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Abstrak :
Latar belakang: Pemberian albumin hiperonkotik intravena lazim dilakukan pada pasien hipoalbuminemia berat (kadar albumin plasma ≤2,5 g/dl). Walaupun demikian, hingga ini, berbagai referensi menunjukkan hasil yang inkonklusif terkait manfaat "koreksi" kadar albumin pada pasien, terutama dalam menurunkan mortalitas dan morbiditas. Metode: Penelitian ini menilai karakteristik pasien hipoalbuminemia berat dan pola penggunaan albumin intravena hiperonkotik di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo. Analisis kesintasan dilakukan dengan variabel bebas berupa pemberian albumin intravena, penyakit dasar, kadar albumin saat admisi dan sebelum pemberian, serta durasi hingga temuan hipoalbuminemia berat. Data deskriptif ditampilkan terkait pemberian albumin, yaitu mencakup jumlah yang diberikan dan respons terhadap pemberian albumin. Hasil dan Diskusi: Mayoritas pasien (79,19%) dengan kadar albumin ≤2,5 g/dl diberikan albumin hiperonkotik intravena. Insidens mortalitas 30 hari pada pasien hipoalbuminemia berat adalah 47,20%. Pemberian albumin intravena didapatkan tidak memiliki hubungan bermakna dengan kesintasan 30 hari (HR 0,902; IK 95% 0,598-1,361; p=0,624). Faktor yang berhubungan bermakna dengan kesintasan 30 pada pasien hipoalbuminemia berat adalah sepsis, syok hipovolemik, keganasan padat, serta temuan kadar albumin sebelum pemberian ≤2,0 g/dl. Kesimpulan: Pemberian albumin hiperonkotik intravena pada pasien rawat inap tidak berhubungan dengan kesintasan 30 hari. ......Introduction: Intravenous hyperoncotic albumin administration is a common practice to be done to patients with severe hypoalbuminemia (plasma albumin level ≤2.5 g/dl). However, until now, many references has shown inconclusive results associated with "correction" of albumin level in patients, especially in reducing mortality and morbidity. Method: This study assessed severe hypoalbuminemia patients' characteristics and pattern of use from hyperoncotic albumin intravenously in Cipto Mangunkusumo National Hospital. Survival analysis was done with independent variables including: intravenous albumin administration, underlying diseases, albumin level during admission and before albumin administration, as well as time duration from admission to severa hypoalbuminemia detection. Descriptive data was also shown associated with albumin administration consisted of amount of albumin given and response after albumin administration. Result and Discussion: Majority of subjects (79.19%) with albumin level ≤2.5 g/dl was given hyperoncotic albumin intravenously. Incidences of 30-day mortality in severe hypoalbuminemia patients is 47.20%. There as no association between intravenous albumin administration and 30-day survival (HR 0.902; 95 CI% 0,598-1.361; p=0.624). Factors which were found associated with 30-day mortality are sepsis, hypovolemic shock, solid malignancy, and findings of albumin level ≤2.0 g/dl before albumin administration. Conclusion: Hyperoncotic intravenous albumin administration didn't associate with 30-days survival.

