Study Control Team to Probe Cause of Acute Kidney Injury

KOMPAS

Minister of Health Budi Gunadi Sadikin, Monday (10/24/2022), said that drugs for patients with acute kidney disorders would be given free of charge.

JAKARTA, KOMPAS — There is strong suspicion that the cause of atypical progressive acute kidney injury affecting more than 300 children in Indonesia lies in the consumption of contaminated medicines. Nevertheless, the definite cause of the kidney disorder is to be investigated by a study control team set up by the Health Ministry.

Health Minister Budi Gunadi Sadikin in his visit to the Editorial Board of Kompas in Jakarta on Friday (4/11/2022) said the study control team was tasked with an epidemiological investigation to find the definite cause of acute kidney injury in children. It is strongly suspected that the cause is poisoning by ethylene glycol (EG) and diethylene glycol (DEG) in syrup medicines. Cases have been found in patients without any history of syrup medicine consumption and there have also been cases of patients drinking the medicine without being affected by acute kidney injury.

“It’s necessary to conduct systematic examination or research to find out its definite cause. We hope this will be finished within the next two to four weeks,” he said.

DOK DPR ACEH

Members of Commission V of the Aceh House of Representatives review the treatment of children with acute kidney failure at the Zainoel Abidin Regional General Hospital, Banda Aceh, Monday (24/10/2022).

However, the biggest risk of acute kidney injury cases in children is now still the consumption of drugs contaminated by EG and DEG. “Is it 100 percent due to drugs? Maybe not. But such a possibility is very slim. It’s because as proven, when we stopped (drug consumption), they (the cases) drastically decreased straightaway,” he pointed out.

Besides, another proof is based on results of examination of blood and urine samples of children with acute kidney injury. In more than 70 percent of patients the dangerous EG and DEG chemical compounds were found.

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From a number of drugs consumed by patients harmful chemicals were also found. Yet another proof is based on results of the patients’ kidney biopsy, which confirmed the toxic impact of the medicines contaminated by EG and DEG.

This proof convinced us that the biggest risk factor comes from medicines.

“When patients are given special drugs concerned with toxicology rather than parasites, they get better and recover. This proof convinced us that the biggest risk factor comes from medicines,” he said.

Revision of rules

Budi added that the rules in the Indonesian Pharmacopeia would also be revised by the Health Ministry to increase public protection from pharmaceutical products. Today the rules only stipulate standards for basic medicinal substances, while additional materials like solvents are not yet regulated. “Within a week they are expected to be revised to include standards for contaminants of additional drug materials, particularly EG and DEG,” he said.

The World Health Organization (WHO) on its official website issues a warning of contaminated syrup medicines related to the report from the Indonesian Food and Drug Monitoring Agency (BPOM). Eight identified drugs in Indonesia belong to the list of contaminated medicines, which are Termorex syrup batch AUG22A06, Flurin DMP syrup, Unibebi Cough syrup, Unibebi Demam Paracetamol Drops, Unibebi Demam Paracetamol syrup, Paracetamol Drops, Paracetamol syrup mint and Vipcol syrup.

According to Budi, at present the Health Ministry limits syrup medicine that can be consumed by the public. The list of drugs that are considered safe is limited to those using only water-based solvents and medicines for certain patients, such as epileptics, which require a doctor’s prescription.

With reference to data from the Health Ministry on 3 November 2022, acute kidney injury cases in Indonesia totaled 323 comprising 99 cases of recovery, 34 cases of treatment and 190 deaths. With the large number of acute kidney injury cases in children, Budi admitted that he shared responsibility for the situation.

In handling the cases, the institution cannot act as fast as developed countries do. Even so, the Health Ministry keeps striving to deal with these cases optimally. In the initial period of the discovery of cases in Indonesia, experts found it difficult to determine the cause.

Although the definite cause of atypical progressive acute kidney injury has not yet been identified, the Health Ministry has conservatively decided to suspend the use of syrup or liquid medicines. This decision is based on a report by the WHO from similar cases in Gambia.

KOMPAS/PRIYOMBODO

A mother buys medicine at the Wisnu pharmacy, Ciledug, Tangerang City, Banten, Sunday (10/23/2022).

Health Ministry spokesman Mohammad Syahril at a press conference said Fomepizole is part of therapy for children with acute kidney injury, which is fully borne by the government. The use of this drug has a positive effect on patients. After therapy, 95 percent of child patients treated at Cipto Mangunkusumo Hospital in Jakarta have recovered.

A total of 246 vials of Fomepizole have been imported to Indonesia; 146 vials of which were distributed to 17 hospitals treating children with acute kidney injury. Meanwhile, the other 100 vials will be kept as reserve.

A pharmacologist of Gadjah Mada University in Yogyakarta, Zullies Ikawati, said EG and DEG contaminant poisoning had various degrees of severity. The levels of severity in patients depend on the doses consumed, the status of nutrition, the activity of body enzymes and the factor of other illnesses.

“Actually, syrup drugs containing these compounds are easily and quickly discarded from the body through urine and feces. But there can be a serious impact if they are consumed in big quantities and doses,” she said. Malnutrition can also cause severe poisoning of EG contaminants because immunity is lowered. (TAN/Z03/Z14)

This article was translated by Aris Prawira.