SLlb Bagian Ginjal
SIvF/l ab llrru Penyakrl Dalam '
Gadjdh f'lada
Falultdc P pdokteran Universitas
logjakarta

lnti sori
PemokoionosomfololpqdokosusgogolginiolselorongsedongromoidlleliliPodoposien <plro'no
dilemufon r'odor nolnoJ'itoiri' obnor mol linqgioon berloniul 'neninqkol
ooootoiniol rngon
progrpsrviro goqot qrniol
'
X"iJ"" t""i"ql"'*" memiliki
85% penderilo gogqlginiol lerminol
Penelili lennifer Snovely (20021 meloporion bohwo
k"d;il;;;,;i"; o,'o'p'q'iJp*:"^::::l*:,"1ru;$iii::1t"ff
;";insko'
'T; *;f
er"''"r"' T:t:-":::'ill:"-q:")::HT,i:,:"Jlil'ffiil;J;;;lij",n"o'o'iir"'n"'io '"oone
ffi ;;.oi ioioi iunsoor'ouo'|in d;k o'nb rosi donoon viro
lffi lxi: f ixru?. ;::ru#::ffi
min 86 don Bl2 pulo
lleinem o 'ri berhosil molo oiholoplo'mompl
Apobilo pengondolon I'ipelhomos pemol olon
menoendol;kon I elodlo n cot dio vos'utot
dl'il'l r'ool ditem'l on odonyo elel:o'np'ng
podo kosus gogol
ao''' *utiilbLi n ir' p"tortoion osom folot
oso; folol dosis linggi toupun '"ii
giniol kronik songot dioniurkon

hiperhomasisleinemio - osam folot

Koto kunci: gogoiginlo I kronik-

Pendohuluon dori
merupolon soloh solu foklor lndependen
Ieloh disepokoli bohwo hiperhomosrstarnemio giniol lerminol yong
ortero slleros,s {Boushey er ot toos'
no-o:nso'iliJ' rnoir' cooo posien gogol
5";" berodo oolom leodoon hiper
homosisle'nemio lBoslom
dilolukon l'emodiohsis ["'op' p"nggonf i
Do;;i"rnt;;;""""gogolginlor lerminolyonq mengolomi
a crrllelon. lossl Teloh drkelohur pulo {conspnsus Davelop-
oleikeioo'on penvoliitoi'a;ovoskulor
hemodioIsrs lerspbul 5o"t disebooton i"r'o'p"r'l't lerbukli bohwo menurunlon
monr conlp'pnce oor'tt toqat eeroos;r"io;pl-nlrili"
gogol grnlol lerrninol denoor
keodoon hrperhomositteinem o
do"gon oi"ifo'oi pooo la posien
i"i jllii!
pr o/' 20011
i
","0
*
"ccess
rro'nbosi< menu'un rcrowiord