Abstrak :
Studi eksperimental hewan memperlihatkan bahwa kadar vasopresin serum yang tinggi berhubungan dengan hiperfiltrasi, albuminuria dan hipertrofi glomerulus, dan dikhawatirkan berlanjut menjadi penurunan laju filtrasi glomerulus (LFG) dalam jangka panjang. Namun, belum terdapat laporan yang membuktikan hubungan sebab-akibat antara peningkatan vasopresin serum dengan gangguan ginjal. Studi ini bertujuan untuk mengetahui hubungan peningkatan vasopresin serum dengan gangguan ginjal, beserta lokasi gangguan ginjal tersebut. Studi ini juga ditujukan untuk melihat kemampuan berat jenis (BJ) urin untuk mendeteksi gangguan ginjal. Penelitian ini adalah studi potong lintang dengan consecutive sampling di sebuah pabrik sepatu pada bulan Januari–Maret 2020. Subjek adalah pekerja terpajan panas yang dinyatakan sehat berdasarkan medical checkup tahun 2019. Sampel darah dan urin diambil lima jam setelah subjek bekerja. Subjek diperiksakan kreatinin plasma, estimasi LFG berdasarkan CKD-EPI, BJ urin, albuminuria carik-celup, albumincreatinine ratio (ACR) urin, vasopresin serum, kidney injury molecule-1 (KIM-1) urin, dan nefrin urin. Data masa kerja, dan jenis kelamin diperoleh melalui wawancara. Pada studi ini, diperoleh 119 subjek wanita dengan median usia 38 (31–51) tahun dan median masa kerja 10 (3–14) tahun. Hiperfiltrasi didapatkan pada 18 subjek, LFG tidak menurun pada 104 subjek (87,4%), dan peningkatan nefrin urin pada 104 pekerja (87,4%). Tidak terdapat hubungan antara vasopresin meningkat dengan hiperfiltrasi, penurunan LFG, albuminuria, nefrin urin, dan KIM-1 urin. Terdapat hubungan bermakna antara peningkatan nefrin urin dengan masa kerja ≥ 10 tahun (p = 0,03). Terdapat hubungan peningkatan KIM-1 urin dengan albuminuria (p = 0,008). Terdapat area under the curve (AUC) antara BJ urin dan nefrin urin sebesar 81,7% (95% CI 68,8–94,6%), dengan titik potong BJ urin ≥ 1,018 yang memiliki sensitivitas 71,2% dan spesifisitas 80% untuk kenaikan nefrin. Sebagai simpulan, peningkatan vasopresin serum tidak berhubungan dengan hiperfiltrasi, penurunan LFG, albuminuria, dan peningkatan KIM-urin. Masa kerja > 10 tahun dihubungkan dengan peningkatan nefrin urin. BJ urin ≥ 1,018 dapat dijadikan acuan untuk mendeteksi kenaikan nefrin urin pada pekerja terpajan panas.

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Animal experimental studies have shown that high serum vasopressin levels are associated with hyperfiltration, albuminuria, and glomerular hypertrophy, which may lead to decreased glomerular filtration rate (GFR) in long-term. However, there was no earlier report that has established the causal relationship between elevated serum vasopressin and renal impairment. This study aims to determine the association between increased serum vasopressin and kidney impairments, along with the location of these impairments. This study is also aimed to look at the ability of urine specific gravity to detect elevated serum vasopressin and kidney impairments. This study was a cross-sectional study with consecutive sampling in a shoe factory from January–March 2020. Subjects were heat-exposed workers who were declared healthy based on the medical checkup in 2019. Blood and urine samples were taken five hours after the subject worked. Subjects were examined for plasma creatinine, estimated GFR (eGFR) based on CKD-EPI, urine specific gravity, dipstick albuminuria, urine albumin-creatinine ratio (ACR), serum vasopressin, urine kidney injury molecule-1 (KIM-1), and urinary nephrin. Data on age, length of service, and gender were obtained through interviews. There were 119 female subjects with a median age of 38 (31–51) years and a median length of service 10 (3–14) years. eGFR was not decreased in 104 subjects (87.4%) and urinary nephrin increased in 104 workers (87.4%). There were no increase in urinary albumin excretion and urinary KIM-1. There were significant association between increased urinary nephrin with length of service ≥ 10 years (p = 0.03), normal-increased eGFR with age 30–39 years (p = 0.001), and increased urinary KIM-1 with albuminuria (p = 0.008). There was an area under the curve (AUC) of 81.7% (95% CI 68.8–94.6%) between urine specific gravity and urinary nephrin, with a cut-off point of urine specific gravity > 1.018 having a sensitivity of 71.2% and a specificity of 80% for the increase in urinary nephrin. In conclusion, increased serum vasopressin does not cause a decrease in GFR, albuminuria, and increase in urinary KIM, but does cause an increase in urinary nephrin. urine specific gravity ≥ 1.018 can be used as a cut-off for detecting increased urinary nephrin in heat-exposed workers.

