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"Pola sirkadian tekanan darah (TD) adalah gambaran TD 24 jam berupa kurva TD yang meningkat pada pagi hari, menurun pada siang / sore hari dan terendah pada malam hari / waktu tidur. 24 hours Ambulatory Blood Pressure Monitoring (24 hrs ABPM) merupakan alat pengukur TD yang lebih akurat dan dapat memperlihatkan pola sirkadian TD 24 jam. Turunnya TD 10 - 20% pada malam hari disebut dipper, jika turun < 10% disebut nondipper. Meningkatnya TD 24 jam dan nondipper merupakan faktor risiko morbiditas dan mortalitas kardiovaskular. Prevalensi hipertensi dan nondipper pada Penyakit Ginjal Kronik Stadium 5 dalam Terapi Dialisis (PGK 5D) masih sangat tinggi. Faktor utama penyebab hipertensi pada PGK 5D adalah menurunnya Laju Filtrasi Glomerulus (LFG) dan meningkatnya cairan ekstraselular. Transplantasi ginjal akan memperbaiki TD dan nondipper dengan membaiknya LFG, meningkatnya produksi urin dan menurunnya cairan ekstraseluler. Namun demikian satu bulan Pasca Transplantasi Ginjal kebutuhan dosis obat imunosupresan masih cukup tinggi yang dapat mengakibatkan hambatan penurunan TD. Tujuan : Mengetahui perbedaan pola sirkadian TD, data dipper / nondipper dan rerata TD 24 jam pada pasien PGK Pra dan satu bulan Pasca Transplantasi Ginjal. Metode Penelitian : Studi Pre experimental dengan before and after design. Subjek penelitian pasien PGK 5D / Pra Transplantasi Ginjal berusia 18 ? 60 tahun, dilakukan di RSCM pada bulan Oktober sampai dengan Desember 2014. Jumlah subjek sebanyak 15 orang. Dilakukan pengumpulan urin 24 jam, pemeriksaan LFG, pengukuran TD 24 jam dengan 24 hrs ABPM, Pra dan satu bulan Pasca Transplantasi Ginjal. Analisis statistik dengan uji McNemar dan uji t dependen. Hasil : Terdapat 12 subjek nondipper dan 3 subjek dipper pada pasien PGK Pra Transplantasi Ginjal. Satu bulan Pasca Transplantasi Ginjal seluruh subjek (15 orang) memperlihatkan keadaan nondipper. Uji McNemar tidak dapat dilakukan karena seluruh subjek PGK satu bulan Pasca Transplantasi Ginjal nondipper (homogen). Terdapat penurunan rerata TD sistolik 24 jam pasien PGK satu bulan Pasca Transplantasi Ginjal yang tidak signifikan (p > 0,05) dan penurunan rerata TD diastolik 24 jam yang signifikan (p < 0,05). Simpulan : Belum terdapat perbaikan nondipper pada pasien satu bulan Pasca Transplantasi Ginjal. Terdapat penurunan rerata TD sistolik 24 jam yang tidak signifikan dan penurunan rerata TD diastolik 24 jam yang signifikan pada pasien satu bulan Pasca Transplantasi Ginjal.

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The circadian pattern of blood pressure (BP) is a 24 hours blood pressure (24hrs BP) curve which increases in the morning, decreases in the afternoon/evening and the lowest state is at night/bedtime. 24 hrs Ambulatory Blood Pressure Monitoring (ABPM) is a BP measuring device that is accurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20% at night is called as a dipper, while less than 10% is called as a nondipper. The increasing of 24 hrs BP and nondipper are the risk factor for cardiovascular morbidity and mortality. The prevalence of hypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis (CKD 5D) are still very high. The main factors causing hypertension in CKD 5D are decreased Glomerular Filtration Rate (GFR) and increased extracellular fluid. Kidney transplantation will improve BP and nondipper by GFR improvement, increases urine production and decreases extracellular fluid. However, one month after kidney transplantation, the dose of immunosuppressant drugs is relatively high, which is an obstacle to decrease BP.

Aim: To determine differences in the circadian pattern of BP, the data of dipper and nondipper, and the mean of 24 hrs BP in CKD before, and one month after kidney transplantation.

Methods: Design of the study is before and after design. Subjects of the study were patients with CKD 5D before kidney transplantation, aged 18-60 years, were conducted in Cipto Mangunkusumo Hospital during October to December 2014. 15 subjects were included in the study. 24 hrs urine collection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in all subjects, before and one month after kidney transplantation. McNemar test and t dependent test were used in statistical analysis.

Results: Before kidney transplantation, 12 of 15 subjects were nondippers while the others 3 subjects were dippers. After kidney transplantation, all subjects (15 patients) were nondippers. McNemar test can not be used because all subjects one month after kidney transplantation were nondippers (homogeneous). The decreasing of the mean of 24 hrs systolic BP was found in all CKD one month after kidney transplantation, but statistically not significant (p>0.05), while decreasing of the mean of 24 hrs diastolic BP was statistically significant (p<0.05).

Conclusion: There were still no improvement in nondipper patients one month after kidney transplantation. There were a decrease in the mean of 24 hrs systolic BP but statistically not significant and a decrease in the mean of 24 hrs diastolic BP which is statistically significant in patients one month after kidney􀀃transplantation."

