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"Perubahan bentuk kaki pada pasien neuropati diabetik mempengaruhi fungsi kaki sebagai landasan penopang dalam mempertahankan keseimbangan tubuh. Penelitian ini bertujuan untuk mengetahui hubungan bentuk kaki dengan keseimbangan fungsional pada pasien neuropati diabetik. Desain penelitian ini adalah analitik cross sectional dengan jumlah sampel 132 pasien neuropati diabetik. Analisis data menggunakan Chi Square, Pooled T-test, dan regresi logistik berganda. Hasil penelitian menunjukkan adanya hubungan antara bentuk kaki dengan keseimbangan fungsional pada pasien neuropati diabetik, dengan kekuatan hubungan sedang dan arah hubungan positif (p= 0,001; α= 0,05; r= 0,352). Penelitian ini merekomendasikan perawat untuk melakukan deteksi dini dan mencegah resiko jatuh pada pasien neuropati diabetik terkait perubahan bentuk kaki dan keseimbangan fungsional.

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Changes in foot posture in diabetic neuropathy patients affects the function of the legs as the base of support in maintaining body balance. The study aimed to determine the correlation of foot posture with functional balance in diabetic neuropathy patients. This study design was analytic cross sectional, recruited 132 diabetic neuropathy patients. Statistical analysis used Chi Square, Pooled T-test, and multiple logistic regression. The results showed a significant correlation between foot posture and functional balance in diabetic neuropathy patients the power of correlation is moderate and positive direction (p= 0.001; α= 0.05; r= 0.352). This study suggests the nurse to perform early detection and prevention of the risk of falls in diabetic neuropathy patients related to changes in foot posture and functional balance."

"Latar Belakang : Ultrasonografi dua dimensi sampai saat ini masih digunakan untuk mendeteksi penyakit ginjal kronik , namun hasil yang didapat sering tidak memuaskan terutama pada penderita penyakit ginjal diabetik karena hasil yang didapatkan seringkali normal. Pemeriksaan ultrasonografi color doppler dengan renal resistive index(RI) banyak digunakan sebagai alat diagnostik dan prognostik bebagai kondisi vaskuler ginjal baik pada transplantasi maupun pada penyakit ginjal kronik, namun manfaat pemeriksaan RI pada penyakit ginjal diabetik masih belum jelas. Tujuan : Mengetahui korelasi Renal Resistive Index dengan e GFR (CKD-EPI) pada penderita penyakit ginjal diabetik. Metode Penelitian : Studi Potong Lintang dengan subjek penelitia pasien PGD stadium 1-5, dilakukan di RSCM pada Bulan Januari-Februari 2015. Jumlah subjek sebanyak 34 orang. Dilakukan Pemeriksaan USG 2 Dimensi dan USG doppler dan pemeriksaan eGFR (CKDEPI). Analisa statistik dengan Spearman?s correlation. Hasil : Rerata Usia subjek penelitian 55,8 tahun, Rerata RI pada stadium 1 adalah 0,65, stadium 2 ,0,64, stadium 3 rerata RI adalah 0,72, stadium 4 adalah 0,78 dan stadium 5, rerata RI 0,8. Korelasi antara RI dan e GFR (CKD-EPI) pada penderita penyakit ginjal diabetik adalah r=-0,84 dengan p=0.000, R2 =0,714. Simpulan : Terdapat korelasi negatif yang kuat antara Renal resistive index dengan eGFR(CKD-EPI) pada penyakit ginjal diabetik.

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Background : Two dimension ultrasonografi is still be used to detect chronic kidney disease but the result is not satisfying because the image shows normal on early phase of diabetic kidney disease. Doppler ultrasound with using renal resistive index (RI) Doppler ultrasound with renal resistive index (RI) used as diagnostic and prognostic tool in every vasculer condition of kidney in transplantation or chronic kidney disease, but the advantages of RI in diabetic kidney disease still unclear.

Objective : To Determine correlation between renal resistive index (RI) and e GFR (CKDEPI) in diabetic kidney disease.