Podomokolohiniokondilqporkonbeberopopenelllionpodoposiengogolgin]olierminoldenqor diturunkor
hemodiolisis vong dilokuron r"'op'o'orn
ioioi[!it t"oJoon nip"tf'otosisreinemro dopol
pulo
kordiovoskulor dopoi dilurunkon
.l] it'JJ'i"iti,ilo;;vokit
PenemuonlmlohTohLrnon LlmLrPenvokrDolom 20(
 Pombohqson
l, gogolmqno mekonism€
teriodinyq hiperhomosisteinemlq podo gqgol
giniql ,ermlnql?
Podo posien goqor qinior konik sering,m-engoromi
hiperhomosisreinemio. Kodor
berkisor onroro 20_80 umot,/t {Dierkes el
a. rccar. r"oor.;.;riJ;i" oo.ioiilrriso. homosisrein
onrorq s_is
lmotlL dionggop normol Aoobito kodor homosistein *,..
moderote. sedonq opobito kodornv., meningkot
njo rrrn# oijnggqp meningkot
onroro rr-too pm-oitioiJnig";; ,nlerm"a.re
opobito kodor homosistein > 100 don
umot/r dionggop,""ingkoif"ri'ii""#riXt ,noof
"r,
pooo nonoin'lio, i.on,r,' ,"',,o
*""0'"""n"";1ilTfi#?1"'jfl?Yifi?J:l'r"j#tli'terhom-o-sisteiiemio
o"'nuo'ngon longsung densqn keodoon gog.olginlolnfo
ruo,nrn orgoon inii."rijion'inl"j#i
rio"r.ar".i,i"" r,."'.,i;;; #::,f,T'.*iiJt:il"3"B:fl : g'?flJ1rutr',".:fr*[;:i
terjodrnyo hiperhomosisteinemio odoroh
siruosiuremik sendiriyong dipoiri"-n,,i'oooron o"r"r pooo
melobolisme homosistein {Bostom & Culle,on,
19991.
Podq posien gogol gjnjol kronik vong,tidok
mendqpol suplemen vilomin yong
mengolomi defisiensi osom lotor rnrtnko; cukup, sering
hemoOiofigs ienalriilenylio'o"lon ll"nyor,
hilong termosukvitomin B Boqi ui,ornin yong
Oender o-gogol giniql terminol yong bonyok
mokon don ridok mendopqr supremen viromin yong dilokukon pembotoson
cukup, moio oion tlioji a-e'niiensrosom
Keodoon defisiensiosom fotot inimendorong totor
rer.i"ji"1," ilip"rh"rn"lri",iJillo"6lrt", ,ocrt
Poro peneliti yong lergobunq dolom ,Clevelond
Clinic foundotion, "rot.
teloi rn"nyirnpuf f.on Uotro
podo penderiro gooor qinior rerminor mempunvoi
rooo. rro,nosisiein v'on'g i;iqlai aoro, ao,ot.
Keodoon ini dopot diproleksi dori keiodion penyokit
kor;iovo;;;;r'il;n;""Lr"
.. memberikon
supJemen osom fotot. vitomin 86 don vitomin
brz rn"oi".on "-
2. potogenesishipefiomosisteinemiodonorleriosklerpsis
"r,i.'iii;i"
Bogoimono mekonisme keodoon hioerhomosisleinemio
dopqt menim6ulkon terjodinyo orlerio
skterosis berum dikerohui secoro ieros boro
sitotoksik podo endolel pembuluh doroh
peneriri seruiu oJ;;
r'r-J"iiiiil"lillinemio bersifor
Meningkqtnyo t"a", f,"r;r,r[i"'",i.,to produksi
oxide podo set set dindjnq pembutuh doroh niki,
diteion ."hinggo
p"rUrfriO",Ji","rr"but ku.ong
'teksibet
don keodoon inj mempermudoh terioOin},o plogii;vio;_6in;.
Teoriroin menyorokon bohwo mcningkotnyo
ffi;' -
kodor tromosistein dorohiiiperhomosiseinemiot
dkqn menyebqbkon kerusokon dindino nimbrirr,
o_ot vo"g ;"io;i,iirl oi"unXi,iru
odhesi plotetet (Reeder et o/. 20001 -sementoro o"nrnro"r,
p"nOopor i"n"iiriioi,in-r'o'"r""n,i"orrfon
hiperhomosisieinemio dopor memocu oedumbuho; 'ltr."r, Oot,*o
menimbutkon orrerio skterosis lGubq eiot.l99zt.
set_s;t oi; ;;;ur.tiilL p.o".tt n"v"
reoritoin menffioil"o|"'ilii'i"#on'o.,r,"in",nto
mengoktilkon koskode kooqutosidon denqon
g;ro,nUor, oOonvo t"rJrJi"o" O'"iif,n
moko okon teriodiorlerio sklerosis
lcub;e, ol, 19971. o",nOrf"r, aor.t

3. pengobctqn hherhomosisleinemio
pcdo penyokil kordiwoskulor

dengon risiko tinggi, kodor homosist"in -t

f:i'Jil;,T:::'ij"":i*::i:jlll - -'
'''""'t"rvuP
::l:1':1dvjsory croup'dioniurkon
ururrlulKon bohwo
oonwo podo penderilo
penderilo
di l0 pmol/L
urnor/L lMolrnow
lMolinow el ol,
et
1999). Ado ?
19991. 2 kelompok .,",r^ r,^^^,
ketomnnr. risiko tinqqivono
'iikior d
-^^^ ,l.l1lo^hokon .selolu -bqwoh mereko menqenlo
voskulqr
voskutqr don belum diketohui i;L;^.
betum r,ikpr6h'i ;.,JT:i1"*':L
isil t""o {2) ryiru:.ll) 'c^u vurrq
vong menoeriro
mereko yong memiiiki riwoyot keluorlo
penyoiii
penyokil
mender
menderitoo penyokii
oenvokii voskulor
voskrrlnr lBerger,
rRoraar l99Bl.
,oootonYo
Obotyong dipokoiunluk menurunkon kodorhomosislein
yong meningkol lersebulodoloh
totol, viromin,86 don viromin Bt2 osom
t'erger. rcsot. asom foroiad;ui,;;; ;?;;;i:;""tuk
proses remetirisosi. sedonqkon memocu
vi'omin 86 dituiukon nu;ruk
sislolhionin b-sinlose {lihol gombor lompironl ;";;;;i;;ff;;;; dori
"nzimorik

PerlemLron llmioh Iohunof tlmlr penyokilDotom 2oo2

t3
l-

Podo penderjto dengon hiperhomosisleinemio telopi lidok qdo

derisiensi vitomjn, pember0l
osom foiot 1,2 mg soio selomo 6 minaqu dopot menurunion
hipernomosi.i"i""rio +o Soy" fsoW
t99B). obot gobungon yong dipokqiodoloh 2.5 mg osomfotot.
z5 mg Bo J*i,ig'Biiyong aionggp
mompvu menurunkon hiperhomosislejnemio yong seloniutnyo
morn-pu m"nc"gJ;ki;oOlon penyott