"Latar Belakang: Prevalensi obesitas, hipertensi dan penyakit ginjal kronis (PGK) pada pekerja kantor di Jakarta cukup tinggi. Meningkatnya volume lemak viseral pada obesitas, khususnya obesitas sentral,  memiliki kemaknaan klinis yang lebih besar dalam memprediksi kejadian hipertensi dan PGK. Studi ini bertujuan untuk meneliti korelasi nilai lemak viseral tubuh dengan tekanan darah (TD) dan fungsi ginjal pada populasi pekerja kantor dengan obesitas di Jakarta.Metode: Studi potong lintang dilakukan pada 101 pekerja kantor dengan obesitas di RSUPN Cipto Mangunkusumo Jakarta. Pengukuran volume lemak viseral menggunakan alat bioelectrical impedance analysis multifrekuensi SECA mBCA 525. TD diukur dengan tensimeter digital, fungsi ginjal dari hasil perhitungan estimasi laju filtrasi glomerulus (eLFG) berdasarkan nilai kreatinin serum.Hasil: Subjek terbagi menjadi dua kelompok berdasarkan kategori lemak viseral. Sebanyak 91% subjek berada di dalam kelompok lemak viseral tidak normal, dimana didominasi perempuan serta rerata usia dan indeks massa tubuh lebih tinggi dibandingkan kelompok normal. Pada kelompok tersebut, 33,7% diantaranya memiliki TD sistolik ≥140 dan/ atau diastolik ≥90 mmHg, dan 18,5% memiliki eLFG <90 ml/menit/1,73 m2. Adanya korelasi positif antara nilai lemak viseral dengan tekanan darah sistolik (r =0,436, p =0,000) dan diastolik (r =0,306, p =0,002), serta korelasi negatif dengan eLFG (r =-0,284, p =0,004).Kesimpulan: Terdapat korelasi yang bermakna antara lemak viseral dengan tekanan darah dan fungsi ginjal pada pekerja kantor dengan obesitas.

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Background: The prevalence of obesity, hypertension and chronic kidney disease (CKD) among office workers in Jakarta is relatively high. Increased visceral fat in obesity, especially central obesity, has greater clinical significance in predicting the incidence of hypertension and CKD. This study aims to examine the correlation of visceral fat values with blood pressure (BP) and kidney function in office workers in an obese population in Jakarta.

Methods: A cross-sectional study was conducted on 101 office workers with obesity at Cipto Mangunkusumo General Hospital, Jakarta. Visceral fat volume was measured using a multi-frequency bioelectrical impedance analysis SECA mBCA 525. BP was measured with a digital tensimeter, and kidney function was taken from the estimated glomerular filtration rate (eGFR) calculation based on serum creatinine.

Results: Subjects were divided into two groups based on the category of visceral fat. About 91% of the subjects were in the abnormal visceral fat group, dominated by women, and the mean age and body mass index were higher than the normal group. In this group, 33.7% had systolic BP ≥140 and/or diastolic ≥90 mmHg, and 18.5% had an eGFR <90 ml/min/1.73 m2. There was a positive correlation between visceral fat values with systolic (r =0.436, p =0.000) and diastolic BP (r =0.306, p = 0.002) and a negative correlation with eGFR (r =-0.284, p =0.004).

Conclusion: There is a significant correlation between visceral fat and blood pressure and kidney function in office workers with obesity."

"Transplantasi ginjal TG merupakan salah satu terapi pilihan utama pada pasien Gagal Ginjal Terminal GGT . TG dapat meningkatkan kualitas hidup pasien GGT. Kualitas hidup dapat dipengaruhi oleh berbagai faktor, seperti faktor fisik, psikologis dan mental.Tujuan penelitian ini adalah untuk mengetahui faktor- faktor yang mempengaruhi kualitas hidup pasien TG. Desain Penelitian menggunakan Cross Sectional Study, Sampel dalam penelitian ini berjumlah 110 pasien TG dengan tehnik pengambilan sampel menggunakan metode purposive sampling. Instrumen penelitan menggunakan kuesioner kualitas hidup WHOQoL ndash; BREF, yaitu kuesioner yang telah banyak digunakan dalam mengukur kualitas hidup di dunia dan secara validitas dan reabilitas merupakan kuesioner yang valid dan reliabel. Analisi data menggunakan: proporsi, chi- square dan regresi logistik ganda.Hasil penelitian menunjukkan bahwa kualitas hidup pasien TG di RSUPN Dr. Cipto Mangunkusumo adalah baik 71, 8 . Faktor yang mempengaruhi kualitas hidup pasien adalah: usia p = 0,002 , pendidikan p = 0,001 pekerjaan p = 0,010 , dukungan keluarga p = 0,024 , dan kepatuhan pasien dalam mengkonsumsi obat immunosupressant p = 0,009 , faktor yang dominan mempengaruhi kualitas hidup adalah: pendidikan OR= 11, 490 dan kepatuhan dalam mengkonsumsi obat immunosuppressant OR= 10, 530.Kesimpulan: Kualitas hidup pasien TG dipengaruhi oleh, usia, pendidikan, pekerjaan, dukungan keluarga dan kepatuhan pasien dalam mengkonsumsi obat immunosupressant Rekomendasi: Penelitian lebih lanjut terkait dimensi kualitas hidup: dimensi fisik, psikologis, hubungan sosial dan lingkungan dan pemberian intervensi keperawatan berupa edukasi sebelum dan sesudah TG.

