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"Batu ginjal merupakan salah satu penyakit urologi tersering di Indonesia dan dipengaruhi oleh berbagai faktor inflamasi, faktor klinis dan demografi, namun, 50% faktor predisposisi batu ginjal diketahui juga dipengaruhi oleh faktor genetik. Namun, sampai saat ini, belum ada studi yang menganalisis faktor risiko kejadian batu ginjal dari segi polimorfisme gen, sitokin inflamasi, klinis, dan demografi secara komprehensif, serta belum diketahui mekanisme keseluruhan faktor-faktor tersebut dalam menyebabkan batu ginjal. Oleh sebab itu, penelitian ini dibuat untuk menjelaskan mekanisme faktor risiko tersebut terhadap kejadian batu ginjal sebagai pencegahan terjadinya batu ginjal. Penelitian dilakukan di RSUPN Dr. Cipto Mangunkusumo dengan desain kasus kontrol sejak Maret 2021 hingga Maret 2024 dengan jumlah 308 subjek, yaitu 154 subjek kelompok kasus dan 154 subjek kelompok kontrol sehat. Pada setiap pasien dilakukan pencatatan dan evaluasi terhadap data demografi, pemeriksaan biokimia dan polimorfisme genetik dievaluasi dari sampel darah, ekspresi gen sitokin inflamasi dan urinalisis dari sampel urin pagi, serta pemerikaan urin 24 jam. Asupan cairan dinilai menggunakan kuesioner Liq-In7. Analisis bivariat dan multivariat dilakukan menggunakan SPSS versi 20 sedangkan analisis jalur dilakukan menggunakan JASP 0.19.1.0. Dari penelitian didapatkan usia lebih tua, peningkatan kadar kreatinin darah, peningkatan kadar kalsium urin, kondisi ISK, genotipe GT gen CaSR rs1801725, genotipe CT gen CLDN14 rs219780, genotipe AG dan GG gen VDR rs2228570, genotipe CT gen VDR rs1544410, dan genotipe CT gen ALPL rs1256328 berhubungan dengan peningkatan risiko kejadian batu ginjal. Peningkatan kadar sitrat urin dan genotipe AG gen CaSR rs1042636 menurunkan risiko batu ginjal. Selain itu, rerata asupan cairan lebih rendah, asam urat urin lebih rendah, asam urat serum lebih tinggi, dan proporsi Genotipe CT gen VDR rs731236 dan pekerja kantor lebih rendah didapatkan pada kelompok kasus secara bermakna, namun tidak termasuk dalam faktor risiko independen berdasarkan hasil multivariat. Upregulation ekspresi IL-8 juga didapatkan pada kelompok kasus. Pada analisis jalur, varian gen VDR rs2228570, CLDN14 rs219780, CaSR rs1801725, kreatinin serum, dan usia lebih dominan memiliki efek positif langsung terhadap batu ginjal. Di sisi lain, varian gen VDR rs1544410 memiliki efek positif tidak langsung yang lebih dominan terhadap batu ginjal melalui kalsium urin. Prediktor batu ginjal dengan sistem skoring menggunakan beberapa variabel telah dikembangkan dengan sensitivitas dan spesifisitas yang baik. Dengan mengidentifikasi faktor risiko terkait batu ginjal yang dapat dan tidak dapat dimodifikasi bisa menjadi target utama dalam pencegahan primer batu ginjal.

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Kidney stones are among the most common urological diseases in Indonesia, influenced by various inflammatory, clinical, and demographic factors, but 50% of the predisposition is also attributed to genetic factors. To date, no comprehensive studies have analyzed kidney stone risk factors by considering genetic polymorphisms, inflammatory cytokines, clinical, and demographics factors. Moreover, the comprehensive mechanisms by which these risk factors contribute to kidney stone formation remain unclear. Therefore, this study was conducted to elucidate how these risk factors contribute to kidney stone occurrence, aiming to prevent kidney stones. The study was conducted at Dr. Cipto Mangunkusumo Hospital using a case-control design from March 2021 to March 2024, involving 308 subjects, comprising 154 cases and 154 healthy controls. Demographic data were collected through subject interviews. Biochemical and genetic polymorphism analyses were performed using blood samples, while inflammatory cytokine gene expression and urinalysis were evaluated from morning urine samples. Twenty-four-hour urine samples were utilized to analyze the levels of dissolved molecules and urine pH. Fluid intake was assessed using the Liq-In7 questionnaire. Bivariate and multivariate analysis was conducted using SPSS version 20, whereas path analysis was performed using JASP 0.19.1.0. The study identified that older age, increased serum creatinine levels, increased urinary calcium levels, urinary tract infections, the GT genotype of the CaSR rs1801725 gene, the CT genotype of the CLDN14 rs219780, the AG and GG genotypes of the VDR rs2228570, the CT genotype of the VDR rs1544410, and the CT genotype of the ALPL rs1256328 were associated with an increased risk of kidney stone. In contrast, higher urinary citrate levels and the AG genotype of the CaSR rs1042636 gene were associated with a reduced risk of kidney stones. Furthermore, the case group showed significantly lower mean fluid intake, lower urinary uric acid levels, higher serum uric acid levels, and a lower proportion of the CT genotype of the VDR rs731236 gene and office workers. However, these variables were not identified as independent risk factors based on multivariate analysis. IL-8 expression was also observed to be upregulated in the case group. Path analysis revealed that the VDR rs2228570, CLDN14 rs219780, and CaSR rs1801725 genetic variants, serum creatinine, and age, predominantly exerted direct positive effects on kidney stone. Conversely, the VDR rs1544410 genetic variant had a more pronounced indirect positive effect through urinary calcium levels. Scoring systems for kidney stone prediction, incorporating these variables, had been developed with good sensitivity and specificity. Identifying modifiable and non-modifiable risk factors related to kidney stones could serve as critical targets for primary prevention strategies."

