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"Diabetes mellitus DM dapat menyebabkan kerusakan ginjal dan nefropati diabetik merupakan penyebab gagal ginjal tersering. Penelitian ini bertujuan untuk mengetahui jumlah sel epitel tubulus ginjal dalam sedimen urin yang dapat dijadikan penanda kerusakan ginjal pada penderita DM. Penelitian ini juga bertujuan mencari nilai cut off jumlah sel epitel tubulus ginjal sebagai penanda kerusakan ginjal pada penderita DM, korelasi antara jumlah sel epitel tubulus ginjal dengan urine albumin/creatinine ratio UACR dan ?2-microglobulin urin serta korelasi antara ?2-microglobulin serum dengan UACR. Desain penelitian adalah potong lintang deskriptif analitik dengan 90 subjek, penelitian berlangsung selama Juni hingga Oktober 2017. Sampel menggunakan urin dan serum penderita diabetes mellitus. Jumlah sel epitel tubulus ginjal diperiksa dengan Sysmex UF-4000. Kadar albumin urin diperiksa dengan NycoCard. Kadar ?2-microglobulin serum dan urin serta kreatinin urin diperiksa dengan Cobas C501. Hasil penelitian didapatkan perbedaan bermakna jumlah sel epitel tubulus ginjal pada kelompok nefropati diabetik dengan non nefropati diabetik 2,4 sel /?L vs 1,6 sel /?L . Tidak ada korelasi antara jumlah sel epitel tubulus ginjal dengan UACR dan ?2-microglobulin urin. Korelasi antara ?2-microglobulin serum dengan UACR adalah lemah dan bermakna.

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Diabetes mellitus DM can cause kidney damage and diabetic nephropathy is the most common cause of renal failure. This study aimed to determine the number of renal tubular epithelial cells in urine sediments that could be used as a marker of kidney damage in patients with DM. This study also aimed to determine cut off point of renal tubular epithelial cells as a marker of kidney damage in patients with DM, the correlation between the renal tubular epithelial cells with urine albumin creatinine ratio UACR and 2 microglobulin urine and the correlation between serum 2 microglobulin and UACR.

The study design was cross sectional, descriptive analytic with 90 subjects, the study took place during June to October 2017. The sample used urine and serum of diabetic patients. The renal tubular epithelial cells was examined with Sysmex UF 4000. Urinary albumin levels are determined with NycoCard. Serum 2 microglobulin and urine and urinary creatinine levels were determined with Cobas C501.

The results showed significant differences in number of renal tubular epithelial cells in the diabetic nephropathy group with non diabetic nephropathy 2.4 cells L vs. 1.6 cells L . There was no correlation between the number of renal tubular epithelial cells with UACR and urine 2 microglobulin. The correlation between serum 2 microglobulin with UACR was weak and significant."