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Kidney transplantation KT is one of the major therapies in terminal renal failure. KT can increase Quality of Life QoL of the patients with terminal renal failure. QoL can be affected by several factors, such as physical, psychological and mental factors.The aim of this research is to identify the factors that affects QoL of KT patients. The research design used Cross Sectional Study, with purposive sampling. The samples of study is 110 KT patients. The research instrument uses WHOQoL ndash BREF, instrument WHOQoL ndash BREF has been widely used in measuring the QoL in the world and the validity and reliability is a valid and reliable questionnaire. Data analysis uses proportion, chi square and multiple logistic regression.The results of this research showed that the QoL of KT patients at General Hospital Cipto Mangunkusumo is good 71, 8 . The Factors influencing of the QoL of the patients were age, p 0,002, education p 0,001 occupation p 0,010 , family p 0,024 , and patient adherence to taking immunosuppressant drugs p 0,009.Conclusions The QoL of patients affected by age, education, occupation, family and patient adherence to taking immunosuppressant drugs. Recommendations Further research related to the dimensions of the Qol with are physical, psychological, social and environmental dimensions and Intervention of Nursing through prre and post opertif education of KT."

"Latar Belakang: Transplantasi ginjal adalah modalitas terapi pengganti ginjal yang paling baik bagi pasien dengan Penyakit Ginjal Tahap Akhir (PGTA). Saat ini di Indonesia transplantasi ginjal dengan donor hidup mulai semakin sering dilakukan, terutama di RSUPN Cipto Mangunkusumo, di mana dalam beberapa tahun terakhir lebih dari 50% kasus transplantasi ginjal di Indonesia dilakukan di rumah sakit ini. Walaupun demikian, data mengenai hasil transplantasi di Indonesia, baik kesintasan 1 tahun graft maupun pasien, serta faktor yang diduga mempengaruhinya masih belum ada. Diharapkan hasil transplantasi di rumah sakit ini dapat menggambarkan hasil secara keseluruhan di Indonesia. Metode: Studi kohort retrospektif pada resipien transplantasi ginjal di RSUPN-CM dari Januari 2010 hingga Mei 2014. Data didapatkan dari penelusuran rekam medis serta menghubungi pasien secara langsung. Masing-masing resipien diikuti sejak tanggal transplantasi hingga kematian atau Mei 2015. Proporsi kesintasan graft dan pasien pada 1 tahun post transplantasi dan pada akhir studi didokumentasikan. Kurva Kaplan-Meier digunakan untuk menggambarkan kesintasan pasien secara keseluruhan. Studi deskriptif dilakukan dengan melihat perbedaan proporsi variabel serta perbedaan rerata atau median pada pasien yang mengalami kegagalan graft 1 tahun serta tidak, serta pasien yang bertahan hidup atau meninggal. Hasil: Berdasarkan hasil consecutive total sampling didapatkan 157 resipien yang menjalani transplantasi ginjal di RSUPN-CM, 137 resipien di antaranya memenuhi kriteria penelitian, seluruhnya mendapatkan ginjal dari donor hidup. Usia resipien rata-rata adalah 47,9 ± 13,9 tahun, rerata IMT 22,8 ± 3,7 kg/m2, dan proporsi resipien dengan diabetes 35,8%. Didapatkan 7 pasien mengalami disfungsi graft primer (kegagalan transplantasi), sehingga 130 pasien diikuti untuk melihat kesintasan jangka panjang. Pada akhir tahun pertama, didapatkan angka death-censored graft survival adalah 95,4%, all-cause graft survival 85,4%, kesintasan pasien 88,5%, dan death with a functioning graft sebesar 10%. Pada akhir studi, didapatkan angka kesintasan tersebut berturut-turut adalah 94,6%, 80%, 82,3%, dan 14,6%, dengan median waktu pengamatan 24 bulan (1 ? 64 bulan). Kurva Kaplan Meier menunjukkan angka mortalitas tertinggi didapatkan pada bulan-bulan awal post transplantasi. Kegagalan graft dan kematian didapatkan lebih banyak pada resipien yang berusia lebih tua, mengidap diabetes melitus, serta memiliki indeks komorbiditas yang tinggi. Penyebab kematian utama adalah infeksi (11,5%) diikuti dengan kejadian kardiovaskular (3,8%). Simpulan: Death-censored graft survival 1 tahun resipien transplantasi ginjal di Indonesia sudah sangat memuaskan. Angka death with functioning graft masih cukup tinggi, sehingga menurunkan all-cause graft survival dan kesintasan pasien 1 tahun. Walaupun demikian, secara keseluruhan hasil ini masih sebanding dengan negara-negara berkembang lainnya.

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Background: Kidney transplant is established as the preferred modality for end stage renal disease patients. Living donor kidney transplant is increasingly popular in Indonesia, especially in Cipto Mangunkusumo Hospital, comprising more than 50% of all transplant procedures performed in Indonesia. However, data regarding one-year graft and patient survival in Indonesia is still scarce. This single-center study is hoped to represent the characteristics and results of graft and patient survival of living donor kidney transplant in Indonesia.

Methods: A retrospective cohort study with total consecutive sampling is performed on all kidney transplant recipients in Cipto Mangunkusumo Hospital from January 2010 until May 2014. Data is acquired by analysing medical records and contacting patients directly. Each recipient is followed from the day of transplant until death or May 2015, whichever comes first. One-year graft and patient survival is documented. Kaplan-Meier Curve is used to describe patient survival until the end of study. Descriptive studies on risk factors of graft and patient survival is also conducted, using differences in proportions, means, and medians appropriately.

