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"Infeksi saluran kemih (ISK) pada anak memiliki manifestasi klinis yang tidak khas dan bervariasi sehingga sulit terdiagnosis secara dini. Biakan urin memerlukan waktu hingga lima hari sehingga dapat menyebabkan keterlambatan terapi serta tingginya komplikasi ISK pada anak. Kelainan urinalisis yang saat ini digunakan masih memiliki spesifisitas yang rendah. Penelitian ini merupakan studi diagnostik NGAL urin, kelainan urinalisis, dan kombinasi keduanya, khususnya pada anak usia 2–5 tahun. Penelitian dilakukan menggunakan desain potong lintang pada anak dengan tersangka ISK, yaitu anak dengan salah satu gejala ISK (demam lebih dari 380C, muntah, diare, sakit pinggang, atau gejala lokal saluran kemih) disertai kelainan urinalisis (leukosituria, dan/atau nitrit positif dan/atau leukosit esterase positif) yang berusia 2–5 tahun dan dirawat di Rumah Sakit Dr. Cipto Mangunkusumo. Uji diagnostik pemeriksaan NGAL urin, kelainan urinalisis, dan kombinasi keduanya dibandingkan dengan biakan urin sebagai baku emas. Kombinasi ketiga kelainan urinalisis berupa leukosituria, nitrit dan leukosit esterase positif memiliki sensitivitas 38,1% dan spesifisitas 94,9%. NGAL urin diketahui memiliki sensitivitas 85,7% (IK95%: 63,6–96,9%), spesifisitas 74,3% (IK 95%: 57,8–86,9%), positive predictive value 64,3% (IK95%: 50,6–75,9%), dan negative predictive value 90,6% (IK95%: 76,9–96,5%) pada anak dengan minimal satu kelainan urinalisis. Pemeriksaan NGAL urin hanya meningkatkan spesifisitas kelainan urinalisis berupa leukosituria saja dan tidak meningkatkan spesifisitas pada yang telah memiliki tiga kelainan urinalisis. NGAL urin tidak dianjurkan untuk meningkatkan spesifisitas urinalisis dalam diagnosis ISK pada anak usia 2–5 tahun. Gabungan tiga kelainan urinalisis tanpa NGAL urin sudah memiliki spesifisitas yang baik. Perlu dilakukan penelitian biomarker lain yang dapat mendiagnosis dini ISK dengan lebih baik.

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Urinary tract infection (UTI) in children has unspecific clinical manifestations leading to difficulties in its early diagnosis. Using urine culture as the gold standard for diagnosing urinary tract infection may need five days to know and may lead to delayed treatment and high complication rates. Urinalysis abnormalities are used to diagnose UTI early but still have low specificity. This study evaluated the diagnostic value of using urinary NGAL, urinary abnormalities, and their combinations, especially in children aged 2–5 years old. This cross-sectional diagnostic study was conducted in children aged 2–5 years old who were suspected to have UTI (fever more than 380C, vomit, diarrhea, abdominal pain, flank pain, or local UTI symptoms with abnormalities in urinalysis including leukocyturia and/or positive nitrite and/or positive leukocyte esterase) who were hospitalized at Dr. Cipto Mangunkusumo Hospital. The diagnostic test was performed to urinary NGAL, urinary abnormalities, and their combination compared with urine culture as the gold standard for UTI diagnosis. Combination of urinary abnormalities (leukocyturia, positive nitrite, and positive leukocyte esterase) can have sensitivity 38.1% and specificity 94.9%. Urinary NGAL has sensitivity 85.7% (IK 95%: 63.6–96.9%), specificity 74.3% (IK 95%: 57.8–86.9%), positive predictive value 64.3% (IK 95%: 50.6–75.9%), and negative predictive value 90.6% (IK 95%: 76.9–96.5%). Combination of urinary NGAL and urinary abnormality can only increase specificity urinalysis which only shows leukocyturia from 74.3% to 97.4% but not increase specificity of three urinary abnormalities. Urinary NGAL is not recommended to increase urinalysis specificity to make early diagnosis of UTI in children aged 2–5 years old. The three combination of urinalysis abnormalities without urinary NGAL have had a good specificity. Further research about other biomarkers to make early diagnosis of UTI in children is needed."