Abstrak :
Latar belakang: Ginjal merupakan target organ hipertensi yang cukup sering terjadi. Deteksi kerusakan ginjal menjadi salah satu hal yang direkomendasikan dalam penatalaksanaan hipertensi terbaru. Indeks resistif renalis IRR yang diperkenalkan pada beberapa dekade terakhir dipercaya dapat mendeteksi lebih awal kerusakan ginjal serta dapat mengevaluasi hasil pengobatan hipertensi yang diberikan. Penelitian terdahulu telah membuktikan terdapat hubungan antara nilai IRR dengan tekanan darah serta kejadian mikroalbuminuria pada populasi pasien hipertensi tidak terkontrol dan hipertensi resisten, tetapi hingga saat ini belum ada penelitian yang menilai hubungan tersebut pada hipertensi terkontrol. Tujuan: Mengetahui hubungan nilai IRR dengan kadar albuminuria pada pasien hipertensi terkontrol. Metode: Pasien hipertensi terkontrol akan menjalani pemeriksaan duplex renalis untuk mendapatkan nilai IRR. Luaran kerusakan ginjal sebagai target organ hipertensi dinilai dengan pemeriksaan albuminuria melalui rasio albumin kreatinin urin (UACR). Hasil: Terdapat 47 pasien yang menjadi subjek penelitian. Rerata nilai IRR pada subyek penelitian ini adalah 0,68 ± 0,07 dan rerata kadar UACR adalah 6,0 (1-122) mg/g. Tidak didapatkan hubungan yang bermakna antara nilai IRR dengan kadar albuminuria pada pasien hipertensi terkontrol (P=0,18 dengan nilai koefisien korelasi r=0,20). Faktor-faktor lain seperti usia, jenis golongan serta jumlah antihipertensi serta lama pengobatan hipertensi tidak berhubungan dengan kadar albuminuria. Kesimpulan: Nilai IRR tidak berhubungan dengan kadar albuminuria pada hipertensi terkontrol.

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Background: Kidney is a target organ hypertension is quite common. Detection of kidney damage is one of the things that is recommended in the management of recent hypertension. The renalis resistive index IRR introduced in the last few decades is believed to detect early kidney damage and can evaluate the results of treatment of hypertension given. Previous research has shown there is a correlation between RRI value with blood pressure and incidence of microalbuminuria in patient with uncontrolled and resistent hypertension, but until now there has been no study that assesses the relationship in patient with controlled hypertension. Objectives: To investigate the relationship between RRI value with albuminuria levels in patient with controlled hypertension. Methods: Patients with controlled hypertension will undergo duplex renalis examination to obtain an RRI score. The outcome of renal impairment as a target organ of hypertension was assessed by albuminuia examination through urine albumin creatinine ratio (UACR) Results: There were 47 patients who became the subject of the study. The average RRI value in this study subjects was 0.68 ± 0.07 and UACR value was 6,0 (1-122) mg/g. There was no significant relationship between IRR and albuminuria levels in hypertensive patients with controlled blood pressure (P = 0.18 with correlation coefficient r = 0.20). Other factors such as age, class type and number of antihypertensives and length of treatment of hypertension are not associated with albuminuria levels. Conclusion: RRI values has no relationship with albuminuria levels in patient with controlled hypertension.

Abstrak :
Nephrotoxic effects of Doxorubicin (DXR) is still a problem in clinical practice. On the other hand Pentoxyfilline (PTX) as an electron-donor material can be nephroprotective. Therefore, combination of DXR and PTX would be expected to reduce nephrotoxic effects of DXR. In this study we examined the effects of PTX on TGF-B1 expression and interstitial fibrosis in an experimental model of DXR nephropathy in mice. Mice were divided into three groups of eight each i.e. untreated Swiss mice (controls), DXR treatment alone to induce nephropathy, and DXR treatment followed by PTX. Following 4 week treatment, each group was sacrificed. Examination of TGF-B1 expression was carried out by immunohistochemistry employing monoclonal antibody. Interstitial fibrosis examination was performed by a histopathologist using Verheoff van Giesen staining and the one way Anova was used for statistical analysis. It was observed that DXR treatment followed by PTX treatment prevented the increase of TGF-B1 expression and interstitial fibrosis in mice with DXRnephropathy (p<0.05). These findings suggested the beneficial nephroprotective effect of PTX.