Results: Within the timeframe there are 157 recipients of living donor kidney transplants, 137 of which fulfill the inclusion criteria. The mean age is 47.9 ± 13.9 years, mean BMI is 22.8 ± 3.7 kg/m2, and 35.8% of all recipients are diabetics. Primary non-function/early transplant failure is present in 7 patients, so that 130 recipients are included for long term survival descriptions. In the end of the first year post transplant, death-censored graft survival is 95.4%, all-cause graft survival is 85.4%, patient survival is 88.5%, and death with a functioning graft is 10%. By the end of the study, the corresponding survival results are 94.6%, 80%, 82.3%, and 14.6%, respectively, with a median observation time of 24 months (1 ? 64 months). Kaplan-Meier curve showed that the mortality rate is higher in the early months after transplant. More deaths and graft failures are found in older and diabetic recipients, as well as those with a high comorbidity index. The main causes of death are infections (11.5%) and cardiovascular diseases (3.5%).

Conclusions: The outcome of one-year death-censored graft survival in Indonesia is very satisfactory. The incidence of death with functioning graft is relatively high, causing a decline in one-year patient survival and all-cause graft survival. However, the overall results are still comparable to other developing countries."

"Latar Belakang: Proses hiperfiltrasi yang ditandai sebagai perubahan dinamik Renal Resistive Index (RRI) merupakan mekanisme adaptasi ginjal pasca berkurangnya massa nefron sudah banyak dielaborasi pada ginjal sisa donor transplan pasca nefrektomi. Belum diketahui bagaimana proses hiperfiltrasi dan rentang nilai RRI normal pada ginjal allograft. Tujuan: Membandingkan proses hiperfiltrasi berdasarkan perubahan dinamis nilai RRI, Peak systolic velocity (PSV), and End Diastolic Velocity (EDV) pada pemeriksaan ultrasonografi pasca operasi hingga satu bulan pasca transplantasi pada kelompok ginjal allograft dan ginjal sisa donor pasangan resipien-donor transplantasi ginjal. Metode: Studi prospektif pada 62 subyek yang merupakan 31 pasangan donor dan resipien transplantasi ginjal yang menjalani operasi transplantasi ginjal di RS dr. Ciptomangunkusumo dari Juli 2023 hingga Februari 2024. Pemeriksaan ultrasonografi dilakukan sebelum operasi, hari ke-7 setelah operasi, dan hari ke-30 setelah operasi. Nilai RRI, PSV, dan EDV dinyatakan dalam nilai rerata dan simpangan baku, dengan perbedaan kedua kelompok nilai menggunakan uji t berpasangan. Hasil: Nilai RRI a. segmental ginjal allograft dan ginjal sisa donor secara berturut-turut saat sebelum operasi, tujuh hari pasca operasi, dan tiga puluh hari pasca operasi adalah 0,61 ± 0,06 vs 0,61 ± 0,06 (p < 0,52), 0,62 ± 0,06 vs 0,68 ± 0,06 (p < 0,001), 0,61 ± 0,06 vs 0,67 ± 0,06 (p < 0,001). Nilai RRI a. arcuata ginjal allograft dan ginjal sisa donor secara berturut-turut saat sebelum operasi, tujuh hari pasca operasi, dan tiga puluh hari pasca operasi adalah 0,56 ± 0,05 vs 0,56 ± 0,05 (p < 0,83), 0,58 ± 0,06 vs 0,62 ± 0,07 (p < 0,05), 0,57 ± 0,06 vs 0,62 ± 0,06 (p < 0,001). Tidak terdapat perbedaan signifikan nilai PSV dan EDV kedua grup. Kesimpulan: Hiperfiltrasi pada ginjal allograft terjadi dengan pola serupa dengan ginjal residu donor transplantasi, dengan perbedaan nilai rerata RRI pada kedua kelompok.

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Background: Hyperfiltration, characterized as a dynamic change in the Renal Resistive Index (RRI), is an adaptation mechanism following reduction in nephron mass, has been elaborated on residual kidneys of transplant donors. It is not yet known how the hyperfiltration process is and the range of normal RRI values in allograft kidneys. Objective: To study the difference of RRI, Peak Systolic Velocity (PSV), and End Diastolic Velocity (EDV) dynamic changes of the allograft kidney and the remaining kidney of the donor, pairs of recipient-donor before transplantation until up to one month after transplantation Method: Prospective study of 62 subjects who were 31 pairs of donor and kidney transplant recipients who underwent kidney transplantation at dr. Ciptomangunkusumo- Hospital from July 2023 - February 2024. Ultrasonography is carried out before surgery, seventh day after surgery, and thirtieth days after surgery. RRI, PSV, and EDV is expressed in mean and standard deviation, with differences between two groups are compared using t-paired test. Results: Comparison of RRI value of segmental artery of allograft kidney and donor residual kidney, before surgery, seventh day, and thirtieth day post nephrectomy/transplantation consecutively are 0,61 ± 0,06 vs 0,61 ± 0,06 (p < 0,52), 0,62 ± 0,06 vs 0,68 ± 0,06 (p < 0,001), 0,61 ± 0,06 vs 0,67 ± 0,06 (p < 0,001). Comparison of RRI value of arcuate artery of allograft kidney and donor residual kidney, before surgery, seventh day, and thirtieth day post nephrectomy/transplantation consecutively are 0,56 ± 0,05 vs 0,56 ± 0,05 (p < 0,83), 0,58 ± 0,06 vs 0,62 ± 0,07 (p < 0,05), 0,57 ± 0,06 vs 0,62 ± 0,06 (p < 0,001). No differences of PSV and EDV values between two groups. Conclusion: Hyperfiltration in allograft kidneys occurs in a similar pattern to transplant donor residual kidneys, with significant differences in mean RRI values between two groups."

