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Abstrak :
Kebocoran plasma sistemik pada sepsis dapat mengakibatkan berbagai komplikasi dari renjatan sampai kematian. Belum ada teknik andal untuk menilai kebocoran plasma sistemik pada anak. Degradasi glikokaliks, ditandai meningkatnya sindekan-1 dalam darah, menyebabkan perubahan permeabilitas vaskular sistemik. Pada glomerulus bermanifestasi sebagai albuminuria sehingga kenaikan rasio albumin-kreatinin (ACR) urin berpotensi menggambarkan kebocoran plasma sistemik. Sampai saat ini belum ada rujukan nilai sindekan-1 dan ACR urin sebagai penanda kebocoran plasma sistemik pada anak. Penelitian ini bertujuan untuk mengetahui peran ACR urin dan nilai rujukan ACR urin sebagai penanda kebocoran plasma sistemik pada anak sepsis dan mengkaji kaitannya dengan sindekan-1. Penelitian ini terdiri atas studi deskriptif pada anak sehat dan penelitian longitudinal prospektif dengan rancangan potong lintang berulang terhadap anak sepsis, dilakukan di RSUP Cipto Mangunkusumo Jakarta, RSUP H. Adam Malik Medan dan RSUP Kariadi Semarang dalam rentang waktu Maret–Desember 2015. Dilakukan pemeriksaan sindekan-1 dan ACR urin pada pasien sepsis yang dirawat di instalasi rawat intensif anak pada hari rawatan ke-1, 2, 3 dan 7, dan mencatat skor Pediatric Logistic Organ Dysfunction pada hari rawatan ke-1 dan 3. Tiga puluh subjek sehat dan 49 subjek sepsis diikutsertakan dalam penelitian. Pada kelompok sehat didapati median ACR urin 10,5 (3–88) mg/g dan rerata sindekan-1 sebesar 27,7 (SB 2,24) ng/mL. Sindekan-1 di atas persentil 90 (41,42 ng/mL) ditetapkan sebagai batasan kebocoran plasma sistemik. Didapati 40 orang (81,6%) subjek sepsis dengan sindekan-1 > 41,42 ng/mL dan 33 orang (67,3%) menunjukkan ACR urin > 300 mg/g pada hari rawatan 1. Didapati koefisien korelasi (r) 0,32 (P < 0,001) antara ACR urin dan sindekan-1. Area under the curve ACR urin terhadap kebocoran plasma sistemik diperoleh sebesar 65,7% (95% IK 54,5–77%; P = 0,012). ACR urin > 157,5 mg/g ditetapkan sebagai cut-off point kebocoran plasma sistemik dengan sensitivitas 77,4% dan spesifisitas 48%. ACR urin dapat digunakan sebagai penanda kebocoran plasma sistemik, peningkatan ACR urin akan mengikuti peningkatan sindekan-1. ......Systemic plasma leakage during sepsis can cause several complications from shock to death. There is no feasible measurement of systemic plasma leakage in children. Glycocalyx degradation, marked by increased serum syndecan-1, alters vascular permeability. In the glomerulus this can manifest as albuminuria, therefore elevated urinary albumin-creatinine ratio (ACR) potentially provides an index of systemic plasma leakage. Nowadays. there is no reference value of syndecan-1 and urinary ACR as a marker of systemic plasma leakage in pediatric population. This study aims to analyze the role of urinary ACR and to determine its reference value as a marker of systemic plasma leakage in pediatric sepsis, by analyzing its correlation with syndecan-1. This study consisted of descriptive study on healthy children and longitudinal prospective study with repeated cross-sectional design on septic children, was conducted at Cipto Mangunkusumo Hospital Jakarta, Haji Adam Malik Hospital Medan and Kariadi Hospital Semarang from March to December 2015. We examined serum syndecan-1 and urinary ACR of septic patients in pediatric intensive care unit on day 1, 2, 3 and 7. Pediatric Logistic Organ Dysfunction (PELOD) score were recorded on day 1 and 3. Thirty healthy subjects and 49 septic subjects were recruited. In the healthy group, median of urinary ACR was 10.5 (3–88) mg/g and mean of syndecan-1 was 27.7 + 2.24) ng/mL. Syndecan-1 more than 90th percentile (41.42 ng/mL) was determined as systemic plasma leakage. Forty (81.6%) septic subjects had syndecan-1 > 41.42 ng/mL and 33 (67.3%) subjects had urinary ACR > 300 mg/g on day 1. Correlation coefficient (r) between urinary ACR and syndecan-1 was 0.32 (P < 0.001). Area under the curve of urinary ACR and plasma leakage was 65.7% (95% CI 54.5–77%; p = 0.012). Urinary ACR > 157.5 mg/g was determined as cut-off point of systemic plasma leakage with sensitivity 77.4% and specificity 48%. Urinary ACR can be used as marker of systemic plasma leakage. Increased urinary ACR would indicate increased syndecan-1.