"The cytokine is one of the proteins responsible for the immune system. Several types of cytokines acting as key regulators of infection include IL-10, IL-12, and IL-14. The chemical content of Zingiber cassumunar shows potential immunomodulatory effects. This study aimed to determine the effect of the ethanol extract of Zingiber cassumunar (EEZC) on the expressions of IL-10, IL-12, and IL-14. The test animals were BALB/c mice, which were divided into five groups, i.e., normal group (untreated), negative control group (treated with 10% of tween 80), and three treatment groups that respectively received 1.25 mg, 2.5mg, and 5mg/20g BW of EEZC. The treatment was carried out for 21 days. On the 22ndday, the mice were induced with LPS intraperitoneally (except for the normal group). The interleukin expression was observed by immunohistochemistry using specific antibodies, and the expressed cells were counted under a microscope. The administration of EEZC at the doses of 1.25 mg, 2.5mg, and 5mg/20g BW for 21 days increased the expression of IL-10, IL-12, and IL-14 significantly and proportionally to the dose. and suggested the potency of extract to induce both innate and adaptive immunity. This activity may be attributable to curcumin as an active compound in this extract."

"Polimorfisme gen reseptor vitamin D (RVD) merupakan kandidat genetik yang dapat menjelaskan rentannya suatu populasi terhadap tuberkulosis. Namun, hingga kini, sejumlah penelitian yang mencoba membuktikan hal tersebut menunjukkan hasil bervariasi pada berbagai populasi. Studi ini merupakan studi kasus-kontrol yang mengikutsertakan 35 pasien pascatuberkulosis paru (14 laki-laki dan 21 perempuan, median usia 40) serta 35 kontrol serumah (14 laki-laki dan 21 perempuan, median usia 39) yang tinggal di Nusa Tenggara Timur, salah satu provinsi di Indonesia dengan prevalensi tuberkulosis paru yang tinggi. Polimorfisme genetik diperiksa melalui metode polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) dengan menggunakan enzim restriksi BsmI dari sampel darah yang diisolasi dan ditambahkan EDTA. Sebaran frekuensi genotipe BsmI RVD pada kelompok kasus adalah BB=9 (26%), Bb=24 (69%), dan bb=2 (5%) sementara pada kelompok kontrol adalah BB=5 (14%), Bb=25 (72%), dan bb=5 (14%) dengan p=0,232 (OR 2,07, IK 95% 0,62-6,98). Distribusi frekuensi alel pada kelompok kasus adalah B=42 (60%) dan b=28 (40%) sementara pada kelompok kontrol adalah B=35 (50%) dan b=35 (50%). Frekuensi alel varian (alel b) pada penelitian ini adalah 0,45. Distribusi genotipe pada penelitian ini tidak memenuhi persamaan Hardy-Weinberg. Sebagai kesimpulan, penelitian ini tidak menunjukkan adanya hubungan antara polimorfisme gen RVD terhadap kejadian tuberkulosis paru.

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Vitamin D receptor gene (VDR) polymorphism is a genetic candidate which may explain the susceptibility of tuberculosis (TB) in a single population. However, until now, some studies which had tried to prove this showed varied results in different populations. This is a case-control study involving 35 post pulmonary tuberculosis patients (14 males and 21 females, median age 40) and 35 healthy household controls (14 males and 21 females, median age 39) who dwelled in East Nusa Tenggara, one of the provinces in Indonesia with high prevalence of pulmonary tuberculosis. The genetic polymorphism was examined using polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) method with BsmI restriction enzyme from EDTA added-isolated blood sample. The distribution of VDR BsmI genotype frequency in case group was BB=9 (26%), Bb=24 (69%), and bb=2 (5%) whereas in control group was BB=5 (14%), Bb=25 (72%), and bb=5 (14%) with p=0.232 (OR 2.07, 95% CI 0.62-6.98). Furthermore, the distribution frequency of allele in case group was B=42 (60%) and b=28 (40%) whereas in control group was B=35 (50%) and b=35 (50%). Frequency of variant allele in this study was 0.45. Genotype distribution in this study did not meet the Hardy-Weinberg equilibrium. As conclusion, this study did not show any association between VDR gene polymorphism and pulmonary tuberculosis."