4. PengEunoon osom toldt podo penderitq gogol giniol terminol

Bqnyok penelili yonq mencobo menurunkon hiperhomosjsleinemio
podo gogol ginioltermin0
honyo dengon,memokoi osom fotor soio^Di doto..pungoln;to;
p;;J,[iu'i)irJi orrot gooungo,
ontoro osom foloi, vilqmin 86 don vitomin Bt2 dirosokon Jopot
menurunion-niJJrn'ororu,"in.r,
Telopi peneliti yonq loin menemukon tqndo,tondo r efrokter
Oleh seLoL ,,, L"O",5io p"n"fiti.*.lo
menggunokon osom folql dosis besor unluk menurunkon
hjperhomosrsLrneriL.pooo penderiro
gogol giniol terminol
Beberopo penelit,on Vonq dilot,ukon dtConodo NewZeolond
don Uniled Slotes tBoslorr ei0I
2000. sunder ptossrnonn p/ ol 2000. Trernbtoy eroi. 2000t
mJ;il;;"-k;#;;i.n rrenurunton
hiperhomosis'ernemro podo pendenro gogot
binr"r o""g;n ,;;kij or"oir,' ioiii oori. tinggiloo
#li:::,rl]11fl.,:":,i,Sl:"i:9:l
,,,Fopurru oonwo Dooo penatttron 9"091
men, opo, n-orgo ;,;"r ;;k;;;o" pere,jri yo.s
Oende to hemodlolisis yong drkerlokon 5e(oro /ondom?ed
double blnd monymoulr on bohwo hdol odo OoOonyo .enqjun;kln
orim''rotl'cfos,. Oeso, S-zO
mg dibonding dengon dosis 1mg untuk menurunton niperfio"mo.ift"l";; j; --
"
Ringkqson/Kesimpulon
Teloh disepokoti bohwo hiperhomosisleinemjq merupokon
soloh sotu foklor dori keiodion
penyol.il l.ordiovostuJor podo penderiro gogot ginlot
ringon iomloi!;gof g;t"f ,lrii""r OiO"p",k*
keodoon hiperhomosisterfemro Denoon menuruntonieodoon
hipieiior-o.ili"inurnio ainoropt*
dopor ma"uJ unl on lo;odion penyofu ilordiovo<l urol
Penggunoon osont folol secoro sendiri oloupun secoro
bersomo dengon vtlomin 86 don Bl2
diloporkon mompu menurunkon keodoon hrperlomosisteinemio peig;;n"o";n
diperlukon didolom usoho pengendotion hipe,nornoss"inu.io poOo
;r1rrl iofot .ongoi
sompoi gogol ginictl berol JJ"j",i" i"gof g,ni"t ,irg,

Kepustokoon
Berger, P fl99B). Homocysteine ond coronory orlery
diseose. Amerco n Coltege of Cardiotogy. l3l2l,

Boslom, A & Cullelon, B. {1999). Hyperhomocysleinemio in chronic renol

fqiJure: Djseose ot the monlh
Jounal of the Americon Society of Nephrolaqy, 10, B9j,89g
u"ttRT: j;.^tn"Il:13."t:91%l zonob[ A., chrisrophe, K. spiesel. p, rocques, p,
(2000). lo.,.v,,,2,
conlroled comporison of L s
?^ry:,|:*:i
ocid for the treotment I
!:,lyo. of hyperhomocysteinemio
in "[Llr"lro"[v".il.oii,r"i"";;fi:]ri;
r,".oaioiyiil'po-ir:;;;'r-;i;;i;;7"i;iill,
2829 2832
Boushey, C., Beresford, S.. Omenn, c. & Molulsky. A. (1995). A quonrilotjve ossessmenl of plosmo
homocysleine os o risk foctor for vosculor diseose proboble
benefils of increosing folic qcid
JAMA. 27409.1049 1057
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11994) MorL .Jily ond mortolily of renol diolysis: An N H
, onsorsrs, onle erro \totpn pnr
A4nols ol /n tet nol Medrne 12llll L;.7;
Crowford, F, Rosenthol, A, Speors, C & Tqbori. H {2001j Normolizofion
olhomocysteine in djolysis
Oo',enrs by dite,'od ep'.t,on wlh oDoor^rl r^duclion ot o.Lpss
plot1loliot1. 301& 512 521
f","afr"." Dot)sts E hot1,.

PerlemLron lm oh Tohunon m! penvok I Dotom

I 200,
Dierkes, J., Domrose, U., Ambrosch, A., Bosselmonn, H., Neumonn, K. & tuley, C. (1999). Response of
hyperhomocysleinemio lo folic ocid supplemenlolion in polienls with end sloge renol diseose.
Clinicol Nephrology, 51(21, 108-ll5.
Gubo,5., Fink, L. & tonsecq, V {19971. Hyperhomocysteinemio. An emerging ond imporlont risk
foclor for lhromboembolic ond co[diovosculot diseose. Americon Jounol of Clinical Palhology,
t06161,709-722.
Molinow R., goslom, A. & Krouss, R. {1999}. Homocysteine, diet, ond cordiovosculor diseoseiA slole-
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Monns, 8., Hyndmon, E., Burgess, E., Porsons, H., Schoeffer,1., Snyder, F. & Scott-Douglqs, N. 12001).
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Perlemuon llmioh lohunon lmu Penyokll Dolom 2002 15