"Patogenesis nefropati diabetik (ND) merupakan hasil interaksi faktor hemodinamik, metabolik dan lingkungan serta faktor genetik. ND biasanya tidak terdeteksi secara klinis sampai terjadi kerusakan ginjal yang bermakna dapat berupa glomerulosklerosis, tubular atrofi dan fibrosis interstitial. KIM-1 dapat digunakan sebagai penanda adanya kerusakan tubulus ginjal. Hubungan polimorfisme gen ACE dengan nefropati diabetes masih tidak konsisten. Penelitian ini merupakan studi cross sectional komparasi antara dua kelompok penyandang DMT2 dengan atau tanpa nefropati yang bertujuan untuk mengetahui adanya kerusakan tubulus, polimorfisme gen ACE dan menganalisis hubungannya dengan kadar KIM-1 terhadap terjadinya kelainan tubulus. Didapatkan adanya peningkatan ekskresi KIM-1 urin pada 19 subjek pre-nefropati dengan median 1,3 (interquartile 1,5) ng/mL, 25 subjek nefropati insipien dengan median 1,6 (interquartile 2,3) ng/mL dan 12 subjek nefropati overt dengan rerata kadar KIM-1 3,1 ± 2,4 ng/mL. Terdapat polimorfisme gen ACE pada penyandang DMT2. Proporsi genotipe DD 9,3%, ID 33,3% dan II 57,4% pada kelompok NND, pada kelompok ND proporsi genotipe DD 4,7%, ID 34,1% dan genotipe II 61,2%. Dijumpai adanya hubungan bermakna antara alel D dengan peningkatan ekskresi KIM-1 urin pada kelompok pre-nefropati (p = 0,030). Peningkatan kadar KIM-1 urin pada kelompok pre-nefropati menunjukkan adanya kerusakan tubulus yang merupakan proses awal nefropati DM. Distribusi genotipe polimorfisme gen ACE pada penelitian ini menyerupai penelitian lain di negara-negara Asia, sedangkan di negara Eropa genotipe DD lebih banyak daripada genotipe II. Hubungan bermakna alel D dengan kadar KIM-1 hanya pada kelompok prenefropati mungkin disebabkan adanya faktor lain seperti kadar glukosa, kontrol glikemik, ureum, kreatinin dan kadar trigliserida yang memengaruhi. Simpulan: Terdapat peningkatan ekskresi KIM-1 urin pada penyandang DMT2 kelompok pre-nefropati yang meningkat secara bermakna pada penyandang DMT2 dengan nefropati overt. Peningkatan ekskresi KIM-1 urin dapat dipakai sebagai penanda kerusakan tubulus. Terdapat polimofisme gen ACE pada penyandang DMT2. Genotipe II lebih banyak dibanding genotipe ID dan DD. Dijumpai adanya hubungan alel D dengan peningkatan kadar KIM-1 urin pada penyandang DMT2 pre-nefropati.

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The pathogenesis of nephropathy diabetic (ND) is the result of the interaction of haemodynamic, metabolic, environment, and genetic factors. In general, ND was clinically undetectable until kidney has been damaged significantly, in the form of glomerulosclerosis, tubular atrophy, or interstitial fibrosis. KIM-1 can be used as the initial indicator of kidney tubules damage. The relationship between ACE gene polymorphism and diabetic nephropathy was still inconsistent.

This research was a comparative cross-sectional study on two groups of DMT2 patients with and without nephropathy diabetic. The objectives of this study were to identify the tubules damage, ACE gene polymorphism, and to analyze the relationship between the degree of KIM-1 and the tubules damage. The increase of KIM-1 urine excretion was found in 19 pre-nephropathy subject (median = 1.3 with interquartile 1.5 ng/mL), in 25 incipient nephropathy subject (median = 1.6 (2.3) ng/mL), in 12 overt nephropathy subject (Mean = 3.1 ± 2,4 ng/mL). ACE polymorphism gene was found in DMT2 patients. In the NDD group, the genotype proportion of DD = 9.3%, ID = 33.3% and II = 57.4%. Whereas, in the ND group, the figures were 4.7%, 34.1% and 61.2%, respectively.

Significant relationship was found between allele D and the increase of KIM-1 urine on pre-nephropathy group (p = 0.030). The increase of KIM-1 urine on prenephropathy group shows the tubules damage which is the initial process of nephropathy diabetic. The genotype distribution of ACE gene polymorphism in this study was similar with the studies in Asian countries; however, in European countries the genotype DD is found higher than genotype II. The significant relationship between allele D and KIM-1 level in pre-nephropathy group might be the influence of other factors, such as glucose level, glycaemic control, urea, creatinine, and triglyceride level.

Conclusion: There was KIM-1 excretion increased on DMT2 pre-nephropathy group, which increase significantly in DMT2 overt nephropathy group. The increase of KIM-1 urine excretion can be used as the indicator of tubules damage. ACE gene polymorphism was found in DMT2 group, with genotype II was higher than genotype ID and DD. A significant relationship between allele D and the increase of KIM-1 urine excretion was found in pre-nephropathy group."