"Latar Belakang: Transplantasi ginjal telah menjadi pilihan utama terapi bagi pasien dengan penyakit ginjal tahap akhir, baik yang berasal dari donor hidup maupun donor jenazah. Transplantasi ginjal memiliki risiko yang lebih rendah baik untuk mortalitas maupun kejadian kardiovaskular, serta memiliki kualitas hidup yang lebih baik dibandingkan pasien yang menjalani dialisis kronis, baik hemodialisis maupun dialisis peritoneal. Penelitian ini bertujuan mengetahui faktor-faktor yang mempengaruhi kesintasan transplantasi ginjal di RSUPN Ciptomangunkusumo tahun 2010-2017. Metode: Penelitian Desain penelitian ini adalah kohort retrospekstif menggunakan data rekam medis pasien transplantasi ginjal. Sampel penelitian adalah resipien transplantasi ginjal ≥ 18 tahun di di RSUPN Ciptomangunkusumo tahun 2010-2017, yaitu sebanyak 548 pasien. Hasil: penelitian probabilitas kesintasan resipien transplantasi ginjal selama pengamatan 5 tahun adalah 84,1% Hasil analisis dengan regresi cox menunjukkan bahwa resipien dengan donor yang berusia ≥ 40 tahun lebih cepat 1,487 kali untuk meninggal dibandingkan resipien dengan donor yang berusia < 40 tahun, resipien yang berusia ≥ 45 tahun lebih cepat 2,356 kali untuk meninggal dibandingkan pasien yang berusia <45 tahun, lama hemodialisis ≥ 24 bulan lebih cepat 2,356 kali untuk meninggal dibandingkan pasien yang lama hemodialisisnya < 24 bulan, skor charlson > 1 lebih cepat 2,861 kali untuk meninggal dibandingkan pasien yang skor charlson ≤ 1, resipien yang memiliki DM lebih cepat 2,947 kali untuk meninggal dibandingkan dengan yang tidak DM. Simpulan: Kesintasan lima tahun di Indonesia cukup baik. Insiden kematian relatif tinggi, menyebabkan penurunan kelangsungan hidup pasien lima tahun. Namun, hasil keseluruhan masih sebanding dengan negara-negara berkembang lainnya.

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Background: Kidney transplantation has become the main choice of therapy for patients with end-stage kidney disease, both from living donors and donor bodies. Kidney transplantation has a lower risk for both mortality and cardiovascular events, and has a better quality of life than patients who undergo chronic dialysis, both hemodialysis and peritoneal dialysis. This study aims to determine the factors that influence the survival of kidney transplants in Ciptomangunkusumo Hospital in 2010-2017.

Methods: A retrospective cohort study with total consecutive sampling is performed on all kidney transplant recipients in Cipto Mangunkusumo Hospital from March 2019 until May 2019. Data is acquired by analysing medical records and contacting patients directly. Each recipient is followed from the day of transplant until death or december 2018, whichever comes first. Five-year death and patient survival is documented. Kaplan-Meier Curve is used to describe patient survival until the end of study and analysis with Cox regression.

Result: which was as many as 548 patients. The results of this study indicate the probability of survival of kidney transplant recommendations during the 5-year observation was 84.1%. The results of the analysis with Cox regression showed that donors aged ≥ 40 years were 1,487 faster to die than recipients with donor aged <40 years, prescriptions aged ≥ 40 years 2,356 times faster to die than patients aged <40 years, duration of hemodialysis ≥ 24 months faster 2,356 times to die compared to patients with long hemodialysis <24 months, Charles score> 1 faster 2,861 times to die than patients who score charlson ≤ 1, the recipients who have DM are 2.97 times faster to die compared to those without DM.

Conclusions: The outcome of five-year death in Indonesia is very satisfactory. The incidence of death is relatively high, causing a decline in five-year patient survival. However, the overall results are still comparable to other developing countries."