"Latar Belakang. Mortalitas akibat sepsis di ICU masih cukup tinggi meskipun telah semakin cepatnya diagnosis dan perbaikan perawatan suportif dan angkanya semakin meningkat dengan insiden acute kidney injury yang merupakan bagian dari disfungsi organ akibat sepsis. Asam askorbat dikatakan dapat memperbaiki disfungsi organ disebabkan efeknya yang sinergis terhadap patofisiologi sepsis. Peranan asam askorbat dalam menurunkan disfungsi organ masih kontroversial. Penelitian ini ingin menganalisis efek pemberian asam askorbat intravena terhadap perbaikan fungsi ginjal pada pasien sepsis/ syok sepsis yaitu dengan melihat efek terhadap kadar urin neutrophil gelatinase associated lipocalin (uNGAL), produksi urin dan balans kumulatif. Metodologi. Penelitian ini merupakan penelitian uji klinis dengan desain penelitian uji acak terkontrol, dilakukan pada pasien usia > 18 tahun dengan sepsis berdasarkan kriteria sepsis-3 yang masuk ICU dalam 6 sampai 24 jam pascaresusitasi setelah diagnosis sepsis. Kriteria penolakan yaitu pasien dengan gangguan ginjal kronik dengan hemodialisis, kelainan batu ginjal, dengan masalah ginjal dalam 3 bulan terakhir. Pasien akan dikeluarkan apabila diberikan kortikosteroid dan mendapatkan terapi pengganti ginjal dalam < 72 jam observasi. Penelitian dilakukan di ICU Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo pada April 2019-Juli 2019. Sebanyak 33 sampel dirandomisasi secara randomisasi sederhana dan dikelompokan menjadi kelompok perlakuan (18 sampel) dan kontrol (15 sampel). Data demografik dasar dicatat saat masuk ICU. NGAL urin (ng/mL) diperiksa pada jam 0, 24, 48 dan 72 setelah terapi. Produksi urin (ml/kg/jam) dan balan kumulatif (L) dicatat pada jam 24, 48 dan 72 setelah terapi. Analisis statistik dengan uji Mann Whitney untuk data numerik dengan persebaran tidak normal, uji T independen untuk data dengan persebaran normal dan uji Fisher untuk data kategorik perbandingan antara kedua kelompok intervensi. Analisis multivariat untuk pengukuran serial menggunakan generalized estimating equations (GEE) untuk membandingkan antara kedua kelompok dalam waktu pengukuran yang berulang. Nilai signifikansi dengan nilai p < 0,05. Hasil. Tidak terdapat perbedaan pada kadar NGAL urin, produksi urin, balans kumulatif antara dua kelompok di setiap jamnya. Kesimpulan. Pada penelitian ini pemberian asam askorbat intravena tidak mempunyai efek terhadap kadar NGAL urin, produksi urin, balans kumulatif.

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Background. Sepsis-related mortality in intensive care unit (ICU) remains despite improved diagnostic technology and supportive treatment. Acute kidney injury, one of frequent organ dysfunctions in sepsis, increases risk of mortality. Ascorbic acid could improve organ dysfunction because its direct effect on sepsis pathophysiology. The role of ascorbic acid on improving organ dysfunction remains controversial. This study wished to analyze the effects of intravenous ascorbic acid on kidney function improvement among septic patients by evaluating urine neutrophil gelatinase associated lipocalin (uNGAL), urine output and cumulative fluid balance.

Method. This study was randomized controlled trial held in Cipto Mangunkusumo Hospital from April to July 2019. The inclusion criteria were adult patients aged > 18 years who met sepsis-3 criteria and were admitted to the ICU within 6-24 h after resuscitation and sepsis recognition. The exclusion criteria were patients with hemodialysis-dependent chronic kidney disease, kidney stones or other kidney problems within last 3 months. The drop out criteria were patients underwent renal replacement therapy in the ICU and given corticosteroid less than 72 h after recruitment. Subjects were randomized using simple randomization and divided into two groups with treatment (18 subjects) and control (15 subjects). Baseline demographic data was recorded on the first day. Daily measurements of urine NGAL (ng/ mL) was started as baseline level and continued at 24, 48 and 72 h after treatment. Urine output (ml/kg/h), cumulative fluid balance (L) was recorded at at 24, 48 and 72 h after treatment. Comparison between both groups was analysed by using Mann Whitney test (not normally distributed data), T independent test (normally distributed data) for numerical data and Fisher test for categorical data. Multivariate analysis using generalized estimating equations was used for serial measurement analysis. Level of significant was determined at p-value <0.05.