Methods : A cross sectional Study, All patients with diabetic kidney disease stage 1-5 (n=34). Patients were examined using doppler ultrasound to look for renal resistive index and e GFR using CKD-EPI method, from January to February 2015 in Cipto Mangunkusumo Hospital Jakarta. Statistically analyzed by Spearman's Correlation.

Results : The mean Age of the patients was 55,8 yr. The mean RI in stage 1 was 0,65, stage 2 was 0,64, stage 3 was 0,72, stage 4 was 0,78 and stage 5 was 0,8. The correlation between RI and e GFR (CKD-EPI) in diabetic kidney disease, r= -0,84 with p=0,000, R2=0,714.

Conclusion :There is a strong negative correlation between RI and e GFR (CKD-EPI) in diabetic kidney disease."

"Nefropati diabetik merupakan salah satu gangguan sistem perkemihan yangdiakibatkan oleh komplikasi dari diabetes melitus. Analisis praktik residensikeperawatan ini menggambarkan pengalaman penulis dalam melakukan asuhankeperawatan pada pasien khususnya pasien dengan gangguan sistem perkemihan.Adapun fokus kegiatan yang dilaksanakan yaitu penerapan teori self care pada 30asuhan keperawatan pasien dengan gangguan sistem perkemihan, pelaksanaanintervensi keperawatan berdasarkan bukti ilmiah yaitu penerapan kompres hangatlembab untuk mengurangi intensitas dan nyeri kram otot pada pasien hemodialisis sertapenerapan program inovasi berupa upaya peningkatan adekuasi pasien melaluipemenuhan durasi hemodialisis. hasil yang diperoleh menunjukkan bahwa penerapankompres hangat lembab dapat menurunkan intensitas kram dan nyeri otot pada pasienhemodialisis dan pemenuhan durasi hemodialisis l0 - 12 jam per minggu dapatmeningkatkan capaian adekuasi pasien hemodialisis.

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Disbetic nephropathy is one of the urinary system disorders caused by complications from diabetes mellitus. Analysis of nursing practice residency describes tlte author's experience in performing nursing care to patients, especially patients with urinary system disorders. The focus of activities include the application of self-care theory to 30 nursing care of patients with urinary system disorders, the implementation of nursing interventions based on scientific evidence, that the application of moist u)arm

compresses to reduce the intensity and pain of muscle cromps in hemodialysis patients

and the opplication of innovation progrqffis in the form of efforts to increase patient adequacy through fulfilling the duration of hemodialysis. The results obtained indicate

that the application of moist warm compresses can reduce the intensity of cramps and

muscle pain in hemodialysis patients and the fuffillment of the duration of hemodialysis

10-12 hours per week can improve the achievement of adequacy of hemodialysis

patients."

"Latar Belakang: Hiperglikemia kronik pada diabetes akan menyebabkan peningkatan produksi reactive oxygen species ROS yang berkontribusi terhadap progresifitas nefropati. Kurkumin telah terbukti memiliki khasiat renoprotektif pada nefropati diabetik melalui efek antioksidan. Tetapi, kurkumin memiliki kekurangan yaitu, bioavailabilitas rendah, metabolisme lintas pertama yang ekstensif, dan kelarutan yang buruk. Penelitian ini bermaksud untuk mengetahui efek kurkumin dalam bentuk nanopartikel nanokurkumin terhadap tikus diabetes yang diinduksi Streptozotocine-Nikotinamide terhadap progresifitas nefropati melalui hambatan stress oksidatif. Metode: Tikus jantan Sprague Dawley diinduksi diabetes melalui pemberian Nikotinamide 100 mg/kg , dilanjutkan dengan Streptozotocine 55 mg/kg , dosis tunggal, intraperitoneal. Kemudian, tikus dibagi menjadi 4 kelompok; normal, DM tanpa treatment, DM treatment kurkumin 100 mg/kg, dan DM treatment nanokurkumin 100 mg/kg, selama 30 hari. Fungsi fisiologis dinilai berdasarkan BB, GDP, dan rasio berat ginjal. Fungsi ginjal dinilai berdasarkan klirens kreatinin, BUN, dan proteinuria. Kerusakan histologis dinilai dari scoring pewarnaan HE. Stress oksidatif diukur dari kadar malondialdehyde MDA dan kadar superoxide dismutase SOD. Hasil: Meski tidak signifikan, pemberian nanokurkumin menunjukkan efek yang lebih baik daripada pemberian kurkumin berdasarkan parameter SOD, GDP, berat badan, rasio berat ginjal, klirens kreatinin, protein urin, dan gambaran histopatologi. Pemberian nanokurkumin secara signifikan menurunkan kadar BUN. Kesimpulan: Setelah 30 hari pemberian nanokurkumin 100 mg/kg BB maupun kurkumin dengan dosis sama tidak dapat menurunkan stress oksidatif, namun dapat mencegah progresifitas nefropati diabetikum.