"Latar belakang: Cisplatin diketahui sebagai agen kemoterapi yang paling sering digunakan dalam terapi keganasan hematologi dan tumor padat. Namun, efek samping cisplatin nefrotoksisitas menjadi masalah utama, sebab pemberian cisplatin sesuai dengan dosis terapeutik saja sudah menimbulkan kerusakan ginjal.Tujuan penelitian: Membuktikan efek kurkumin yang bersifat renoprotektif terhadap kerusakan ginjal yang diinduksi cisplatin melalui penurunan ekspresi endothelin-1 (ET-1). Endothelin-1 merupakan peptida yang berkaitan dengan fungsi ginjal, karena memiliki peran sebagai vasokonstriktor poten dan sebagai hemodinamik di organ ginjal.Metode: Sampel yang digunakan dalam penelitian ini berupa organ tersimpan dari penelitian Ni Made Dwi Sandhiutami, S.Si, M.Kes, Apt. Sampel dibagi dalam 4 kelompok perlakuan, yaitu kelompok tikus normal (N), kanker ovarium tanpa perlakuan (Ca), kanker ovarium perlakuan cisplatin (Cis), dan kanker ovarium perlakuan cisplatin+curcumin (Cur). Induksi kanker ovarium dengan cara injeksi 7,12-Dimethylbenz[a]anthracene (DMBA) melalui benang silk dan dirawat selama 20 minggu membentuk adanya tumor pada ovarium.Hasil: Hasil yang diperoleh memperlihatkan kelompok Ca mengalami peningkatan ET-1 sebesar 2,8555±0,69981, kelompok Cis terjadi peningkatan ET-1 sebesar 6,0965±2,1558, namun pada kelompok Cis+Cur terjadi penurunan ekspresi ET-1 sebesar 2,1616±0,71623. Meskipun, data pada pemeriksaan ekspresi ET-1 tidak berbeda bermakna secara statistik, namun pemberian kurkumin dapat dikatakan bermakna secara kondisi klinis karena menurunkan ekspresi ET-1 sebesar 64,5%. Pada pemeriksaan serum kreatinin, hanya kelompok tikus normal (N) dengan kelompok tikus kanker ovarium dengan perlakuan cisplatin (Cis) yang berbeda bermakna dan signifikan.Kesimpulan: Cisplatin bersifat nefrotoksisitas meskipun dalam dosis terapi, serta pemberian kurkumin bermanfaat sebab dapat bersifat renoprotektif bagi kerusakan ginjal yang diinduksi cisplatin.

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Introduction: Cisplatin is known as a chemotherapy agent that is most often used in the therapy of hematologic malignancies and solid tumors. However, the side effects of cisplatin nephrotoxicity are the main problem, because giving cisplatin in accordance with the therapeutic dose alone has caused kidney damage.

Purpose of the study: To prove the effect of curcumin which is renoprotective against cisplatin-induced renal damage through decreased expression of endothelin-1 (ET-1). Endothelin-1 is a peptide related to kidney function, because it has a role as a potent vasoconstrictor and as a hemodynamic agent in the kidney.

Methods: The samples used in this study were stored organs from research by Ni Made Dwi Sandhiutami, S.Si, M.Kes, Apt. Samples were divided into 4 treatment groups, namely normal mice (N), ovarian cancer without treatment (Ca), ovarian cancer treated with cisplatin (Cis), and ovarian cancer treated with cisplatin + curcumin (Cur). Ovarian cancer induction by injection of 7,12-Dimethylbenz [a] anthracene (DMBA) through silk thread and treated for 20 weeks to form a tumor in the ovary.

Results: The results showed that the Ca group experienced an increase in ET-1 by 2.8555 ± 0.69981, the Cis group had an increase in ET-1 by 6.0965 ± 2.1558, but in the Cis + Cur group there was a decrease in ET-1 expression. equal to 2.1616 ± 0.71623. Although, the data on the examination of ET-1 expression were not statistically significant, but curcumin administration can be said to be clinically significant because it reduces the expression of ET-1 by 64.5%. In the serum creatinine examination, only the normal (N) group of mice with ovarian cancer mice treated with cisplatin (Cis) was significantly and significantly different.

Conclusion: Cisplatin is nephrotoxicity even in therapeutic doses, and curcumin administration is beneficial because it can be renoprotective for cisplatin-induced renal damage"

"Latar Belakang: Proses inflamasi dengan respons maladaptif merupakan mekanisme terjadinya disfungsi multiorgan dan kematian pada sepsis. Heparin merupakan sediaan yang digunakan secara luas untuk terapi gangguan koagulasi, secara in-vitro heparin juga memiliki pengaruh sebagai antiinflamasi melalui penurunan aktivitas nuclear factor kappa B (NFkB) dan tumor necrosis factor alpha (TNF-. Penggunan heparin pada sepsis, khususnya sebagai antiinflamasi, masih merupakan kontroversi dan memerlukan penelitian lebih lanjut.Tujuan Penelitian: Tujuan primer penelitian ini adalah mengetahui pengaruh terapi heparin terhadap konsentrasi NFkB, inhibitor kappa B kinase beta (IKK dan TNF-pada pasien sepsis berat Tujuan sekunder adalah menilai pengaruh terapi heparin terhadap mortalitas dan perbaikan disfungsi organ.Metode: Uji klinis acak tersamar ganda membandingkan terapi heparin tidak terfraksinasi, dosis 10 unit/kg berat badan/24 jam, infus kontinu selama 72 jam, dengan plasebo. Kriteria inklusi adalah: subjek usia 18 tahun atau lebih dengan sepsis berat awitan maksimal 48 jam dan bersedia berpartisipasi dalam penelitian. Seleksi subjek dilakukan secara konsekutif dengan alokasi subjek secara acak. Pemantauan terhadap respons klinis dilakukan dengan menilai mortalitas 14 hari serta perbaikan skor APACHE II. Analisis intention to treat (ITT) dilakukan terhadap subjek yang telah mendapat terapi heparin minimal selama 24 jam, pada subjek yang melengkapi seluruh protokol penelitian dilakukan analisis per-protocol (PP).Hasil: Sebanyak 115 subjek telah diinklusi dan dirandomisasi, 58 subjek mendapat heparin dan 57 subjek plasebo. Rentang usia 21 hingga 82 tahun dengan rerata 51 tahun. Analisis ITT dan PP dilakukan terhadap masing-masing 46 dan 22 subjek kelompok heparin dan 50 dan 28 subjek kelompok kontrol. Tidak didapatkan perbedaan yang bermakna konsentrasi NFkBterfosforilasi dan IKK terfosforilasi kelompok heparin dibandingkan kontrol. Didapatkan penurunan konsentrasi TNF-pada kelompok heparin dibandingkan kontrol walaupun secara statistik belum bermakna. Didapatkan penurunan mortalitas pada analisis PP (RR 0,212 [IK 95% 0,053 - 0,815], p = 0,008), dengan ARR 33,8 % dan NNT 3. Terdapat kecenderungan perbaikan disfungsi organ pada kelompok heparin, walaupan secara statistik belum menunjukkan kemaknaan.Simpulan: Terapi heparin memberikan pengaruh terhadap proses inflamasi pada pasien sepsis berat, terlihat dari penurunan konsentrasi TNF-, walaupun pada pengujian statistik tidak didapatkan perbedaan bermakna. Tidak didapatkan pengaruh terapi heparin terhadap penurunan konsentrasi IKKdanNFkB. Heparin memberikan manfaat terhadap penurunan mortalitas, terutama pada subjek yang mendapat heparin selama 72 jam. Pada pengamatan selama 72 jam, heparin belum telihat memberikan pengaruh terhadap perbaikan disfungsi organ.