Abstrak :
Latar Belakang: Penyakit ginjal diabetik (PGD) merupakan komplikasi mikrovaskular yang paling sering terjadi pada diabetes melitus. Podositopati merupakan kunci utama dari kerusakan glomerular pada PGD. miRNA-21 merupakan regulator epigenetik yang mempunyai peran dalam kerusakan podosit pada PGD, namun hasil dari penelitian yang sudah ada sebelumnya masih menyisakan kontroversi tentang peran miRNA-21 pada patogenesis PGD. Tujuan: Mengetahui korelasi antara kadar miRNA-21 dengan kadar nefrin urin, podosin urin, dan rasio albumin kreatinin urin pada pasien PGD. Metode: Studi potong lintang terhadap 42  pasien PGD di RSUPN Cipto Mangunkusumo Jakarta selama periode April sampai Juli 2023. Uji korelasi dilakukan untuk menilai hubungan miRNA-21 dengan nefrin, podosin, dan rasio albumin kreatinin urin. Regresi linier dilakukan untuk menilai variabel perancu terhadap hubungan tersebut. Hasil: Didapatkan hasil rerata ekspresi relatif miRNA-21 0,069 (0,024) , median nefrin 35,5 (15,75 – 51,25)ng/ml, median podosin 0,501 (0,442– 0,545) ng/mL, dan rasio albumin kreatinin urin 150 (94,56 – 335,75) ng/ml.Ditemukan korelasi antara miRNA-21 dengan nefrin (r = 0,598; p = <0,0001). Ditemukan korelasi antara miRNA-21 dengan rasio albumin kreatinin urin (r = 0,604; p = <0,0001). Tidak didapatkan korelasi antara miRNA-21 dengan podosin. Simpulan: Terdapat korelasi positif antara miRNA-21 dengan nefrin dan rasio albumin kreatinin urin namun tidak didapatkan korelasi yang bermakna antara miRNA-21 dengan podosin urin. ......Diabetic kidney disease (DKD) is the most common microvascular complication in diabetes mellitus. Podocytopathy is a key component of glomerular damage in DKD. miRNA-21 is an epigenetic regulator that plays a role in podocyte damage in DKD, however, the results of previous studies have not resolved the controversy about the role of miRNA-21 in the pathogenesis of DKD. Objective: The aim is to investigate the correlation between miRNA-21 levels and the urinary nephrin, urinary podosin, and urinary albumin-creatinine ratio (uACR) in patients with DKD.  Methods: A cross-sectional study of 42 patients with DKD was conducted at Cipto Mangunkusumo Hospital Jakarta from April to June 2023. A correlation test was performed to assess the association of miRNA-21 with the nephrin, podosin, and uACR. A linear regression test was performed to assess the confounding variables in these relationships. Results: The mean relative expression of miRNA-21 was 0.069 (0.024), the median nephrin was 35.5 (15.75 - 51.25) ng/ml, the median podocin was 0.516 (0.047 - 0.620) ng/ml, and the uACR was 150 (94.56 - 335.75) ng/ml. There was a correlation between miRNA-21 and nephrin (r = 0.598; p = <0.0001). There was a correlation between miRNA-21 and the uACR (r = 0.604; p = <0.0001). No correlation was found between miRNA-21 and podocin. Conclusions: There was a positive correlation between miRNA-21 and nephrin and urinary albumin-creatinine ratio, but no significant correlation between miRNA-21 and urinary podocin.