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Background: Chronic hyperglycaemia in diabetes leads to the overproduction of reactive oxygen species ROS that these contribute to the development of diabetic nephropathy. Curcumin, has been recently discovered to have renoprotective effects on diabetic nephropathy DN through its antioxidant properties. However, low peroral bioavailability, extensive first pass metabolism, and low solubility is a major limiting factor for the success of clinical utilization of curcumin. The present study was undertaken to examine the effect of curcumin formed in nanoparticles nanocurcumin treatment in Streptozotocine Nicotinamide induced diabetic rat on the progressivity of nephropathy through its stress oxidative inhibition.

Method: Diabetes was induced by Nicotinamide 100 mg kg followed by Streptozotocine 55 mg kg, single dose, intraperitoneal, in male Sprague Dawley rats. Then rats divided into four groups, namely normal, diabetic, diabetic treated with curcumin 100 mg kg, and diabetic treated with nanocurcumin 100 mg kg for 30 days. Physiological function was assessed by body weight, FBG, and kidney weight ratio. Renal function was assessed by creatinine clearance, BUN, and proteinuria. Diabetic renal damage was determined by Hematoxyclin Eosin HE staining. Oxidative stress was measured by renal malonaldehyde MDA level, and superoxide dismutase SOD level.

Result: Although did not significant, nanocurcumin showed better effect than curcumin based on SOD, FBG, body weight, kidney weght ratio, creatinine clearance, proteinuria, and renal histopathological changes. Nanocurcumin showed significant decreases in BUN level.

Conclusion: After 30 days of treatment, both nanocurcumin and curcumin 100 mg kg did not decreases oxidative stress but showed inhibition in progressivity of nephropathy."

"Latar Belakang: Tindakan revaskularisasi menjadi hal yang penting dalam penyembuhan ulkus kaki diabetikum dengan penyakit arteri perifer, karena berperan dalam merestorasi fungsi perfusi jaringan tungkai. Selain itu, beberapa studi juga melaporkan bahwa tindakan ini juga dapat mengurangi risiko komplikasi kardiovaskular. Namun, belum ada penelitian di Indonesia yang secara ekslusif membahas efektivitas revaskularisasi pada pasien ulkus kaki diabetik dengan penyakit arteri perifer. Tujuan penelitian ini adalah membandingkan tingkat kesembuhan ulkus kaki diabetik dengan penyakit arteri perifer terhadap pasien yang dilakukan revaskularisasi maupun yang tidak dilakukan revaskularisasi.Metode: Penelitian ini berlangsung dari Januari hingga Mei 2023, di RSUPN Cipto Mangunkusumo, dengan desain kohort retrospektif.Hasil: Jumlah sampel pada masing-masing tindakan adalah 23 pasien. Tingkat kesembuhan pasien ulkus kaki diabetik dengan penyakit arteri perifer yang mendapatkan tindakan revaskularisasi adalah 78,3% (18 pasien), sementara yang tidak mendapatkan tindakan revaskularisasi 26,1% (6 pasien). Pasien yang menjalani tindakan revaskularisasi memiliki peluang 14,944 (1,102–202,692) kali lebih tinggi untuk mengalami kesembuhan luka dibandingkan pasien ulkus kaki diabetik dengan penyakit arteri perifer yang tidak mendapatkan tindakan revaskularisasi (p < 0,01). Setelah mengontrol faktor perancu, tindakan revaskularisasi tetap ditemukan berpengaruh terhadap kesembuhan pasien dengan WIfI stadium 2-3 memiliki peluang 11,926 (1,438–98,883) untuk mengalami penyembuhan luka dibandingkan pasien dengan WIfI stadium 4.Kesimpulan: Tingkat kesembuhan pasien revaskularisasi lebih tinggi dibandingkan non-revaskularisasi. Selain itu, keparahan luka berdasarkan WIfI juga berpengaruh pada kesembuhan luka pasien.