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Background. Multiple organ dysfunction and mortality in sepsis are developed as the consequence of the inflammation with maladaptive host response. Heparin has been widely used as an anticoagulant treatment. Based on in vitro evaluation, heparin has an antiinflammatory property by reducing the activity of nuclear factor kappa B (NFkB) and tumor necrosis factor alpha (TNF-. However, the effect of heparin as the anti-inflammatory agent is still controversial. To ascertain the anti-inflammatory effects of heparin in sepsis, further study is needed.Objectives. The primary aim of this study was to determine the effect of heparin in severe sepsis based on the concentration of NFkB, Inhibitor kappa B kinase beta (IKK), and TNF-. Secondary objective was to determine the effect of heparin on mortality rate and improvement of organ dysfunction.Methods. A randomized, double-blind, clinical trial was conducted to compare the unfractionated heparin (UFH) treatment, in dosage of 10 units/ kg BW for 24 hours, continuous infusion for 72 hours, in comparison to placebo. The inclusion criteria were subject 18 years old or above, with severe sepsis in maximum 48 hours after onset and agreed to participate in this study. Furthermore, subjects were consecutively selected and randomly allocated. Clinical responses were monitored by evaluating the 14-days mortality rate and improvement of APACHE II score. Subjects who had received heparin treatment for at least 24 hours were analyzed by intention to treat (ITT), while others who had completed all the protocol, were analyzed by per protocol (PP).Results. There were 115 subjects included and randomly assigned to heparin (n = 58) and placebo (n = 57) groups. The range of age was 21 to 82 years, mean of age was 51 years. ITT and PP analysis were conducted to 46 and 22 subjects in heparin group; 50 and 28 subjects in control group respectively. There were no significant differences in concentration of Phosphorylated-NFkB and Phosphorylated-IKK in both groups. The concentration of TNF-decreased in heparin groups, although statistically was not significant. The 14 days mortality rate reduced in PP analysis (RR 0.212 [95% CI 0.053 – 0.815], p = 0.008), with ARR 33.8 % and NNT 3. Moreover, there are trend of organ dysfunction improvement in heparin group, yet not statistically significant.Conclusion. Heparin treatment has an impact on inflammatory process in severe septic patients; as shown in the reduction of the TNF- concentration, although was not significant statistically. There was no clear impact of heparin treatment on IKK and NFkB concentration. Moreover, heparin shows benefit in reducing the mortality, especially in subjects who has received heparin for 72 hours. No benefit on improvement of organ dysfunction was shown in 72-hour monitoring of heparin treatment."