"Hingga saat ini, belum ada penanda biologis yang menggambarkan kondisi penyakit ginjal kronik (PGK) akibat diabetes melitus (DM) sejak dini. Studi ini bertujuan untuk mengetahui hubungan antara rasio albumin kreatinin urin (Urine Albumin Creatinine Ratio, UACR) dengan laju filtrasi glomerulus yang diestimasi (estimated Glomerular Filtration Rate, eGFR) sebagai penanda gangguan fungsi ginjal pada pasien DM tipe 2 RSUPN Dr. Cipto Mangunkusumo. Sampel urin dan serum diambil dari 18 subjek sehat dan 10 pasien DM tipe 2. Metode spektrofotometri digunakan untuk mengukur kadar albumin urin, kreatinin urin dan kreatinin serum. Data lain diperoleh dari kuesioner. Hasilnya, nilai eGFR pasien DM (68,85 ± 15,36 (Cockroft); 73,94 ± 16,30 (CKD-EPI)) lebih rendah dibandingkan dengan subjek sehat (90,51 ± 15,69, p < 0,01 (Cockcroft); 91,13 ± 21,21, p < 0,05 (CKD-EPI)), sedangkan nilai UACR pasien DM (314,99 ± 494,92) lebih tinggi dibandingkan dengan subjek sehat (0,48 ± 0,75, p < 0,01). Namun, tidak ditemukan hubungan yang bermakna antara UACR dengan eGFR pasien DM.

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Until now, no biological marker that describes the condition of chronic kidney disease (CKD) due to diabetes mellitus (DM) from the outset. This study aimed to determine the relationship between urine albumin creatinine ratio (UACR) with estimated Glomerular Filtration Rate (eGFR) as a marker of renal dysfunction at type 2 diabetes mellitus patients at RSUPN Dr. Cipto Mangunkusumo. Urine and serum samples taken from 18 healthy subjects and 10 type 2 diabetic patients. Spectrophotometric methods used to measure levels of urinary albumin, urinary creatinine and serum creatinine. Other data obtained from questionnaires.

Results, eGFR values were lower in DM patients (68.85 ± 15.36 (Cockroft); 73.94 ± 16.30 (CKD-EPI)) compared with healthy subjects (90.51 ± 15.69, p < 0.01 (Cockcroft); 91,13 ± 21,21, p < 0,05 (CKD-EPI)), while the value of UACR in DM patients (314.99 ± 494.92) was higher than healthy subjects (0.48 ± 0.75, p < 0.01). However, there was no significant correlation between UACR with eGFR of DM patients."

"Penyakit Ginjal Diabetes (PGD) merupakan salah satu komplikasi mikrovaskular dari penyakit Diabetes Melitus Tipe 2 (DMT2) yang cenderung tidak terdeteksi secara dini sehingga diperlukan biomarker yang lebih efektif untuk mendeteksi penyakit ini. Tingginya HbA1c diketahui berpengaruh pada progresivitas PGD karena berkaitan dengan penurunan laju filtrasi glomerulus (eGFR) dan peningkatan rasio albumin kreatinin urin (UACR). Penelitian ini merupakan studi metabolomik tidak tertarget dan bertujuan untuk membandingkan metabolit urin pasien DMT2 risiko PGD rendah dengan HbA1c terkontrol dan tidak terkontrol pada pasien yang mengonsumsi terapi metformin-glimepirid. Penelitian dilakukan dengan desain potong lintang dengan teknik pengambilan sampel non-probabilitas di Puskesmas Kecamatan Pasar Minggu. Sebanyak 32 sampel dibagi menjadi dua kelompok, yakni kelompok HbA1c terkontrol (n=16) dan kelompok HbA1c tidak terkontrol (n=16). Sampel darah diambil untuk pengukuran HbA1c dan eGFR sedangkan sampel urin diambil untuk pengukuran UACR dan dianalisis metabolitnya. Analisis metabolit dilakukan menggunakan LC/MS-QTOF dan diolah datanya menggunakan MetaboAnalyst 6.0 serta berbagai database. Signifikansi metabolit antarkelompok diseleksi dengan parameter VIP>1, log2(FC)>1,2, dan p-value<0,05. Tiga metabolit yang berpotensi menjadi biomarker (AUC>0,65), yaitu oxaloacetate, 5'-phosphoribosyl-N-formylglycinamidine, dan (S)-dihydroorotate. Berdasarkan ketiga metabolit tersebut, jalur metabolisme yang terlibat meliputi (1) alanin, aspartat, dan glutamat, (2) asam sitrat (siklus Krebs), (3) glukoneogenesis, (4) piruvat, (5) pirimidin, dan (6) purin.