Abstrak :
Tujuan Mikroalbuminuria (MA) adalah prediktor kuat untuk nefropati diabetik serta morbiditas dan mortalitas kardiovaskular pada pasien DM tipe 2. Studi ini bertujuan untuk mengumpulkan informasi mengenai prevalensi dan faktor risiko untuk MA pada pasien Indonesia dengan DM tipe 2. Metode Studi DEMAND adalah survei potong lintang 1 hari mengenai prevalensi MA dan faktor risikonya pada pasien DM tipe 2. Studi ini melaporkan hasil survei yang dilakukan di Puskesmas di Indonesia dari Juni sampai Desember 2003. Pasien hipertensi dan normotensi dewasa laki-laki dan perempuan dengan DM tipe 2 tanpa diketahui adanya proteinuria dan/atau penyakit ginjal diikutsertakan dalam studi. Pasien yang diketahui hamil, sedang haid atau menderita demam akut tidak diikutsertakan dalam studi. Uji albumin urin/kreatinin dilakukan satu kali pada semua pasien. Hasil Seluruhnya ada 770 pasien yang memenuhi syarat untuk dianalisis. Sekitar 80% pasien menderita mikro-/makroalbuminuria, sedangkan insufisiensi ginjal ditemukan pada kira-kira 36% dari 433 pasien yang ada datanya. Target HbA1c (<7%) dicapai hanya oleh 40% dari 118 pasien yang mempunyai nilai HbA1c. Kebanyakan obat anti diabetes yang diresepkan adalah oral (82%), sedangkan insulin digunakan hanya oleh 14% pasien. Target tekanan darah (< 130/80 mmHg) dicapai hanya oleh 9% pasien. Pasien yang menerima antihipertensi 52%, statin 18%, dan aspirin 26%. Antihipertensi yang paling banyak dipakai adalah penghambat RAS (45%), sedangkan diuretik digunakan oleh 7% pasien. Riwayat DM dalam keluarga ditemukan pada 43% pasien, riwayat retinopati 16%, kaki diabetik 9%, dan riwayat merokok pada 20% pasien. Kesimpulan Data ini menunjukkan bahwa Indonesia mempunyai frekuensi penyakit ginjal diabetik asimtomatik yang tertinggi di antara berbagai negara yang ikut studi DEMAND di dunia. Deteksi dini, pemantauan komplikasi vaskular, dan pengobatan multifaktorial yang lebih agresif yang ditujukan untuk proteksi ginjal dan vaskular sangat dibutuhkan untuk pasien Indonesia dengan DM tipe 2.

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Abstract
Aims Microalbuminuria (MA) is a strong predictor of diabetic nephropathy and cardiovascular morbidity and mortality in patients with type-2 DM. The present study aimed to gather information on the prevalence and risk factors for MA in Indonesian patients with type-2 DM. Methods The DEMAND study was an international open cross-sectional 1-day survey on microalbuminuria prevalence and its risk factors in type-2 diabetic patients. This study reports the results of the Indonesian survey which was performed in primary care practice in Indonesia from June to December 2003. Normotensive or hypertensive adult patients of both genders with type-2 DM without known proteinuria and/or kidney disease were recruited into the study. Patients with known pregnancy, having menstruation or acute fever were excluded. A single urinary albumin/creatinine test was carried out in all patients. Results A total of 770 patients were eligible for analysis. Approximately 80% of the patients had micro-/ macroalbuminuria, while renal insufficiency was detected in about 36% of the 433 patients with available data. Target HbA1c (< 7%) was reached by only 40% of the 118 patients who had HbA1c values. Most antidiabetic treatment prescribed was oral (82%), while insulin was used by only 14% of patients. Goal BP (< 130/80 mm Hg) was achieved in only 9% of patients. The frequency of patients receiving antihypertensives was 52%, statins 18%, and aspirin 26%. The most frequently used antihypertensives were RAS blockers (45%), while diuretics were used in 7 % of the patients. The family history of DM was found in 43% of patients, the history of retinopathy in 16%, diabetic foot 9%, and history of smoking in 20% of patients. Conclusion These data reveal that Indonesia has one of the highest frequencies of silent diabetic kidney disease seen in any national group in the global DEMAND Study. Early detection, monitoring of vascular complications, and more aggressive multifactorial treatment aiming at renal and vascular protection are urgently needed for Indonesian patients with type-2 diabetes.