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Background: Revascularization is important in the healing of diabetic foot ulcers with peripheral arterial disease, because it plays a role in restoring the perfusion function of the leg tissues. In addition, several studies also report that this action can also reduce the risk of cardiovascular complications. However, there is no study in Indonesia that exclusively discusses the effectiveness of revascularization in diabetic foot ulcer patients with peripheral arterial disease. This study aims to compare the healing rates of diabetic foot ulcers with peripheral arterial disease in patients who underwent revascularization and those who did not undergo revascularization.

Methods: This study was conducted from January to May 2023, at Cipto Mangunkusumo General Hospital, with a retrospective cohort design.

Results: The number of samples in each group was 23 patients. The healing rate for diabetic foot ulcer patients with peripheral arterial disease who received revascularization was 78.3% (18 patients), while those who did not receive revascularization was 26.1% (6 patients). Patients who underwent revascularization had a 14.944 (1.102–202.692) times higher chance of getting their wound healed than patients with diabetic foot ulcers with peripheral arterial disease who did not receive revascularization (p <0.01). After controlling for confounding factors, revascularization was still found to have an effect on healing. Patients with WIfI stage 2-3 had a 11,926 (1,438–98,883) chance of experiencing wound healing compared to patients with stage 4 WIfI.

Conclusion: The wound healing rate for revascularized patients is higher than non-revascularized patients. In addition, the severity of the wound based on WIfI score also affects the patient's wound healing.

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"Penyakit Ginjal Diabetes (PGD) dapat menyebabkan albuminuria, yang berkembang menjadi insufisiensi ginjal. Namun, sekitar 20-40% kasus PGD merupakan PGD normoalbuminuria, yaitu gangguan fungsi ginjal dengan kadar albumin normal. Penelitian ini untuk membandingkan metabolit urin pada pasien penyakit ginjal diabetes dengan normoalbuminuria dan albuminuria yang mengonsumsi metformin-glimepirid. Desain penelitian potong lintang dengan metode consecutive sampling di Puskesmas Kecamatan Pasar Minggu dan RSUD Jati Padang. Sampel urin dan darah dikumpulkan untuk pengukuran HbA1c, UACR, dan analisis metabolit urin. Sebanyak masing-masing 16 pasien dibagi menjadi kelompok PGD normoalbuminuria dan PGD albuminuria, serta dianalisis metabolit urinnya menggunakan metabolomik tidak tertarget dengan Quadruple Time of Flight Liquid Chromatography-Mass Spectrometry. Metabolit yang berbeda signifikan divisualisasi dengan Projections to Latent Structures Discriminant Analysis (PLS-DA). Lalu, dianalisis nilai Variable Importance for the Projection (VIP) > 1.0; Fold Change (FC) >1,2 (p<0,05); dan Area Under the Receiver Operating Characteristic Curve (AUROC). Metabolit dengan nilai Area Under Curve (AUC) > 0,65 dinilai sebagai biomarker potensial. Tidak ada perbedaan bermakna pada karakteristik dasar dan klinis pada kedua kelompok, kecuali HbA1c (p<0,001). Terdapat 20 metabolit urin yang berbeda signifikan pada kelompok PGD normoalbuminuria dan albuminuria. Dari analisis jalur metabolisme pada metabolit tersebut ditemukan empat jalur metabolisme, yaitu metabolisme gliserofosfolipid, eter lipid, fenilalanin, dan triptofan. Dari keempat jalur metabolisme tersebut, ditemukan tiga metabolit biomarker potensial, yaitu glycerophosphocholine, hippuric acid, dan 2-aminobenzoic acid. Ketiga metabolit tersebut berkurang secara signifikan dari kondisi normoalbuminuria ke albuminuria. Oleh karena itu, diperlukan studi lanjut mengenai ketiga metabolit tersebut pada perkembangan PGD normoalbuminuria dan albuminuria.