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Diabetic Kidney Disease (DKD) is one of the microvascular complications of Type 2 Diabetes Mellitus (T2DM) which tended not to be detected early, necessitating more effective biomarkers for its detection. Uncontrolled HbA1c was significantly associated with the progression of DKD because it is associated with a decrease in glomerular filtration rate (eGFR) and an increase in the urine albumin creatinine ratio (UACR). This study was an untargeted metabolomics study and aimed to compare urine metabolites in low-risk DKD T2DM patients with controlled and uncontrolled HbA1c undergoing metformin-glimepiride therapy. Conducted with a cross-sectional design and non-probability sampling at Pasar Minggu District Health Center, 32 samples were split into controlled (n=16) and uncontrolled HbA1c groups (n=16). Blood samples were taken for measurement of HbA1c and eGFR, while urine samples were taken for measurement of UACR and analyzed for metabolites. Metabolite analysis was carried out using LC/MS-QTOF and the data were processed using MetaboAnalyst 6.0 and various databases. Significant metabolites were identified with VIP>1, log2(FC)>1.2, and p-value<0.05. Three metabolites, namely oxaloacetate, 5'-phosphoribosyl-N-formylglycinamidine, and (S)-dihydroorotate, emerged as potential biomarkers (AUC>0.65). The involved metabolic pathways included (1) alanine, aspartate, and glutamate, (2) citric acid (Krebs cycle), (3) gluconeogenesis, (4) pyruvate, (5) pyrimidine, and (6) purine."

"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."

"ABSTRAKLatar Belakang: Prevalensi penyakit ginjal kronik (PGK) meningkat pada usia lanjut. Berdasarkan Riskesdas 2013, prevalensi PGK lebih tinggi pada usia 55-75 tahun dibandingkan usia kurang dari 55 tahun. Pada usia lanjut terjadi perubahan struktur dan fungsi ginjal, serta adanya riwayat penyakit komorbid seperti diabetesmelitus (DM), hipertensi, penyakit jantung dan pembesaran prostat, menjadi faktor risiko yang meningkatkan terjadinya PGK. Komplikasi yang dapat timbul pada penderita PGK antara lain frailty dan protein energy wasting, yang menyebabkan penurunan kapasitas fungsional dan kualitas hidup, serta peningkatan morbiditas dan mortalitas. Terapi nutrisi yang adekuat berperan penting untuk mencegah protein energy wasting dan komplikasi lain yang dapat timbul pada PGK.Metode: Laporan serial kasus ini memaparkan empat kasus PGK pada pasien usia di atas 60 tahun. Dua pasien memiliki penyakit komorbid DM dan hipertensi, dandua lainnya hanya hipertensi. Keempat pasien dalam serial kasus ini termasuk PGK derajat IV dan V. Pada dua kasus dilakukan hemodialisis, sementara pada dua lainnya belum dilakukan. Masalah yang timbul pada keempat kasus adalahterdapat gejala-gejala sindroma uremia yaitu mual, muntah, anoreksia, lemas, sesak, dan anemia sehingga asupan makanan tidak adekuat dan terjadi penurunankapasitas fungsional. Kebutuhan energi pasien dihitung dengan menggunakan persamaan Harris-Benedict ditambah faktor stres dan pemberian protein disesuaikan dengan sudah atau belum dilakukan hemodialisis. Komposisikarbohidrat dan lemak disesuaikan dengan rekomendasi theurapeutic lifestyle changes (TLC) dan American Diabetes Association (ADA). Suplementasi mikronutrien diberikan sesuai dengan kondisi pasien. Pemantauan pasiendilakukan setiap hari dengan memperhatikan perubahan gejala klinis, tanda vital, imbang cairan, kapasitas fungsional, analisis dan toleransi terhadap makanan,serta hasil pemeriksaan laboratorium.Hasil: Pemantauan yang dilakukan pada empat pasien selama perawatan di rumah sakit menunjukkan terjadi perbaikan gejala klinis serta peningkatan asupan makanan dan kapasitas fungsional.Kesimpulan: Terapi nutrisi dapat mendukung terapi utama pada penderita PGK usia lanjut dalam memperbaiki keadaan klinis dan kapasitas fungsional, serta mencegah komplikasi lebih lanjut