Result. There were no significant differences in uNGAL, urine output, cumulative fluid balance between the two groups at each hour respectively.

Conclusion. This study showed that intravenous vitamin CMultin administration had no effect on urine NGAL, urine output, cumulative fluid balance."

"ABSTRAKLatar Belakang : Para pekerja yang melakukan aktivitas fisik di lingkungan panas tinggi dapat mengalami gangguan pada ginjal. Selain glomerulus, bagian tubulointerstium yang memiliki fungsi penting reabsorsi dan sekresi, diduga juga mengalami gangguan. Ingin diketahui lebih lanjut ada tidaknya gangguan pada sel tubulus ginjal para pekerja setelah 4 jam pajanan panas tinggi melalui pemeriksaan NGAL urin yang lebih spesifik.Metode : Desain penelitian ini adalah baseline study dan pre-post study.Dilakukan di bagian hotpress outsole pabrik sepatu di Tangerang bulan April 2015. Data primer didapat melalui wawancara, pemeriksaan langsung tinggi dan berat badan serta pengambilan sampel NGAL urin dilakukan 2 kali, sebelum dan sesudah 4 jam kerja terpajan tekanan panas tinggi (29,0 oC - 31,05 oC ISBB). Untuk pemeriksaan kadar NGAL menggunakan kit komersial (Quantikine kit Human Lipocalin-2/NGAL Immunoassay).Hasil : 68 pekerja memenuhi kriteria inklusi penelitian dan 100 % adalah laki-laki berusia 20-40 tahun yang sehat. Didapatkan nilai NGAL urin awal sebelum terpajan panas antara 0.03 ng/ mL ? 12,82 ng/mL dengan median 1.52 ng/mL. Dari pemeriksaan setelah 4 jam kerja terpajan panas terdapat 25 responden (36,8% ) mengalami kenaikan nilai NGAL dalam urin dengan median kenaikan sebesar 0,35 mg/dL sedangkan 43 responden (63,2%) tidak mengalami kenaikan nilai NGAL dalam urin .Simpulan: Tidak terdapat peningkatan yang dianggap bermakna pada rerata nilai NGAL dalam urin para pekerja pabrik yang tepajan tekanan panas tinggi selama 4 jam kerja.

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ABSTRACT

Background : Workers performing physical activities in heat-stress environment could have kidney disorder. Beside glomerulus, tubulointerstitium which has important function of reabsorption and secretion, is suspected to also have injury. Further exploration on the impact on kidney tubules cells on the workers after 4 hours exposed to heat-stress through more specific examination of urine NGAL (uNGAL).

Method : Design of this research are baseline study and pre-post study, conducted at the hotpress outsole department at a shoe factory in Tangerang in April 2015. Primary data obtained through interview, direct examination on height and weight and taking sample of uNGAL twice time, before and after 4 hours of moderate working activities in the area of high heat-stress (29,0 oC - 31,05 oC WGBT) . Examining NGAL level by using commercial kit (Quantikine kit Human Lipocalin-2/NGAL Immunoassay).

Result : 68 workers fit with criteria inclusion study and 100% are healthy men aged between 20-40 years. The result of uNGAL initial scores are between 0.03 ng/ mL ? 12,82 ng/mL with median of 1.52 ng/mL. After 4 hours of moderate working activities in the area of high heat-stress there are 25 workers ( 36,8% ) have increase uNGAL level with median of 0,35 mg/dL, while the other 43 workers (63,2%) have not.

Summary : There is no significant changes of urine NGAL score after 4 hours of working within worker population in the area of high heat-stress."