"Sindrom koroner akut (SKA) merupakan masalah utama penyakit jantung yang merupakan penyebab kematian tertinggi setelah stroke di Indonesia. SKA dapat dinilai keparahannya melalui skor Gensini dan prognosisnya melalui kejadian Major Adverse Cardiac Event (MACE). High Sensitive Troponin T (hsTroponin T) adalah biomarker yang direkomendasikan beberapa badan internasional dalam mendiagnosis infark miokard. Pada pasien SKA yang disertai penyakit ginjal kronik (PGK) akan mempengaruhi hasil pemeriksaan hsTroponin T. Hal ini disebabkan oleh kadar ureum darah yang tinggi bersifat toksik dan kondisi PGK menurunkan fungsi ginjal sehingga mempengaruhi kadar hsTroponin T. Penelitian ini bertujuan mengetahui hubungan hstroponin T dan ureum dengan skor Gensini, MACE jangka pendek pada pasien SKA yang disertai PGK di RSUPN dr. Cipto Mangunkusumo. Metode penelitian adalah potong lintang dilakukan pada bulan Januari-Oktober 2018. Subjek penelitian meliputi seluruh pasien yang mengikuti penelitian terdahulu “ Pengaruh Beta 2- Mikroglobulin dan Fibroblast Growth Factor 23 terhadap Keparahan Koroner dan Major Adverse Cardiac Event pada Pasien Sindrom Koroner Akut dengan Penyakit Ginjal Kronik”. Kadar hsTroponin T dan ureum subjek SKA dengan PGK dihubungkan dengan skor Gensini dan kejadian MACE jangka pendek. Terdapat 80 subjek SKA dengan PGK, terdiri dari 63 subjek STEMI -NSTEMI dengan peningkatan hsTroponin T dan 17 subjek UAP. Terdapat 34 subjek mengalami MACE diantaranya ada 11 subjek yang meninggal. Tidak terdapat korelasi kadar hsTroponin T dengan skor Gensini, r = 0,095, p=0,401 dan juga ureum dengan skor Gensini, r = 0,107, p = 0,343. Peningkatan kadar hsTroponin T memberikan peningkatan Odds Ratio (OR) sebesar 1,59 dan ureum OR 3,14 dengan p<0,05 terhadap kejadian MACE jangka pendek. Titik potong hsTroponin T terhadap kejadian MACE jangka pendek sebesar 150,5ng/L dengan sensitivitas 53,5%, spesifisitas 55,3%, nilai prediksi positif (NPP) 48%, nilai prediksi negatif (NPN) 63,33%. Titik potong ureum terhadap kejadian MACE jangka pendek 47,45mg/dL dengan sensitivitas 52,9%, spesifisitas 47,8%, NPP 63,63%, NPN 63,79%. Berdasarkan hasil tersebut peningkatan kadar hsTroponin T diatas 150,5ng/L dan ureum47,45mg/dL berperan dalam meningkatkan risiko kejadian terjadinya MACE jangka pendek dengan OR 1,59 dan 3,14 pada pasien SKA dengan PGK. Gambaran kadar hsTroponin T bervariasi pada setiap stadium PGK tetapi ada kecenderungan peningkatan kadar seiring dengan peningkatan stadium PGK, untuk itu diperlukan penelitian lebih lanjut untuk mendapatkan gambaran kadar hsTroponin T yang lebih jelas.

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Acute Coronary Syndrome(ACS) is the main problem in heart disease which is the highest mortality after stroke in Indonesia. ACS can be assess the severity degree by Gensini scoring and its prognosis by Major Adverse Cardiac Event (MACE). High sensitive Troponin T (hsTroponin T) is biomarker that recomended by several international associations in diagnosing miocard infarct. Level of hs Troponin T can be affected in patients with ACS and chronic kidney disease (CKD), because lower filtration in CKD and high level ureum has toxic effect.This research aimed in knowing the relation of hsTroponin T and ureum with Gensini score, short term MACE, in ACS and CKD in RSUPN dr. Cipto Mangunkusumo. Methods using cross sectional in January-October 2018. All patients in elder research “ Pengaruh Beta 2- Mikroglobulin dan Fibroblast Growth Factor 23 terhadap Keparahan Koroner dan Major Adverse Cardiac Event pada Pasien Sindrom Koroner Akut dengan Penyakit Ginjal Kronik”, are included in this research, and then search for the correlation between hsTroponin T, ureum and Gensini score, short term MACE. There are 80 subjects ACS with CKD, 63 subjects with STEMI -NSTEMI (ST Elevation Miocard Infarct-Non ST Elevation Miocard Infarct) and elevated level of hs-troponin T, 17 subjects UAP (Unstable Angina Pectoris), 34 subjects MACE and 11 subjects within were died. There is no correlation between hsTroponin T and Gensini score is not , r=0,095 with p=0,401. There is no correlation between ureum and Gensini score r= 0,107 with p=0,343. Level of hsTroponin T and ureum has odds ratio OR= 1,59 and 3,14, p<0,05 towards short term MACE. The cut off for hsTroponin T towards short term MACE is 150,5ng/L with sensitivity 53,5%, specificity 55,3%, positive predictive value (PPV) 48%, negative predictive value (NPV) 63,33%. The cut off for ureum towards short term MACE is 47,45mg/dL with sensitivity 52,9%, specificity 47,8%, PPV 63,63%,NPV 63,79%. The descriptions of hsTroponin T level are various in every stage of CKD. According to that results, ascending level in hsTroponin T with cut off 150,5ng/L and ureum 47,45mg/dL has an impact in short term MACE (OR hsTroponin T=1,59 and ureum=3,14) in patients with ACS and CKD. The descriptions of level hsTroponin T are variety, but have tendency to escalate level hsTroponin T in every stage of CKD and need advance research to have clear descriptions."