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ABSTRACT

Background: The prevalence of chronic kidney disease (CKD) increases in the elderly. Based on Riskesdas 2013, the prevalence of CKD is higher in the age of 55-75 years old compared to below 55 years of age. In the elderly, there are alterations in kidney structure and function, as well as history of comorbidities include diabetes mellitus, hypertension, heart disease and prostate hypertrophy that increase the factor CKD. Complication that may occur in patients with CKD including frailty and protein energy wasting, which can cause decreased

functional capacity and quality of life, and increased morbidity and mortality. Adequate nutrition therapy plays an important role in preventing protein energy wasting and other complications that may arise in CKD.

Methods: This case series report describes four cases of CKD in patients aged above 60 years old. Two patients have comorbid disease diabetes mellitus and hypertension and the others have only hypertension. The four patients in this case series are in CKD stage IV and V. Two cases with hemodialysis, while in the others has not done yet. Problems arising in all cases are uremic syndrome

symptoms such as nausea, vomiting, anorexia,fatigue, dypsnea, and anemia causing inadequate food intake and decreased functional capacity. Energy requirements of the patients calculated using the Harris-Benedict equation added by stress factor and the amount of protein depends on whether the hemodialysis has or has not been applied. Carbohydrate and fat composition appropriated to the

theurapeutic lifestyle changes (TLC) and the American Diabetes Association (ADA) recommendations. Micronutrients supplementation was given in

accordance to patient's condition. Patient monitoring is carried out every day by observing changes in clinical symptoms, vital signs, fluid balance, functional

capacity, dietary analysis and food tolerance, and laboratory resultsResults: Monitoring conducted in the four patients during treatment at the hospital showed the improvements in clinical symptoms, and increased in food

intake and functional capacity."