Abstrak :
Nefropati diabetik adalah salah satu komplikasi yang banyak terjadi pada pasien diabetes melitus tipe 2 DM tipe 2 . Salah satu metode untuk mengukur tingkat kerusakan ginjal dan memprediksi perkembangan serta progresivitasnya adalah rasio albumin kreatinin urin UACR . Selain UACR, kolagen tipe IV urin diduga dapat menjadi penanda alternatif yang lebih sensitif. Penelitian ini bertujuan untuk menganalisis UACR, kadar kolagen tipe IV urin, serta mengetahui hubungan keduanya pada pasien DM tipe 2 yang berusia lebih dari 25 tahun di Puskesmas Kecamatan Pasar Minggu dengan desain studi cross sectional dan teknik pengambilan consecutive sampling. Terdapat 3 kelompok sampel, yakni subjek nondiabetes sebagai kontrol n = 10 , pasien DM tipe 2 dengan normoalbuminuria n = 62 , dan pasien DM tipe 2 dengan albuminuria n = 27. Albumin urin diukur secara imunoturbidimetri sedangkan kreatinin urin diukur secara kolorimetri enzimatik. Kadar kolagen tipe IV diukur berdasarkan prinsip sandwich ELISA. Hasil uji beda rerata pada ketiga kelompok menunjukkan terdapat perbedaan bermakna pada nilai UACR p < 0,001 dan kadar kolagen tipe IV urin p < 0,001 . Uji korelasi antara nilai UACR dan kadar kolagen tipe IV menunjukkan adanya hubungan moderat pada kelompok pasien DM tipe 2 r = 0,336; p = 0,001 sehingga dapat disimpulkan bahwa kolagen tipe IV belum cukup kuat untuk dijadikan penanda kerusakan ginjal. ......Diabetic nephropathy DN is one of the most complications that happened in Type 2 Diabetes Mellitus Patients T2DM . Urine albumin creatinine ratio UACR is a gold standard method to assess renal dysfunction levels and predict the development and progression of early DN. Type IV collagen is glomerular basement membrane's component which expected to be an earlier marker for determining renal dysfunction levels. The aim of this study was to assess UACR, urinary type IV collagen, and correlation both of them in T2DM patients more than 25 years old at Pasar Minggu Community Health Center by cross sectional study and consecutive sampling method. There were 3 sampling groups of this study, nondiabetic subjects as control n 10 , normoalbuminuric patients n 62 , and albuminuric patients n 27 . Urine albumin was measured by immunoturbidimetry, meanwhile urine creatinine was measured by colorimetric enzymatic assay. Urinary type IV collagen was analyzed by sandwich ELISA. The result of comparing means of the groups showed significant differences on urinary type IV collagen p 0,001 and UACR p 0,001 . The correlation test showed possitive moderate correlation r 0,336 p 0,001 between UACR and urinary type IV collagen in T2DM patients. It might be indicate that urinary type IV collagen was not an accurate biomarker for assessing renal dysfunction.

Abstrak :
Hiperglikemia pada pasien diabetes melitus dapat menyebabkan kerusakan selular dan komplikasi. Salah satu komplikasi yang muncul yaitu pada jaringan mikrovaskular dan menyebabkan nefropati diabetik. Nefropati diabetik secara klinis diawali dengan kondisi albuminuria. Selain albuminuria, produksi spesies oksigen reaktif ROS berlebihan melalui NADPH oksidase juga merupakan salah satu patogenesis dari nefropati diabetik. Penelitian ini bertujuan untuk menganalisis aktivitas NADPH Oksidase yang diukur melalui rasio NADP /NADPH serum, dan hubungannya terhadap rasio albumin kreatinin urin. Penelitian dilakukan dengan studi cross sectional dan menggunakan teknik consecutive sampling. Populasi sampel pada penelitian ini adalah 89 orang pasien diabetes melitus tipe 2 usia 39-75 tahun di Puskesmas Kecamatan Pasar Minggu. Sampel penelitian dibagi menjadi 3 kelompok, yaitu kelompok subjek non DM sebagai kontrol n=10 , kelompok normoalbuminuria n=62 dan kelompok albuminuria n=27 . Rasio NADP /NADPH serum dan konsentrasi kreatinin urin diukur menggunakan metode kolorimetri, sedangkan albumin urin diukur dengan metode immunoturbidimetri. Hasil uji beda rata-rata menunjukkan terdapat perbedaan rasio NADP /NADPH serum pada ketiga kelompok. ...... Hyperglycemic condition on diabetes mellitus patient can cause a cellular injury and complication. One of those was microvascular complication which lead to diabetic nephropathy. Diabeteic nephropathy defined by proteinuria that preceded by lower degrees of proteinuria or albuminuria condition. Reactive oxygen species derived from NADPH Oxidase also play an important roles in the pathogenesis of diabetic nephropathy. Our study aimed to analyzed the activity of NADPH Oxidase by measuing the NADP NADPH serum ratio, and to find out if there any correlation with the normoalbuminuria and albuminuria condition. Consecutive method is used in this cross sectional study. Population of this study are 89 type 2 diabetes mellitus patient from ages 39 75 years at Pasar Minggu Community Health Center and 10 non diabetes volunteers served as control. For this purpose we divided the samples into three groups,a group of 10 healthy volunteers, normoalbuminuria group n 62 and and albuminuria group n 27. NADP NADPH serum ratio was analyzed by colorimetric method. Urine albumin creatinine ratio was measured by immunoturbidimetri and enzymatic colorimetric. The NADP NADPH serum ratio and urine albumin creatinine ratio were lower in control subject than in type 2 diabetes melitus patient.

