Analysis of the causes of atypical progressive acute kidney failure in children (APAKF)

Abstract

Background: The Acute Kidney Failure in Children (AKF) case in Indonesia has been a significant public health concern. A total of 326 pediatric patients were confirmed to have AKF due to the consumption of syrup drugs containing Ethylene Glycol (EG) and Diethylene Glycol (DEG) exceeding safe limits. Among these cases, 204 patients were confirmed dead. The study aims to investigate the underlying causes, handling, and supervision of these cases. Methods: This research employs a qualitative approach. Primary data were obtained through direct examinations, limited meetings with stakeholders, correspondence, field visits, and interviews with relevant parties. Secondary data were gathered from other agencies and investigations to enrich the findings. The validity of the data was ensured through interviews with various parties, including experts, to gain an overview of the handling and supervision of AKF events. Findings: The findings reveal that GGAPA cases occurred primarily because the syrup drugs consumed by children, aged 1-10 years, contained EG/DEG that exceeded safe limits. The study found that the government's healthcare system was not adequately integrated, leading to the late detection of the surge in AKF cases. Furthermore, the coordination between the Indonesian Ministry of Health and the National Agency of Drug and Food Control (BPOM) was suboptimal and lacked mutual support. As a result, six pharmaceutical industries were sanctioned for producing syrup drugs that exceeded the EG/DEG limits. The Indonesian Ministry of Health's prohibition on the use, prescription, and sale of syrup drugs has been effective in reducing the number of GGAPA cases. Conclusion: The study underscores the critical need for an integrated healthcare system in Indonesia to prevent such incidents in the future. Improved coordination between health agencies is essential to ensure timely detection and response to public health crises. Novelty/Originality of this article: This study highlights the unique contribution of analyzing the AKF cases in Indonesia, particularly focusing on the impact of government coordination and the effectiveness of regulatory measures in addressing the crisis. The findings provide new insights into the consequences of inadequate healthcare systems and the importance of rigorous drug safety protocols.