"ABSTRAKLatar belakang: Interdialytic Weight Gains (IDWG) merupakan peningkatan volume cairanyang dimanifestasikan dengan peningkatan berat badan sebagai indikator untuk mengetahuijumlah cairan yang masuk selama periode interdialitik dan kepatuhan pasien terhadap pengaturancairan pada pasien yang mendapatkan terapi hemodialisis. Peningkatan IDWG melebihi 5% dariberat badan kering dapat menyebabkan berbagai macam komplikasi seperti hipertensi, hipotensiintradialisis, gagal jantung kiri, asites, pleural effusion, gagal jantung kongestif, dan dapatmengakibatkan kematian. IDWG dapat disebabkan oleh berbagai macam factor baik faktorinternal yang meliputi usia, jenis kelamin, tingkat pendidikan, rasa haus, Stres, Self efficacy,maupun faktor eksternal yaitu dukungan keluarga dan social serta jumlah intake cairan. Tujuan:penelitian ini bertujuan untuk mengetahui factor-faktor yang berkontribusi terhadap IDWG padapasien CKD yang menjalani hemodialisis di unit hemodialisis RS PKU MuhammadiyahYogyakarta. Metode: Penelitian ini menggunakan desain penelitian deskriptif analitik denganpendekatan crossectional, dengan menggunakan 48 pasien sebagai responden penelitian yangdiambil dari 79 pasien yang menjalani HD. Hasil: Hasil analisis menunjukkan ada hubunganyang signifikan antara masukan cairan dengan IDWG (r=0,541, p-value = 0,000), dan tidak adahubungan yang signifikan antara umur, jenis kelamin, tingkat pendidikan, rasa haus, dukungankeluarga dan sosial, self efficacy serta stress dengan IDWG. Kesimpulan dari penelitian iniadalah masukan cairan merupakan factor yang berkontribusi secara signifikan terhadap IDWG.Rekomendasi dari penelitian ini adalah dilakukannya pendidikan kesehatan secara terstrukturtentang pengaturan masukan cairan secara mandiri oleh pasien.

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ABSTRACTBackground: Interdialytic Weight Gains (IDWG) is fluid volume excess that manifest by increasing body weight as an indicator of patient fluid intake and patient compliance on fluid restriction during interdialytic period of hemodialysis treatment. Increasing IDWG more than 5% from dry weight can affect more complications like hypertension, intradialysis hypotension, left heart failure, ascites, pleural effusion, Congestive heart failure, and death. Many factors that contribute IDWG are internal factors like age, gender, education, thirst, stress, self efficacy; external factors like family and social support, and fluid intake. The purposes of this research isto know the factors that contribute IDWG on Chronic Kidney Deseases (CKD) patient with haemodialysis at PKU Muhammadiyah Yogyakarta Hospital. Methods: Forty eight patients were collected from seventy nine HD patients. Bivariate analysis revealed that the demographic factors (age, gender, education), fluid intake, sensation of thirst, family and social support, self efficacy, and stress was independent determinant of IDWG. The result of this research showedsignificant relationship between fluid intake and IDWG (r=0,541, p-value = 0,000), and no significant relationship between age, gender, education, thirst, family and social support, self efficacy and stress with IDWG. The research concluded fluid intake is a significant factorcontribute of IDWG. It is recommended to develop health education about fluid management to increase the self care of haemodialysis patient in health care."

"Infeksi saluran kemih dan batu ginjal merupakan masalah kesehatan dengan prevalensi dan insidensi yang tinggi di dunia. Pasien batu ginjal dapat mengalami penurunan fungsi ginjal yang dapat berujung pada Chronic Kidney Disease (CKD). Penelitian ini bertujuan untuk mengetahui hubungan antara infeksi saluran kemih dengan fungsi ginjal pada pasien batu ginjal. Desain penelitian ini adalah potong lintang, melibatkan 5463 pasien batu ginjal yang menjalani perawatan di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPNCM) pada tahun 2000-2013. Pengambilan data dilakukan pada 1140 pasien yang mempunyai data leukosit urin dan kreatinin serum. Sampel didapatkan dengan metode total population sampling. Pengambilan data dilakukan dengan mempelajari rekam medis pasien. Hasil penelitian menunjukkan rasio subjek lakilaki: perempuan sebesar 7:3, prevalensi infeksi saluran kemih pada pasien batu ginjal sebesar 27.3%, prevalensi fungsi ginjal buruk pada pasien batu ginjal sebesar 37.4%, dan nilai kemaknaan p<0.0001 pada hubungan antara infeksi saluran kemih dengan fungsi ginjal pada pasien batu ginjal. Terdapat hubungan yang bermakna antara infeksi saluran kemih dengan fungsi ginjal pada pasien batu ginjal. Diperlukan penatalaksanaan serta pencegahan infeksi saluran kemih pada pasien batu ginjal untuk mencegah perburukan fungsi ginjal.

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Urinary tract infections and kidney stones are among the high prevalence health problems in the world. Kidney stone patients may have reduced kidney function that can lead to Chronic Kidney Disease (CKD). This study investigates possible relations between urinary tract infection with renal function in kidney stone patient.