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Diabetic Kidney Disease (DKD) leads to albuminuria and gradually progresses to renal insufficiency. However, about 20-40% of DKD are normoalbuminuric DKD, which has impaired kidney function with normal albumin levels. This study compared urine metabolites in patients consuming metformin-glimepiride with normoalbuminuric and albuminuria DKD. The research design was cross-sectional with consecutive sampling method at Pasar Minggu District Public Health Centre and Jati Padang Hospital. Urine and blood samples were collected for measurement of HbA1c, UACR, and metabolite analysis. There were each 16 samples divided into normoalbuminuric DKD group and albuminuria DKD group. All subjects were analysed using non-targeted metabolomics with Quadruple Time of Flight Liquid Chromatography-Mass Spectrometry. The signature metabolites were determined by Projections to Latent Structures Discriminant Analysis (PLS-DA) with Variable Importance for the Projection (VIP) > 1.0; Fold Change (FC) >1.2 (p<0.05); and Area Under the Receiver Operating Characteristic Curve (AUROC). Metabolites with an Area Under Curve (AUC) value > 0.65 are considered potential biomarkers. There were no significant differences in baseline and clinical characteristics of two groups, except for HbA1c (p<0.001). There were 20 metabolites identified between two groups. The metabolic pathway analysis of these metabolites found that four metabolic pathways were glycerophospholipid, ether lipid, phenylalanine, and tryptophan metabolism. There were three potential biomarkers, glycerophosphocholine, hippuric acid, and 2-aminobenzoic acid, enriched in these four metabolic pathways. Compared between normoalbuminuric and albuminuria groups these three metabolites were significantly reduced. Therefore, further studies are needed regarding these three metabolites in the development of normoalbuminuric and albuminuria DKD."

"Ulkus diabetikum merupakan salah satu komplikasi kronis diabetes melitus dan menjadi penyebab amputasi kaki. Infeksi pada ulkus tersebut umumnya disebabkan oleh Staphylococcus aureus. Salah satu teknik pencegahan amputasi kaki diabetes adalah perawatan ulkus. Berbagai jenis bahan kompres ulkus diabetikum yang telah dikenal selama ini adalah:kompres madu, gula, Iodine, dan NaCl 0,9%. Penelitian ini bertujuan mengetahui efektifitas bahan kompres ulkus terhadap daya hambat Staphylococcus aureus. Penelitian ini merupakan penelitian eksperimen in vitro menggunakan satu faktor perlakuan yaitu zona hambat bahan kompres terhadap Staphylococcus aureus pada ulkus diabetikum. Enam jenis bahan yang diuji adalah aquadest, gula, Iodine 10%, campuran gula dan Iodine 10 %, madu, dan NaCl 0,9 %. Eksperimen dilakukan sebanyak 10 kali untuk mengetahui rerata luas daya hambatnya selama 24 jam. Sampel diambil dari ulkus diabetikum. Staphylococcus aureus diisolasi dari ulkus tersebut untuk eksperimen dengan berbagai bahan kompres ulkus. Hasil penelitian menunjukkan bahwa zona hambat madu rata-rata sebesar 0,4 mm, gula 3,0 mm, aquadest 0,0 mm, NaCl 0,9% 0,0 mm, Iodine 10% 8,3 mm dan campuran gula-Iodine 6,0 mm. Zona hambat terluas dihasilkan dari uji menggunakkan Iodine 10% (8,3 mm). Sementara campuran gula Iodine 10% menghasilkan zona hambat seluas 6 mm dan gula menghasilkan 3 mm. Penelitian ini merekomendasikan jika ditemukan Staphylococcus aureus maka dilakukan kompres Iodine 10% dengan kasa steril. Penelitian selanjutnya dengan metode in vivo perlu dilakukan untuk mengetahui efektifitas cairan Iodine pada ulkus diabetikum.Effectivity of Iodine Compress to Blocking Zone of Staphylococcus aureus in Diabetes Ulcers. Diabetic foot ulcers is one of diabetes chronic complications that might lead to leg amputations. Staphylococcus aureus is known as the cause of infection in diabetic foot ulcers. One of techniques to prevent diabetic foot amputations is wound care. Various materials are known to be used to compress diabetic foot ulcers. These include of using honey, sugar, 10% of Iodine and 0.9% of NaCl. This study aimed ttify to identify the effectiveness of various wound care materials to block Staphylococcus aureus. This is an in vitro experiment study to investigate the effetiveness of six wound care materials used to wounds compress: distilled water, sugar, 10% of Iodine, a mixture of sugar and Iodine, honey and 0.9% of NaCl. Experiments were carried out in 10 times to determine the average size of block area in 24 hours. Staphylococcus aureus were isolated and soiled with various wound compressss materialls. The results showed that honey produced 0.4 mm of a blocking zone, 3.0 mm for glucose, 0.0 mm for distilled water, 0.0 mm for 0.9% of NaCl, 8.3 mm for 10% of Iodine, and 6.0 mm for mixed-Iodine Sugar. Ten percents of Iodine produced the widest zone to block Staphylicoccus aureus. This study recommends of apllying a 10% of Iodine compress if there is a positive culture of Staphylococcus aureus. A further in vivo study is a necessity to investigate the effectiveness of Iodine to diabetes foot ulcers."