"[Saat ini belum ada penanda biologis yang dapat digunakan untuk mendeteksi PGK sejak dini. Rasio albumin terhadap kreatinin urin (UACR) dan estimasi laju filtrasi ginjal (eLFG) digunakan sebagai penanda gangguan fungsi ginjal. Penelitian ini bertujuan untuk mengetahui hubungan antara UACR dengan eLFG pada pasien DM tipe 2 dengan normoalbuminuria dan mikroalbuminuria. Sampel yang dianalisis adalah urin dan serum 90 orang pasien DM tipe 2 di Puskesmas Pasar Minggu yang dikumpulkan tahun lalu, dengan teknik total sampling. Kreatinin urin diukur dengan metode kinetic jaffe. Albumin urin diukur dengan metode bromkresol hijau. eLFG diperoleh dari nilai kreatinin serum. Hasil rerata UACR yang didapatkan (15,60±1,93). Hasil rerata eLFG Cockroft Gault (95,65±4,17), MDRD (89,71±3,65) dan CKD-EPI (87,00±2,62). Hasil hubungan antara UACR dengan eLFG rendah MDRD (p= 0,004,r= -0,422); Cockroft (p= 0,083,r= -0,261); CKD-EPI (p= 0,006,r= -0,404), sedangkan dengan LFG tinggi MDRD (p= 0,020, r= 0,346); Cockroft (p= <0,0-01, r= 0,540); CKD (p= 0,002, r= 0,449). Kesimpulan yang didapatkan yaitu hubungan bermakna antara UACR dengan eLFG rendah dan tinggi. Tidak ditemukan hubungan yang bermakna antara UACR normoalbuminuria dan mikroalbumnuria dengan eLFG. ;Diabetes mellitus type 2 is one of the causes complication of chronic kidney disease (CKD). Currently there are no biological markers that can be used to detect CKD early. Urinary albumin to creatinine ratio (UACR) and estimated kidney filtration rate (eLFG) is used as a marker of impaired kidney function. This study aimed to determine the relationship between UACR with eLFG in patient type 2 diabetes mellitus with normoalbuminuria and microalbuminuria. Samples were urine and serum of 90 patients with type 2 diabetes mellitus in Puskesmas Pasar Minggu which were collected last year, with total sampling technique. Urinary creatinine was measured by Jaffe kinetic method. Urine albumin was measured by the method bromkresol green. eLFG obtained from serum creatinine values. UACR results obtained (15.60 ± 1.93). Results eLFG Cockroft Gault (95.65 ± 4.17), MDRD (89.71 ± 3.65) and CKD-EPI (87.00 ± 2.62). Results relationship between UACR with low eLFG MDRD (p = 0.004, r = -0.422); Cockroft (p = 0.083, r = -0.261); CKD (p = 0.006, r = -0.404), while the high eLFG MDRD (p = 0.020, r = 0.346); Cockroft (p = <0.001, r = 0.540); CKD (p = 0.002, r = 0.449) so there is a significant relationship between UACR with low and high eLFG. There is no significant relationship between UACR normoalbuminuria and microalbuminuria with eLFG., Diabetes mellitus type 2 is one of the causes complication of chronic kidney disease (CKD). Currently there are no biological markers that can be used to detect CKD early. Urinary albumin to creatinine ratio (UACR) and estimated kidney filtration rate (eLFG) is used as a marker of impaired kidney function. This study aimed to determine the relationship between UACR with eLFG in patient type 2 diabetes mellitus with normoalbuminuria and microalbuminuria. Samples were urine and serum of 90 patients with type 2 diabetes mellitus in Puskesmas Pasar Minggu which were collected last year, with total sampling technique. Urinary creatinine was measured by Jaffe kinetic method. Urine albumin was measured by the method bromkresol green. eLFG obtained from serum creatinine values. UACR results obtained (15.60 ± 1.93). Results eLFG Cockroft Gault (95.65 ± 4.17), MDRD (89.71 ± 3.65) and CKD-EPI (87.00 ± 2.62). Results relationship between UACR with low eLFG MDRD (p = 0.004, r = -0.422); Cockroft (p = 0.083, r = -0.261); CKD (p = 0.006, r = -0.404), while the high eLFG MDRD (p = 0.020, r = 0.346); Cockroft (p = <0.001, r = 0.540); CKD (p = 0.002, r = 0.449) so there is a significant relationship between UACR with low and high eLFG. There is no significant relationship between UACR normoalbuminuria and microalbuminuria with eLFG.]"

"Latar Belakang: Beberapa penelitian telah membuktikan faktor-faktor yang berpengaruh pada maturasi fistula arteriovenosa, namun pengaruh profil lipid(LDL,HDL, Trigliserida, Kolesterol total) belum terlalu jelas.Tujuan: Untuk mengetahui pengaruh profil lipid pada maturasi fistula arteriovenosapada pasien penyakit ginjal tahap akhir dengan komorbid diabetes mellitus tipe 2.Metode: Desain yang digunakan adalah desain potong lintang. Penelitian inimengambil data sekunder dari penelitian dr. Dedy Pratama, SpBSubVE yangmelakukan penelitian di RSUPN Dr. Cipto Mangunkusumo, RS Hermina Bekasi Barat,dan RS Hermina Depok pada pasien penyakit gagal ginjal tahap akhir dengan diabetesmellitus tipe 2 dan dilakukan operasi fistula arteriovenosa brachiocefalica.Hasil: Total sampel 67, sampel terbanyak berjenis kelamin laki-laki 34 (50,7%)sedangkan perempuan sebanyak 33 (49,3%). Sebanyak 47 (70,1%) matur, sedangkanyang tidak matur 20 (29,9%). Didapatkan nilai rerata LDL pada sampel matur FAV110,13(32,786) dan tidak matur 135,6(39,317) P=0,008. Didapatkan diameter arteribrachialis pre operasi 4,25 mm(0,68) pada kelompok matur, 3,85(0,69) pada tidak maturP=0,029. Volume aliran pasca operasi 568,48(44,9-1451) pada kelompok matur,347,12(43,1-1295) pada kelompok tidak matur dengan P=0,031. Usia, hipertensi,merokok, gula darah sewaktu, indeks massa tubuh, trigliserida, HDL, kolesterol total,volume aliran pre operasi, IMT feeding artery, PSV feeding artery per dan pascaoperasi tidak berpengaruh pada maturasi.Simpulan: Nilai LDL lebih tinggi dari 119,5 mg/dL dapat menurunkan angka maturasiFAV pada pasien PGTA dengan DM tipe 2. Sedangkan kolesterol total, HDL, dantrigliserida pada penelitian ini tidak berpengaruh pada maturasi FAV.