"Latar Belakang: Transplantasi ginjal merupakan tata laksana utama pada pasien dengan end-stage renal disease. Salah satu perubahan pascatransplantasi ginjal adalah adaptasi fungsi penyimpanan (storage) dan pengosongan (voiding) dari traktus urinarius bagian bawah dalam enam bulan pertama pascatransplantasi ginjal dimana retensi urine dapat terjadi. Tujuan: Penelitian ini bertujukan mengetahui prevalensi retensi urine pascatransplantasi ginjal dan untuk mendeskripsikan karakteristik urodinamik pasien pascatransplantasi ginjal dengan retensi urine. Metode: Penelitian ini merupakan penelitian studi potong lintang yang dilaksanakan di RSUPN Dr. Cipto Mangunkusumo pada tahun 2011-2017. Data diambil dari pasien pascatransplantasi ginjal yang dilakukan pemeriksaan urodinamik Data diambil dari rekam medis pasien. Hasil: Sebanyak 536 pasien menjalani transplantasi ginjal di RSCM, di antaranya terdapat 11 pasien (2%) disfungsi berkemih yang menjalani pemeriksaan urodinamik dengan rerata usia 41,4 (30,1±52,6) tahun, dimana dua orang diantaranya adalah perempuan. Enam pasien (55%) memiliki diabetes melitus (DM) tipe 2 dan 5 pasien (45%) memiliki hipertensi (HT). Sebanyak 6 dari 11 pasien (54%) mengalami retensi urine, empat pasien (36%) mengeluhkan keluhan frekuensi, dan satu pasien (10%) mengeluh adanya hesitancy dan perasaan tidak lampias setelah miksi. Sebanyak 50% pasien mengalami penurunan bladder compliance, dimana dua pasien (33%) di antaranya mengalami retnesi urine dengan normal bladder compliance. Overaktivitas detrusor ditemukan pada total empat pasien (36%) dan tiga pasien (50%) pada pasien dengan retensi urine. Sebanyak 4 pasien (36%) mengalami bladder outlet obstruction (BOO) dan 50% pasien dengan retensi urine mengalami BOO. Dua pasien juga didiagnosis mengalami instabilitas detrusor yang mana tidak disertai inkontinensia. Dua pasien (44%) memiliki kontraksi kandung kemih normal.Kesimpulan: Disfungsi berkemih dan retensi urine ditemukan sebanyak 2% dan 1,1% dari 536 pasien pascatransplantasi ginjal. Sebagian besar pasien dengan retensi urine memiliki DM tipe 2. BOO dan overaktivitas detrusor ditemukan pada pasien dengan disfungsi berkemih dan retensi urine. Pemeriksaan rutin urodinamik pada pasien sebelum transplantasi ginjal juga disarankan.

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Background: Kidney transplantation is the main treatment for patients with end-stage renal disease. After undergone kidney transplantation, changes in storage and voiding functions of the lower urinary tract in the first six months post-transplantation of the kidney is still occurring. During this period urinary retention can occur.

Objective: This study aimed to determine the prevalence of urinary retention after kidney transplantation and to describe the urodynamic characteristics of post-transplant kidney patients with urinary retention.

Method: This research is a cross-sectional study conducted at Cipto Mangunkusumo National General Hospital in 2011-2017. Data are collected from patients undergone urodynamic examination after kidney transplantation. Data are collected from the patient's medical record.

Results: A total of 536 patients underwent kidney transplants in RSCM, including 11 patients (2%) urinary dysfunction who underwent urodynamic examination with an average age of 41.4 (30.1 ± 52.6) years including 2 women. Six patients (55%) had type 2 diabetes mellitus (DM) and 5 patients (45%) had hypertension (HT). A total of 6 out of 11 patients (54%) experienced urinary retention, four patients (36%) complained of frequency complaints, and one patient (10%) complained of hesitancy and feeling of incomplete emptying. As many as 50% of patients experienced a decrease in bladder compliance, of which two patients (33%) experienced urine retention with normal bladder compliance. Detrusor overactivity was found in four patients (36%) from total sample and three subjects (50%) among patient with urinary retention. Four patients (36%) experienced bladder outlet obstruction (BOO) and 50% of patients with urine retention experienced BOO. Two patients were diagnosed with detrusor instability which was not accompanied by incontinence. Two patients (44%) had normal bladder contractions.

Conclusion: Urinary dysfunction and urinary retention

were found in 2% and 1.1% of 536 patients after renal transplantation respectively. Most

patients with urinary retention have DM type 2. BOO and detrusor overactivity are found

in patients with urinary dysfunction and urinary retention. Routine urodynamic

examinations in patients before a kidney transplant are also recommended.