Abstrak :
Penyakit Ginjal Diabetes (PGD) merupakan salah satu komplikasi yang paling umum terjadi dari diabetes. Deteksi dini gangguan fungsi ginjal pada pasien diabetes melitus tipe-2 (DMT2) dapat mencegah progresivitas PGD. Tujuan penelitian ini adalah menilai perbedaan profil metabolit urin pasien DMT2 yang mengonsumsi metformin-glimepirid pada kelompok risiko rendah dan sedang PGD serta menganalisis pemetaan jalur biokimia yang terjadi. Penelitian dilakukan dengan desain potong lintang dengan metode consecutive sampling di Puskesmas Kecamatan Pasar Minggu dan RSUD Jati Padang. Sampel urin dan darah dikumpulkan untuk pengukuran HbA1c, eLFG (estimasi laju filtrasi glomerulus), UACR (rasio albumin-kreatinin urin), dan analisis metabolomik berbasis LC/MS-QTOF. Total 32 subjek penelitian dibagi menjadi kelompok risiko rendah PGD (n=16) dan kelompok risiko sedang PGD (n=16) berdasarkan kategori prognosis KDIGO. Analisis data karakteristik dasar dan klinis dilakukan menggunakan software IBM SPSS Statistics Premium versi 24. Analisis hasil kromatogram dan spektra dari alat LC/MS-QTOF dianalisis menggunakan software Metaboanalyst 5.0. Hasil yang diperoleh menunjukkan tidak ada perbedaan bermakna secara statistik pada karakteristik dasar dan klinis kedua kelompok, kecuali jenis kelamin (p=0,013) dan HbA1c (p=0,001). Terdapat metabolit urin yang berbeda signifikan (Variable Importance for the Projection (VIP)-score>1; fold change>1,2, dan p<0,05) antara kelompok risiko rendah dan sedang PGD, yaitu sphinganine, lysophospatidic acid, gamma-glutamylalanine, dan N-acetyl-Laspartic acid. Perubahan jalur biokimia yang berkaitan dengan metabolit penanda kerusakan ginjal pada kedua kelompok adalah metabolisme (1) sphingolipid, (2) gliserolipid, (3) gliserofosfolipid, (4) glutation, dan (5) alanin, aspartat, dan glutamat. Dengan demikian, disregulasi metabolisme lipid dan asam amino dapat menjadi biomarker (AUC>0,65) dalam perkembangan PGD pada tahap awal. ......Diabetic Kidney Disease (DKD) is one of the most common complications of diabetes. Early detection of impaired kidney function in type-2 diabetes mellitus (T2DM) patients can prevent the progression of DKD. The study aimed to compare the urine metabolites profile of T2DM patients who consumed metformin-glimepiride with low and moderaterisk groups of DKD and to analyze the mapping of the biochemical pathways that occur. The study was conducted using a cross-sectional design with a consecutive sampling method at Pasar Minggu District Health Center and Jati Padang Hospital. Urine and blood samples were collected for measurements of HbA1c, eGFR (estimated glomerular filtration rate), UACR (urine albumin-creatinine ratio), and LC/MS-QTOF-based metabolomics analysis. A total of 32 subjects were divided into low-risk (n=16) and moderate-risk groups of DKD (n=16) based on KDIGO prognosis category. The baseline and clinical characteristics of the subjects were analyzed using IBM SPSS Statistics Premium software version 24. The chromatogram and spectra results from the LC/MSQTOF were analyzed using Metaboanalyst 5.0 software. The results showed that there were no statistically significant differences in the baseline and clinical characteristics of the two groups, except for sex (p=0.013) and HbA1c (p=0.001). There are significant differences in urine metabolites (VIP-score>1; fold change>1.2, and p<0.05) between low and moderate-risk groups of DKD i.e. sphinganine, lysophosphatidic acid, gammaglutamylalanine, and N-acetyl-L-aspartic acid. Changes in biochemical pathways associated with markers of kidney damage in both groups are the metabolism of (1)sphingolipids, (2)glycerolipids, (3)glycerophospholipids, (4)glutathione, and (5) alanine, aspartate, and glutamate. Therefore, dysregulation of lipid and amino acid metabolism could be biomarkers (AUC > 0,65) for the progression of DKD in the early stage.