Abstrak :
Tujuan: mengembangkan sistem skor dan menentukan nilai tambah diagnostik albuminuria dalam mengestimasi carotid intima-media thickness (CIMT). Metode: studi potong lintang dilakukan di poliklinik endokrin RSCM bulan Maret-Mei 2012 pada pasien DMT2 tanpa komplikasi serebrokardiovaskular, penyakit ginjal kronis (PGK) stadium ≥ III, dan tidak merokok. Kami melakukan analisis statistik yang dilanjutkan dengan pembuatan sistem skor. Hasil: dari 71 subjek, didapatkan CIMT dan albuminuria masing-masing sebesar 67,6% dan 73,3%. Dari 48 subjek dengan CIMT, sebanyak 87,5% mengalami albuminuria. Pemeriksaan albuminuria memiliki sensitivitas sebesar 87,5%. Penambahan nilai albuminuria akan meningkatkan AUC sebesar 2,3%. Skor estimasi untuk variabel lama terdiagnosis DM, hipertensi, dislipidemia berturut-turut sebesar 1, 2, 1. Skor probabilitas CIMT pada skor <2, 2, dan >2 sebesar 15%, 57%, dan 90%. Kesimpulan: pemeriksaan albuminuria meningkatkan nilai tambah diagnostik CIMT. Sistem skor dapat digunakan sebagai alat skrining terhadap CIMT pada pasien DM tipe 2 tanpa komplikasi serebrokardiovaskular, PGK stadium ≥ III, dan tidak merokok.

Aim: to develop a scoring system and measure the diagnostic added value of albuminuria to estimate CIMT. Methods: cross-sectional study was done in Endocrine Outpatient Clinic Cipto Mangunkusumo Hospital between March-May 2012 in T2DM patients without history of cerebrocardiovascular event, CKD stage ≥ III, and smoking. Bivariate analysis and multivariate (logistic regression) analysis was done, followed by developing the scoring system. Results: from 71 subjects, there were 67.6% with increased CIMT and 73.3% with albuminuria. From 48 subjects with increased CIMT, 87.5% had albuminuria. Albuminuria measurement had high sensitivity (87.5%). Adding albuminuria measurement will increase the AUC as 2.3%. Estimation score for duration of DM, hypertension, dyslipidemia were as follows 1, 2, 1 respectively. Probability score of increased CIMT for score <2, 2, and >2 was as follows 15%, 57%, and 90%. Conclusion: albuminuria measurement increase the diagnostic value of CIMT. Scoring system can be used as a screening tool to estimate the increased of CIMT in type 2 DM patients without history of cerebrocardiovascular event, CKD stage ≥ III, and smoking

Abstrak :
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. ......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.