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"Latar belakang: Transplantasi ginjal dapat memperbaiki fungsi endotel. Berbagai penelitian membuktikan bahwa peningkatan kadar eritropoietin (Epo) dapat mengaktifasi dan memobilisasi Endothelial Progenitor Cell (EPC) sehingga mampu memperbaiki fungsi endotel melalui proses angiogenesis dan neovaskularisasi. Membaiknya fungsi endotel akan menurunkan angka kesakitan dan kematian akibat penyakit kardiovaskular pada penderita PGK. Tujuan: Untuk mengetahui hubungan peningkatan kadar Epo dan jumlah EPC CD34+ serta CD133+ dengan perbaikan fungsi endotel pada penderita gagal ginjal 3 bulan setelah transplantasi ginjal. Metode Penelitian: Potong lintang sebelum dengan 3 bulan setelah transplantasi ginjal pada penderita gagal ginjal yang menjalani transplantasi ginjal di RSCM. Jumlah subyek 21 orang yang dikumpulkan dalam kurun waktu Juli 2013 - Februari 2014. Pengambilan sampel darah untuk memeriksa kadar Epo, jumlah EPC CD34+ dan CD133+ dan kadar asimetrik dimetilarginin (ADMA) dilakukan sebelum dan 3 bulan setelah transplantasi ginjal. Analisis statistik dengan uji korelasi Pearson atau Spearman. Hasil: Penelitian ini menunjukkan adanya peningkatan kadar Epo tetapi tidak bermakna secara statistik (p>0.05), sedangkan jumlah EPC CD34+ dan CD133+ meningkat (p<0.05), serta kadar ADMA menurun yang bermakna secara statistik (p<0.05). Tiga bulan setelah transplantasi ada korelasi bermakna antara peningkatan kadar Epo dengan jumlah EPC CD34+ (r = 0.466 ; p < 0.05). Tidak ada hubungan peningkatan kadar Epo dan jumlah EPC CD34+ serta CD133+ dengan perbaikan fungsi endotel 3 bulan setelah transplantasi ginjal. Kesimpulan: Tiga bulan setelah transplantasi ginjal didapatkan adanya peningkatan kadar Epo, jumlah EPC CD34+ dan CD133+ serta penurunan kadar ADMA. Tetapi tidak ada korelasi peningkatan kadar Epo dan jumlah EPC CD34+ serta CD133+ dengan perbaikan fungsi endotel dalam rentang 3 bulan setelah transplantasi ginjal.

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Background: Kidney transplantation improved endothelial function. Various studies have shown that elevated level of erythropoietin (Epo) could activate and mobilize Endothelial Progenitor Cell (EPC), thus would improve endothelial function through the process of angiogenesis and neovascularization. The improvement of endothelial function will decrease morbidity and mortality from cardiovascular disease in patients with CKD.

Aim: To determine association between elevated level of Epo and the numbers of EPC CD34+ - CD133+ with the improvement of endothelial function in patients three months after kidney transplantation.

Methods: cross sectional study prior and 3 months after kidney transplantation in patients with renal failure who underwent kidney transplantation in RSCM. The study included 21 subjects who enrolled from July 2013 to February 2014. Blood samples prior and 3 months after kidney transplantation were collected to evaluate the level of Epo, numbers of EPC CD34+ and CD133+ and level of assymetric dimethylarginine (ADMA). Statistical analysis was performed using Pearson or Spearman correlation test.

Resulys: The results of the study showed that prior to kidney transplantation, level of Epo was increased but not statistically significant (p>0.05). The EPC numbers of CD34+ and CD133+ were significantly increased (p<0.05), whereas the ADMA level was significantly decreased (p<0.05). Three months after transplantation showed a significant association between elevated level of Epo and the numbers of EPC CD34+ (r = 0.466, p > 0.05). There was no association between the elevated level of Epo and the numbers of EPC CD34+ and CD133+ with the improvement of endothelial function three months after kidney transplantation.

Conclusion: Three months after kidney transplantation showed an elevated level of Epo, the numbers of EPC CD34+ and CD133+ and the decreased level of ADMA. However, there was no association between the elevated level of Epo and the numbers of EPC CD34+ and CD133+ with the improvement of endothelial function in patients 3 months after kidney transplantation."

"Pendahuluan: Terwujudnya sikap altruis dan voluntary pendonor merupakan tolok ukur keberhasilan pengelolaan transplantasi ginjal di Rumah Sakit dan diharapkan mampu mencegah adanya permasalahan etik dan hukum terutama masalah komersialisasi ginjal. Sikap altruis dan voluntary pendonor dinilai dalam bingkai kaidah dasar bioetika melalui wawancara, analisa dokumen dan observasi lapangan.Metodologi: Penelitian ini merupakan penelitian kualitatif, menggunakan observasi lapangan, analisa dokumen dan wawancara semiterstruktur. Sampel terdiri dari 3 pendonor unrelated dan 1 pendonor related yang telah menjalankan transplantasi ginjal di RSCM pada tahun 2018 dan bertempat tinggal di wilayah Jakarta, Bogor, Depok, Tangerang dan Bekasi. Penelitian dilakukan di tempat tinggal pendonor atau di tempat sesuai dengan kesepakatan antara subjek dan peneliti dari bulan Oktober hingga bulan Desember tahun 2019.Hasil: Pada penelitian ini, 2 dari ke-4 subjek yang merupakan pendonor ginjal related dan unrelated memenuhi gambaran altruis dan voluntary yaitu terdapatnya aspek empati, tanggung jawab sosial, meyakini keadilan dunia, kontrol diri internal dan ego yang rendah, yang dipengaruhi oleh faktor-faktor psikososial seperti hubungan donor dengan resipien, yang diharapkan dari resipien, motivasi donasi, kualitas hidup, status sosial ekonomi, religi dan keterbukaan perihal donasi.Kesimpulan: tidak semua pendonor ginjal unrelated di Rumah Sakit Cipto Mangunkusumo pada tahun 2018 memiliki sikap altruis dan voluntary.