This cross-sectional study was carried out on 5463 patients undergoing treatment for calculous disease in Cipto Mangunkusumo National Center General Hospital (RSUPNCM) between 2000 and 2013. Data were collected from 1140 patients whose urine leukocytes and serum creatinine data were recorded. Samples were obtained using total population sampling method. Data were collected from patient's medical record. Patient characteristics were well matched generally.

The male to female ratio of subjects were 7:3 with a mean age of 46. Among subjects, 27.3% had urinary tract infections while 37.4% had poor kidney function. There was a significance value of p<0.0001 on the relationship between urinary tract infection and renal function in kidney stone patients.

In conclusion, there is a significant association between urinary tract infections and renal function in kidney stone patients. Management and prevention of urinary tract infections are necessary in kidney stone patients to prevent deterioration of renal function."

"Latar Belakang: Sebagai negara dengan mayoritas penduduk muslim, sebagian besar masyarakat Indonesia termasuk lansia menjalani puasa pada bulan Ramadhan. Dalam mengevaluasi keamanan berpuasa Ramadhan pada populasi lansia, dilakukan berbagai penilaian, salah satunya adalah profil fungsi ginjal. Profil fungsi ginjal, dinilai dari laju filtrasi glomerulus (LFG), merupakan salah satu parameter penting dalam menentukan kesehatan lansia. Namun, belum terdapat penelitian mengenai profil fungsi ginjal dan faktor-faktor yang memengaruhi pada lansia berpuasa. Tujuan: Mengetahui profil dan faktor risiko perubahan fungsi ginjal pada usia lanjut yang berpuasa Ramadhan. Metode: Penelitian ini menggunakan desain kohort prospektif dengan menggunakan data primer pada subyek usia > 60 tahun yang menjalani puasa Ramadhan di kelurahan Jatinegara sejak April 2019 hingga Juli 2019. Profil fungsi ginjal dihitung menggunakan pemeriksaan (LFG) pada 1 minggu sebelum berpuasa, 3 minggu berpuasa, dan 2 minggu pasca berpuasa. Faktor risiko yang dinilai adalah usia, indeks massa tubuh, diabetes melitus, hipertensi, kebiasaan merokok, konsumsi protein, dan konsumsi cairan. Analisa bivariat dilakukan menggunakan uji chi-square atau Fisher. Analisis multivariat dilakukan menggunakan regresi logistik. Hasil: Pada penelitian ini, tidak ditemukan adanya faktor risiko yang secara signifikan berpengaruh terhadap perubahan fungsi ginjal selama puasa bulan Ramadhan pada lanjut usia. Beberapa farktor dapat mempengaruhi fungsi ginjal pada usia lanjut yang berpuasa Ramadhan, salah satunya adalah usia. Mayoritas lanjut usia yang mengalami penurunan GFR selama bulan Ramadhan berusia 60-70 tahun berjumlah 89 orang atau 68,5%. Sisanya berjumlah 10 orang atau 58,8% berusia >70 tahun. Namun, setelah dilakukan analisis, hubungan antara usia dengan penurunan GFR selama puasa Ramadhan tidak bermakna (p=0,426). Kesimpulan: Tidak ditemukan adanya perubahan signifikan pada fungsi ginjal dengan usia lanjut yang menjalankan puasa dibulan Ramadhan.

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Background. As a country with a majority Muslim population, most Indonesians, including the elderly, fast during the month of Ramadan. To evaluate the safety of fasting during Ramadan in the elderly population, various assessments were carried out, one of which is kidney function profile. Kidney function profile, assessed using glomerular filtration rate (GFR), is one of the important parameters in determining the health of the elderly. However, there has been no research on kidney function profile and its affecting factors on fasting elderly in Indonesia.

Aim:. To determine the profile and risk factors for changes in kidney function in elderly who fast during Ramadan.

Methods. This study used prospective cohort design using primary data on subjects aged > 60 years who were undergoing Ramadan fasting in Jatinegara village from April 2019 to July 2019. The kidney function profile was calculated using glomerular filtration rate (GFR) examination on 1 week before fasting, 3 weeks fasting, and 2 weeks post fasting. The risk factors assessed were age, body mass index, diabetes mellitus, hypertension, smoking habits, protein consumption, and fluid consumption. Bivariate analysis was performed using the chi-square or Fisher test. Multivariate analysis was performed using logistic regression.

Result. In this study, no risk factors were found significantly influencing changes in kidney function during the Ramadan fasting in the elderly. Some factors can affect kidney function in elderly who fasted in Ramadan, one of which is age. The majority of elderly who experienced a decrease in GFR during the month of Ramadan aged 60-70 years amounted to 89 people or 68.5%. The rest amounted to 10 people or 58.8% aged> 70 years. However, after analysis, the relationship between age and decreased GFR during Ramadan fasting was not significant (p = 0.426).

Conclusion. There was no significant changes in kidney function on fasting elderly during Ramadan."