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Background: Several studies have shown the factors that influence the maturation of

arteriovenous fistulas, but the effect of the lipid profile (LDL, HDL, triglycerides, total

cholesterol) is not clear.

Objective: To determine the effect of lipid profiles on the maturation of arteriovenous

fistulas in end-stage renal disease patients with comorbid type 2 diabetes mellitus.

Method: The design used is a cross-sectional design. This study took secondary data

from the research of dr. Dedy Pratama, SpBSubVE who conducted research at RSUPN

Dr. Cipto Mangunkusumo, West Bekasi Hermina Hospital, and Hermina Depok

Hospital in patients with end-stage renal failure with type 2 diabetes mellitus and

undergoing surgery for fistula arteriovenosa brachiocefalica.

Results: The total sample was 67, the largest sample was male 34 (50.7%), while the

female was 33 (49.3%). A total of 47 (70.1%) were mature, while 20 (29.9%) were not

mature. The average value of LDL in the mature FAV sample was 110.13 (32.786) and

the immature sample was 135.6 (39.317) P = 0.008. The preoperative brachial artery

diameter was 4.25 mm (0.68) in the mature group, 3.85 (0.69) in the immature P =

0.029. Postoperative flow volume was 568.48 (44.9-1451) in the mature group, 347.12

(43.1-1295) in the immature group with P = 0.031. Age, hypertension, smoking,

temporary blood sugar, body mass index, triglycerides, HDL, total cholesterol,

preoperative flow volume, BMI of artery feeding, PSV feeding arteries per and

postoperatively had no effect on maturation.

Conclusion: LDL values higher than 119.5 mg/dL can reduce the maturation rate of

AVF in ESRD patients with type 2 diabetes. Meanwhile, total cholesterol, HDL, and

triglycerides in this study had no effect on FAV maturation."

"Sambiloto merupakan tanaman herbalyang memiliki kandungan zat aktif utama Andrografolida yang berkhasiat menurunkan kadar glukosa pada penderita diabetes dengan cara menghambat enzim α-glukosidase.Kemampuan ekstrak daun sambiloto dalam menurunkan kadar glukosaakan semakin meningkat dengan adanya teknik enkapsulsi dengan penyalut berupa komposisi Kitosan-STPP sebagai penghantar obat menuju organ target. Penelitian ini bertujuan mendapatkan gambaran profil pelepasan nanopartikel sambiloto pada media fluida sintetik dengan variasi konsentrasi penyalutnya serta pengujian inhibisi ekstrak keji beling dalam menghambat enzim α-glukosidase. Penelitian ini menghasilkan nanopartikel dengan efesiensi penyalutan dan loading capacity terbesar pada variasi kitosan 2% dan STPP 1% sebesar 60% dan 46,29%. Kemampuan ekstrak sambiloto sebagai inhibitor enzim α-glukosidase jugatelah dibuktikan dalam penelitian ini, dengan persen inhibisi sebesar 33,17%. Profil pelepasan dengan karakter penyalut yang resisten pada kondisi lambung diperoleh pada variasi Kitosan 1%:1,5%.