"ABSTRAKPenyakit ginjal diabetes merupakan salah satu penyebab utama gagal ginjal stadium akhir, sehingga dibutuhkan penanda biologis yang spesifik dan sensitif untuk mengantisipasi progresi penyakit. Sistem renin-angiontensin aldosteron diketahui memiliki peran yang signifikan dalam perkembangan awal penyakit ginjal diabetes, sehingga renin sebagai salah satu komponen sistem renin-angiotensin aldosteron memiliki potensi sebagai penanda awal penyakit ginjal diabetes. Penulisan review article ini bertujuan untuk mengkaji literatur-literatur terkini yang meneliti hubungan kadar renin pada urin dengan perkembangan kerusakan ginjal. Review bersifat sistematik berdasarkan acuan Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA) tahun 2009 dengan pendekatan kualitatif. Literatur yang dikaji diperoleh melalui pencarian internet pada database ScienceDirect, PubMed, dan SpringerLink. Sebanyak 5 literatur dipilih berdasarkan kriteria yang ditetapkan. Hasil analisis literatur menunjukkan bahwa potensi renin urin sebagai penanda biologis penyakit ginjal diabetes cukup besar dikarenakan renin urin akan meningkat pada kondisi kerusakan ginjal. Selain itu, renin urin juga dapat menggambarkan aktivitas sistem renin-angiotensin aldosteron intrarenal dan memiliki korelasi positif dengan albuminuria. Hasil analisis literatur juga menunjukkan bahwa tidak adanya korelasi antara eLFG dan renin urin pada pasien dengan penyakit ginjal diabetes. Namun, renin urin secara signifikan lebih tinggi pada pasien dengan penyakit ginjal diabetik dibandingkan dengan pasien dengan penyakit ginjal kronis.

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ABSTRACT

Diabetic kidney disease is one of the main causes of end-stage renal disease, therefore there is a need for specific and sensitive biological markers to anticipate progression of the disease. The renin-angiontensin aldosterone is known to have a significant role in the early development of diabetic kidney disease, that means renin as one of the components of the renin-angiotensin aldosterone system has a potential as an early biomarker for diabetic kidney disease. This review article aims to review latest literatures that studied the relationship of renin levels in urine with the development of kidney damage in patients with diabetes or chronic kidney disease. This systematic review was written based on the Reference Reporting Item Options for Systematic Review and Meta-Analysis Guide (PRISMA) of 2009 with a qualitative approach. The literature studied was obtained through an internet search in the ScienceDirect, PubMed, and SpringerLink databases. A total of 5 literatures were chosen based on specified criteria. The results of the literature analysis showed that urinary renin has a promising potential as a biological marker for diabetic kidney disease because urinary renin will likely increase in presence kidney damage. In addition, urinary renin can also describe the activity of the intrarenal renin-angiotensin aldosterone system and positively corelates with albuminuria. The results of the literature analysis also showed no correlations between eGFR and urinary renin in patients with diabetic kidney disease. However, urinary renin were significantly high in patients with diabetic kidney disease compared to patients with chronic kidney disease."