Abstrak :
Latar Belakang: Pasien pascabedah abdomen mayor seringkali berhubungan dengan terjadinya general increase permeability sindrom akibat kelebihan cairan selama selama durante operasi dan pada saat perawatan pascabedah. Tujuan dari penelitian ini adalah ingin membuktikan apakah keseimbangan cairan kumulatif, tekanan vena sentral dan rasio albumin-kreatinin urin dapat digunakan sebagai prediktor kebocoran kapiler. Metode: Penelitian ini merupakan penelitian kohort prospektif dengan subjek penelitian adalah pasien dewasa yang menjalani tindakan bedah abdomen mayor. Dilakukan pemeriksaan keseimbangan cairan kumulatif, tekanan vena sentral, rasio albumin-kreatinin urin dan indeks kebocoran kapiler, pada saat sebelum induksi anestesi, 48 jam dan 72 jam pasca bedah. Hasil: Pada penelitian ini didapatkan nilai titik potong dari indeks kebocoran kapiler 155 (AUC 0,013, sensitifitas 100% dan spesifisitas 74,50%. Analisis dengan Generalized Estimating Equations didapatkan tekanan vena sentral menujukan hubungan tidak bermakna dengan indeks kebocoran kapiler (OR 1,62 ; CI 95% = 0,92 – 2,83), sedangkan keseimbangan cairan kumulatif dan rasio albumin kreatinin urin menunjukkan hubungan yang bermakna dengan indeks kebocoran kapiler (OR = 2,561 ; CI 95% = 1,352-4,850 dan OR = 2,017 ; CI 95% = 1,086-3,749). Faktor skor SOFA terkategori sepsis juga mempunyai hubungan dengan indeks kebocoran kapiler (OR = 2,764 ; CI 95% = 1,244-6,140). Kesimpulan: Kelebihan cairan kumulatif, rasio albumin kreatinin urin dan skor SOFA terbukti dapat digunakan untuk memprediksi kebocoran kapiler.

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Background: Patients after major abdominal surgery are often associated with the occurrence of general increase in permeability syndrome due to excess fluid during surgery and during postoperative care. The purpose of this study was to prove whether cumulative fluid balance, central venous pressure and urine albumin-creatinine ratio of urine can be used as predictors of capillary leakage. Method: This study is a prospective cohort study with research subjects as adult patients undergoing major abdominal surgery. Cumulative fluid balance, central venous pressure, urine albumin-creatinine ratio and capillary leak index were examined, before anesthesia induction, 48 hours and 72 hours postoperatively. Result: In this study, a cut-off point from the capillary leak index ≥155 (AUC 0.013, sensitivity 100% and specificity 74.50%) was obtained. Generalized Estimating Equations analysis showed that the central venous pressure showed no significant relationship with the capillary leak index (OR 1.62; 95% CI = 0.92 - 2.83), while cumulative fluid balance and urine albumin : creatinin ratio showed a significant association with capillary leak index (OR = 2.561; 95% CI = 1.352-4.850 and OR = 2.017; 95% CI = 1,086-3,749) Sepsis categorized SOFA score factors also have a relationship with capillary leak index (OR = 2.764; 95% CI = 1,244-6,140). Conclusion: Cumulative fluid overload, urine creatinine albumin ratio and SOFA score have been shown to predict capillary leakage.

