Nina A. Loasana, Jakarta – The Health Ministry has formed a team of medical experts to investigate cases of acute kidney failure of unknown origin in children as cases continue to pop up around the country.
As of Monday, the ministry had recorded at least 189 cases of fatal kidney failure in 20 provinces with 74 fatalities since January.
Ministry spokeswoman Siti Nadia Tarmidzi said that the team would study the origins of the mysterious disease.
"The team comprises epidemiologists, clinical pathologists, officials from the Health Ministry, doctors from the Indonesian Pediatrician Association [IDAI], officials from the Food and Drug Monitoring Agency [BPOM] and the World Health Organization's [WHO] representatives in Indonesia," Siti told The Jakarta Post on Monday.
The ministry has found cases of unusual acute kidney failure in the country since January, with cases beginning to show a significant uptick in August. Most of the patients were under the age of five, with no congenital kidney anomalies, chronic kidney diseases, nor major blood or fluid loss prior to their kidney failure.
According to IDAI head Piprim Basarah Yanuarso, almost all patients developed fever, acute respiratory infection or gastrointestinal infections between one and two weeks before their kidney failure.
"Their kidney function worsened quickly and soon they developed either oliguria – abnormally small amounts of urine production – or anuria – failure to produce urine. Both are predictive biomarkers of acute kidney injury," Piprim said on Friday.
Although no definitive cause of the acute kidney failure has been found yet, the ministry is looking into the possibility that it might be linked to similar cases found in Gambia.
Nearly 70 children in Gambia died from acute kidney failure after taking paracetamol syrups made by New Delhi-based Maiden Pharmaceuticals Ltd. used to treat fever. Investigators from the WHO have found "unacceptable" levels of diethylene glycol and ethylene glycol, which can be toxic, in four products made by the company.
The BPOM said in a statement the syrups were not registered in Indonesia and the use of the two contaminants in any medicinal syrup products had been banned. The agency, however, is investigating the possibility that the two toxic ingredients had contaminated other materials that are used as solvents in other medicines sold in Indonesia.
Sumariyono, director of nursing and medical services at Cipto Mangunkusumo Hospital (RSCM) in Central Jakarta, said on Friday that doctors so far had not found any indications of ethylene glycol intoxication in the 44 patients treated at the hospital.
"But we're still continuing to investigate all the medications previously taken by the patients," he said.
Linked to COVID-19?
Epidemiologist Dicky Budiman has said that although it could not be conclusively proven yet, there was a strong possibility that the influx of acute kidney failure in children was linked to previous COVID-19 infections.
"The influx of this mysterious acute kidney failure occurred just months after reports of more than a thousand cases of severe acute hepatitis of unknown etiology in children across the globe," Dicky said recently. "Considering that long COVID has been linked to kidney damage and liver diseases, there is a strong possibility that it might be caused by previous infections of the SARS-CoV-2 virus."
Dicky said there was a possibility that the COVID-19 virus could attack the lymphatic system and impair immune function, causing one's body to be more prone to infections. Children under the age of six are especially vulnerable to this phenomenon, as they have not yet been eligible for COVID-19 vaccines.
IDAI nephrologist Eka Laksmi Hidayati said that doctors found hyper inflammation of various organs in patients with acute kidney injury, which was very similar to multisystem inflammatory syndrome in children (MIS-C). MIS-C is a rare but serious condition associated with COVID-19 in which different body parts – for instance, heart, lungs or kidneys – become inflamed.
"However, after further inspection we found different viruses and bacteria in patients. Usually during an outbreak, we'll find the same virus or bacteria in all patients. So we can't positively conclude that it is linked to long COVID," she said.
Based on RSCM data, only 58 percent of patients treated for acute kidney injury had antibodies against COVID-19, indicating that they had previously contracted the disease.