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Introduction: The realization of altruist and voluntary attitudes of donors is a measure of the success of kidney transplant management in hospitals and is expected to be able to prevent ethical and legal problems, especially the problem of kidney commercialization. Altruist and voluntary attitudes of donors are assessed in terms of basic rules of bioethics through interviews, document analysis and field observations.

Methodology: This research is a qualitative research, using field observations, document analysis and semi-structured interviews. The sample consisted of 3 unrelated donors and 1 related donor who had performed a kidney transplant at the RSCM in 2018 and resided in the Jakarta, Bogor, Depok, Tangerang and Bekasi regions.

Results: In this study, 2 of the 4 research subjects who are donors of related and unrelated kidneys have an altruist description that fulfills all five aspects namely the presence of aspects of empathy, social responsibility, belief in world justice, internal self-control and low ego, which are influenced by psychosocial factors such as donor relations with recipients, which are expected from recipients, donation motivation, quality of life, socioeconomic status, religion and openness about donations.

Conclusion: not all unrelated kidney donors at Cipto Mangunkusumo Hospital in 2018 have altruistic and voluntary attitudes."

"ABSTRAK Analisis Praktik Residensi Keperawatan Medikal Bedah Pada Pasien Gangguan Sistem Perkemihan Dengan Kasus Gagal Ginjal Kronik Stage V Menggunakan Pendekatan Model Keperawatan Adaptasi Roy Di Rumah Sakit Umum Pusat Nasional RSUPN dr. Cipto Mangunkusumo Jakarta. Diana Rhismawati Djupri2017 AbstrakPraktek klinik Ners Spesialis Keperawatan Medikal Bedah Sistem Perkemihan adalah untuk mampu melakukan dan menganalisa asuhan keperawatan pada pasien Gagal Ginjal Kronik Stage V dan 30 pasien lain yang mengalami gangguan pada sistem perkemihan. Selain itu mampu menerapkan Evidence Based Nursing Practice EBNP dan sebagai inovator di ruang perawatan maupun di ruang rawat jalan. Peran pemberi asuhan keperawatan menggunakan Model Adaptasi Roy. Perilaku adaptasi fisiologi yang banyak mengalami gangguan adalah cairan dan masalah keperawatan yang banyak muncul adalah hipervolemia, sehingga intervensi yang diberikan adalah pencatatan secara akurat intake dan output, edukasi pembatasan cairan. Penerapan EBNP yang dilakukan adalah dengan melakukan identifikasi tingkat fatigue pada pasien Gagal Ginjal Kronik Stage V dengan menggunakan instrumen FACIT-F, sehingga dapat diketahui tingkat fatigue pasien dan dapat dilakukan asuhan keperawatan yang komprehensif. Program inovasi yang dilakukan adalah Range of Motion pada pasien intrahemodialisis untuk meningkatkan adekuasi hemodialisis dikaitkan dengan tingkat fatigue menggunakan instrumen FACIT-F Kata Kunci : fatigue, ROM exercise, gagal ginjal kronik, hemodialysis, FACIT-FABSTRACT Analysis of Medical Surgical Nursing Residency Practice on UrinarySystem Disorders with Chronic Kidney Disease CKD STAGE V Cases Using Roy Adaptation Model Approach at Cipto Mangunkusumo Hospital in Jakarta Diana Rhismawati Djupri2017 Abstract Ners Specialist Urinary System is to be able to perform and analyze nursing care in patients with Chronic Kidney Desease CKD Stage V and 30 other patients with urinary system disorders. It is also capable of implementing Evidence Based Nursing Practice EBNP and as an innovator in the treatment room as well as in the outpatient room. The role of nursing care providers uses the Roy Adaptation Model. Behavioral adaptation of many disordered physiology is fluid and nursing problems that many appear is hypervolemia, so that intervention given is accurate recording intake and output, fluid restriction education. Implementation of EBNP is done by identifying fatigue level in patients with Chronic Kidney Desease CKD Stage V using FACIT F instrument, so that can know fatigue level of patient and can be done comprehensive nursing care. The innovation program performed was the Range of Motion in intrahemodialysis patients to improve the hemodialysis adequacy associated with fatigue levels using the FACIT F instrument. Keywords fatigue, ROM exercise, Chronic Kidney Desease, hemodialysis, FACIT F"