Abstrak :
Latar Belakang: Seiiring dengan bertambahnya jumlah pasien diabetes melitus tipe 2 maka angka kejadian nefropati diabetik juga ikut meningkat. Berbagai faktor telah diidentifikasi turut memperberat kejadian nefropati diabetik salah satunya status vitamin D 25(OH)D. Vitamin D memiliki efek non-kalsemik yang dapat memengaruhi sistem renin-angiotensin sehingga turut berperan dalam kejadian albuminuria. Studi sebelumnya menunjukan tingginya prevalensi defisiensi vitamin D 25(OH)D pada pasien diabetes melitus tipe 2 dan defisiensi vitamin D diduga berhubungan dengan kejadian albuminuria. Tujuan: Mengetahui asosiasi antara status vitamin D 25(OH)D dengan albuminuria pada pasien diabetes melitus tipe 2 di Indonesia. Metodologi: Dilakukan studi potong lintang pada 96 pasien diabetes melitus tipe 2 yang berobat ke poliklinik Metabolik-Endokrin RSUPN-CM. Pemeriksaan kadar vitamin D 25(OH)D menggunakan kit Diasorin dengan metode CLIA dan albuminuria dinilai berdasarkan kadar albumin pada sampel urine sewaktu. Analisis bivariat menggunakan metode chi square dan analisis multivariat menggunakan teknik regresi logistik. Hasil: Prevalensi defisiensi vitamin D 25(OH)D pada pasien diabetes melitus tipe 2 sebesar 49% dengan nilai median kadar vitamin D 25(OH)D pada pasien diabetes melitus tipe 2 adalah 16,35 ng/mL (4,2-41,4 ng/mL). Tidak didapatkan adanya hubungan yang bermakna antara defisiensi vitamin D dengan albuminuria baik pada analisa bivariat maupun multivariat (OR 0,887;IK95% 0,335-2,296). Faktor perancu seperti kontrol gula darah yang buruk dan berat badan lebih sangat mempengaruhi hubungan antara defisiensi vitamin D dengan kejadian albuminuria pada pasien diabetes melitus tipe 2. Simpulan: Studi ini belum dapat menyimpulkan adanya hubungan antara defisiensi vitamin D 25(OH)D dengan albuminuria pada pasien diabetes melitus tipe 2 di Indonesia. ...... Background: In line with the increasing number of patients with diabetes mellitus type 2, the incidence of diabetic nephropathy is also increased. Various factors aggravating diabetic nephropathy have been identified, among others vitamin D 25(OH)D level. Vitamin D has a non-calcemic effect on renin-angiotensin system, causing albuminuria. Previous studies showed a high prevalence of vitamin D deficiency in patients with type 2 diabetes mellitus and it was related to the incidence of albuminuria. Aim: To know the association between vitamin D 25(OH)D level with albuminuria in patients with type 2 diabetes mellitus in Indonesia. Methods: A cross-sectional study was conducted in 96 patients with type 2 diabetes mellitus at outpatient clinic of Metabolic-Endocrine Cipto Mangunkusumo Hospital. Serum vitamin D level was assessed using Diasorin kit with CLIA method. Albuminuria was assessed using random urine sample. For bivariate analysis using chi square and multivariate analysis using regression logistic method. Results: The prevalence of vitamin D 25(OH)D deficiency in patients with type 2 diabetes mellitus was 49% with a median value 16,35 ng / mL (4,2 - 41,4 ng /mL). There was no significant correlation between vitamin D deficiency with the severity of albuminuria (OR 0,887; 95% CI 0,335 to 2,296). Confounding factors such as poor blood glucose control and overweight strongly influenced the association between vitamin D deficiency with the incidence of albuminuria in patients with type 2 diabetes mellitus. Conclusion: The results of this study have not been able to show an association between vitamin D deficiency with the severity of albuminuria in patients with type 2 diabetes mellitus in Indonesia.

Abstrak :
Diabetes Melitus adalah penyakit metabolik yang terjadi karena adanya kelainan pada sekresi insulin atau kerja insulin yang ditandai dengan adanya karakteristik hiperglikemia dan dapat berujung komplikasi berupa nefropati diabetik. Pemeriksaan penunjang untuk mendiagnosis Diabetes Melitus salah satunya adalah dengan menggunakan HbA1c, yang merupakan hasil dari proses glikosilasi nonenzimatis glukosa pada hemoglobin. Korelasi antara HbA1c dengan mikroalbumin dan laju filtrasi glomerulus sebagai penanda nefropati diabetik belum banyak diteliti di Indonesia. Penelitian ini menggunakan design penelitian cross-sectional dengan menggunakan 80 subjek yang memeriksakan kadar HbA1c, mikroalbuminuria dan laju filtrasi glomerulus ke Laboraturium RSCM. Data diolah dengan menggunakan uji spearman untuk HbA1c dan mikroalbumin dengan hasil r = 0.381 dan p < 0,001 serta uji pearson untuk HbA1c dengan laju filtrasi glomerulus dengan hasil p > 0,05. Pada penelitian didapatkan terdapat korelasi lemah antara HbA1c dan mikroalbumin serta tidak ada korelasi antara HbA1c dengan laju filtrasi glomerulus.

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Diabetes Mellitus is metabolic disease with impairment of insulin secretion and insulin function which marked by hyperglycemia and could lead to diabetic nephropathy complication. Testing for HbA1c is one of the tests to diagnose diabetes mellitus. HbA1c itself is a substance that results from glucose nonenzimatic glycosylation process to hemoglobin. The correlation between HbA1c with microalbumin in urine and glomerular filtration rate is not fully known in Indonesia. This study is using cross sectional study design on 80 subjects from RSCM laboratory. The data for HbA1c and microalbumin were analyzed using spearman test r 0.381 and p 0,001 and the for HbA1c and glomerular filtration rate were analyzed using pearson test p 0,05. The conclusion are there was a weak correlation between HbA1c and microalbumin in urine and no correlation between HbA1c and glomerular filtration rate.