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Andrographis paniculata (A.paniculata) contain the main active substances Andrografolidawhich helps lower glucose levels in diabetics by inhibiting the enzyme α-glucosidase. The ability of the extract A.paniculatain lowering glucose levels will increase with the technique enkapsulation with a coating of composition Chitosan-STPP as a drug delivery to the target organ. This study aimed to get an overview of A.paniculata release profile of nanoparticles in a synthetic fluid media with various concentrations of coating and inhibition testing nasty shard extract in inhibiting the enzyme α-glucosidase. This research resulted in nanoparticles by coating efficiency and loading capacity of chitosan greatest variation of 2% and 1% STPP 60% and 46.29%. The ability of A.paniculataextracts as α-glucosidase enzyme inhibitors has been demonstrated in this study, the percent inhibition of 33.17%. The release profile of the character of a coating which is resistant to gastric conditions Chitosan is obtained on the variation of 1%: 1.5%."

"Latar Belakang: Catheter-related bloodstream infections (CRBSI) merupakan salah satu bentuk infeksi nasokomial (Healthcare Associated Infection / HCAI) yang sering terjadi dan memiliki gejala berat.Penanganan utama pada kasus CRBSI terdiri dari pemberian antibiotik yang tepat dan manajemen pelepasan atau pencegahan pelepasan kateter intravaskular. Beberapa faktor seperti kadar albumin dan komorbiditas diabetes melitus diketahui memengaruhi jumlah kejadian sekaligus berperan dalam pencegahan CRBSI. Namun, belum ada penelitian yang menghubungkan faktor tersebut dengan keberhasilan terapi empirisCRBSI.Tujuan: Menganalisis faktor-faktor yang berhubungan dengan keberhasilan terapi antibiotik empiris pada pasien CRBSI.Metode: Penelitian ini merupakan penelitian analitik observasional tidak berpasangan dengan metode kohort retrospektif yang dilakukan pada Maret 2022 hingga Juni 2022 di Rumah Sakit Umum Pusat Nasional Dr.Cipto Mangunkusumo Jakarta.Hasil: Terdapat total 64 subjekn pada penelitian ini, subjek dengan nilai albumin diatas 3,12 g/dL memiliki proporsi tingkat keberhasilan terapi antibiotik empiris yang lebih tinggi dibandingkan pada subjek dengan nilai albumin dibawah 3,12 g/dL. Pasien dengan komorbiditas diabetes melitus dan tanpa komorbiditasdiabetes melitus secara proporsi memiliki tingkat keberhasilan terapi antibiotik yang tidak signifikan.Simpulan: Kadar albumin diatas 3,12 g/dL memiliki tingkat keberhasilan terapi antibiotik empiris yang signifikan terhadap kasus penyakit ginjal tahap akhir dengan CRBSI.

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Background: Catheter-related blood infection (CRBSI) is a form of nosocomial infection (HealthcareAssociated Infection / HCAI) that often occurs and has severe symptoms. The mainstay of treatment in cases of CRBSI consists of appropriate antibiotic administration and management of removal or prevention ofintravascular catheter dislodgement. Several factors such as albumin levels and diabetes mellitus are known toinfluence the number of events as well as play a role in the prevention of CRBSI. However, there are no studies linking these factors to the success of empiric CRBSI therapy.

Objective: To analyze the factors associated with the success of empiric antibiotic therapy in CRBSI patients.

Methods: The study is an unpaired observational analytic with a retrospective cohort method, conducted at Cipto Mangunkusumo General Hospital from March 2022 to June 2022.

Results: There were a total of 64 subjects, in which subjects with albumin values of 3.12 g/dL had a higherproportion of antibiotic therapy success rates than subjects with albumin values below 3.12 g/dL. Patients with diabetes mellitus and without diabetes mellitus have a similar proportion of success rates of antibiotic therapy. Patients with quinolone group antibiotics have a higher therapeutic success rate than other antibiotic groups. The multivariate test showed that albumin and diabetes mellitus levels had no significant effect on the success of treatment.

Conclusion: There was a significant relationship between albumin levels and comorbid diabetes mellitus with the success of empiric antibiotic therapy in End Stage Renal Disease patients with CRBSI."