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 :
Glikosaminoglikan merupakan komponen penyusun glikokaliks yang berperan penting dalam per selektivitas muatan anionik kapiler glomerulus. Gangguan hemodinamik dan metabolik akibat hiperglikemia kronis menyebabkan peluruhan komponen glikokaliks endotel. Beberapa pedoman telah menyetujui keamanan tiap OAD berdasarkan fungsi ginjal. Tujuan penelitian adalah menilai keamanan penggunaan metformin (metformin dan metformin-glimepirid) berdasarkan fungsi ginjalnya serta menilai perbandingan kadar GAG urin pasien DMT 2 kelompok risiko rendah terhadap risiko sedang-tinggi PGK. Desain penelitian potong lintang dan metode consecutive di Puskesmas Depok Jaya dan Kecamatan Pasar Minggu. Sampel urin dan darah dikumpulkan untuk pengukuran eLFG, HbA1c, ACR, dan kadar GAG urin. Sebanyak 137 partisipan dinilai keamanan penggunaan metformin berdasarkan fungsi ginjalnya. Terdapat ketidaksesuaian pada 1 partisipan dalam penggunaan metformin (n=55) dan semua partisipan (n=82) sesuai dengan pedoman dalam penggunaan metformin-glimepirid. Hanya 121 partisipan yang dianalisis kadar GAG urin menggunakan 1,9-DMMB dan terdiri dari 4 yaitu kelompok risiko rendah PGK: G1-A1(eLFG ≥90ml/min/1,73m² - <30mg/g) (n=25) dan G2-A1(eLFG 60-89ml/min/1,73m² - <30mg/g) (n=45) serta risiko sedang-tinggi PGK: GI-A2(eLFG ≥ 90ml/menit/1,73m² - >30mg/g) (n=23) dan G2-A2(eLFG 60-89ml/menit/1,73m² - >30mg/g) (n=28). Tidak ada perbedaan bermakna (p<0,05) pada karakteristik dasar dan klinis keempat kelompok kecuali usia (p=0,006) dan HbA1c (p<0,001). Tidak terdapat perbedaan kadar GAG urin yang bermakna antara kelompok G1 dengan G2 (p=0,290) serta pada keempat kelompok (p=0,221). Terdapat perbedaan kadar GAG urin yang bermakna (p=0,034) pada kelompok normoalbuminuria dan albuminuria. Faktor lain seperti durasi DMT 2 >5 tahun dan komorbiditas dapat meningkatkan kadar GAG urin. Oleh karena itu, diperlukan studi lanjut mengenai potensi GAG urin pada awal perkembangan penyakit ginjal diabetes. ......Glycosaminoglycans are components of the glycocalyx which play an important role in the permeselectivity of the anionic charge of the glomerular capillaries. Hemodynamic and metabolic disturbances due to chronic hyperglycemia cause the breakdown of the glycocalyx component of the endothelium. Several guidelines have agreed on the safety of each OAD based on renal function. The aims of this study were to assess the safety of using metformin (metformin and metformin-glimepiride) based on kidney function and to evaluate the comparison of urinary GAG levels in patients with DMT 2 in low-risk groups to moderate-high risk of CKD. Cross-sectional research design and consecutive in Depok Jaya Public Health Center and Pasar Minggu District. Urine and blood samples were collected for measurement of eGFR, HbA1c, ACR, and urinary GAG levels. A total of 137 participants assessed the safety of using metformin based on their kidney function. There was a discrepancy in 1 participant in the use of metformin (n=55) and all participants (n=82) according to the guidelines for the use of metformin-glimepiride. Only 121 participants were analyzed for urine GAG ​​levels using 1,9-DMMB and consisted of 4 low risk groups for CKD: G1-A1(eGFR 90ml/min/1.73m² - <30mg/g) (n=25) and G2-A1(eGFR 60-89ml/min/1.73m² - <30mg/g) (n=45) and moderate-high risk of CKD: GI-A2(eGFR 90ml/min/1.73m² - >30mg/g) (n=23) and G2-A2(eLFG 60-89ml/min/1.73m² - >30mg/g) (n=28). There was no significant difference (p<0.05) in the baseline and clinical characteristics of the four groups except age (p=0.006) and HbA1c (p<0.001). There was no significant difference in urine GAG ​​levels between the groups G1 with G2 (p= 0.290) and in the four groups (p= 0.221). There was a significant difference in urine GAG ​​levels (p= 0.034) in the normoalbuminuria and albuminuria groups. Other factors such as duration of DMT 2 > 5 years and comorbidities can increase urinary GAG levels. Therefore, further studies are needed regarding the potential of urinary GAGs in the early development of diabetic kidney disease.