"[ABSTRAKPasien penyakit ginjal kronik derajat 5 mengalami suatu keadaan di mana ginjal sama sekali tidak dapat mempertahankan homeostasis metabolisme tubuh sehingga membutuhkan terapi pengganti ginjal. Terapi pengganti ginjal yang paling sering dipilih oleh pasien PGK derajat 5 adalah hemodialisis. Perubahan metabolik pada PGK derajat 5 dengan hemodialisis dapat disebabkan oleh gangguan fungsi ginjal dan proses hemodialisis. Perubahan metabolik tersebut antara lain gangguan keseimbangan cairan, dan asam basa serta gangguanmetabolisme protein, karbohidrat, dan lemak. Dibutuhkan terapi terintegrasi pada pasien PGK yang terdiri atas terapi farmakologi, terapi pengganti ginjal, terapi nutrisi dan dukungan psikologis. Peran nutrisi dalam menurunkan komplikasi dan meningkatkan kualitas hidup sangat penting dalam tatalaksana pasien PGK. Pemberian nutrisi pada pasien PGK dengan hemodialisis bertujuan untuk mengatasi gejala akibat gangguan ginjal dan mencegah komplikasi akibat progresivitas kerusakan ginjal. Pemberian nutrisi yang tepat dapat dilakukan dengan memahami patofisiologi yang terjadi pada pasien PGK dan proseshemodialisis yang dipilih sebagai terapi pengganti ginjal. Berdasarkan hal tersebut, dilaporkan empat serial kasus pada pasien PGK derajat 5 dengan hemodialisis rutin. Diberikan terapi nutrisi sesuai panduan yaitu energi 30-35 kkal per kg berat badan, protein 1,2 g per kg berat badan, lemak 25-30% energi total, dan karbohidrat 60-65% energi total. Diketahui bahwa penyebab asupan tidak terpenuhi adalah keadaan klinis yaitu sesak, penurunan kesadaran, dan gangguan saluran cerna yaitu mual dan muntah.

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ABSTRACTStage 5 of chronic kidney disease represents total inability of kidneys to maintain body homeostasis normally. At this stage, it is necessary to use methods that substitute kidney function such as hemodialysis, peritoneal dialysis, or kidney transplantation. The most used method is hemodialysis. Metabolic changes in stage 5 of chronic kidney disease can be caused by kidney disease itself and also hemodialysis treatment. Metabolic complications of chronic kidney disease and hemodialysis include changes in acid-base balance and metabolism of proteins,carbohydrates and lipids. Patients need integrated therapy that consist of medicine, kidney function substitution, nutrition, and psychological support. Nutrition therapy is important in chronic kidney disease therapy because it can help to decrease complication and to increase quality of life. The purpose of nutrition therapy in chronic kidney disease are to overcome the symtoms and to prevent the complication that caused by kidney disease. Nutrition therapy can be done properly by understand the pathophysiologycal mechanism and the process of hemodialysis. Based on the description, four cases of stage 5 of chronic kidney disease with hemodialysis are reported here. The nutrition which is given consist of energy 30-35 kkal per kg body weight, protein 1,2 g per kg body weight, lipid 25-30 % total energy, and carbohydrate 60-65 % total energy. There is inadequacy of intake due to clinical conditions such as dispnoe, the decreased of consciousness, and intestinal disturbance like nausea and vomit. Stage 5 of chronic kidney disease represents total inability of kidneys to maintain body homeostasis normally. At this stage, it is necessary to use methods thatsubstitute kidney function such as hemodialysis, peritoneal dialysis, or kidney transplantation. The most used method is hemodialysis. Metabolic changes in stage 5 of chronic kidney disease can be caused by kidney disease itself and also hemodialysis treatment. Metabolic complications of chronic kidney disease and hemodialysis include changes in acid-base balance and metabolism of proteins, carbohydrates and lipids. Patients need integrated therapy that consist of medicine, kidney function substitution, nutrition, and psychological support. Nutrition therapy is important in chronic kidney disease therapy because it can help to decrease complication and to increase quality of life. The purpose of nutrition therapy in chronic kidney disease are to overcome the symtoms and to prevent the complication that caused by kidney disease. Nutrition therapy can be done properly by understand the pathophysiologycal mechanism and the process of hemodialysis. Based on the description, four cases of stage 5 of chronic kidney disease with hemodialysis are reported here. The nutrition which is given consist of energy 30-35 kkal per kg body weight, protein 1,2 g per kg body weight, lipid 25-30 % total energy, and carbohydrate 60-65 % total energy. There is inadequacy of intake due to clinical conditions such as dispnoe, the decreased of consciousness, and intestinal disturbance like nausea and vomit., Stage 5 of chronic kidney disease represents total inability of kidneys to maintainbody homeostasis normally. At this stage, it is necessary to use methods thatsubstitute kidney function such as hemodialysis, peritoneal dialysis, or kidneytransplantation. The most used method is hemodialysis. Metabolic changes instage 5 of chronic kidney disease can be caused by kidney disease itself and alsohemodialysis treatment. Metabolic complications of chronic kidney disease andhemodialysis include changes in acid-base balance and metabolism of proteins,carbohydrates and lipids. Patients need integrated therapy that consist of medicine, kidney function substitution, nutrition, and psychological support. Nutrition therapy is important in chronic kidney disease therapy because it can help to decrease complicationand to increase quality of life. The purpose of nutrition therapy in chronic kidney disease are toovercome the symtoms and to prevent the complication that caused by kidneydisease. Nutrition therapy can be done properly by understand thepathophysiologycal mechanism and the process of hemodialysis. Based on the description, four cases of stage 5 of chronic kidney diseasewith hemodialysis are reported here. The nutrition which is given consist ofenergy 30–35 kkal per kg body weight, protein 1,2 g per kg body weight, lipid25–30 % total energy, and carbohydrate 60–65 % total energy. There isinadequacy of intake due to clinical conditions such as dispnoe, the decreased of consciousness, and intestinal disturbance like nausea and vomit.]"