Ria Bandiara
Bagian Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Padjadjaran/ Rumah Sakit Hasan Sadikin Bandung

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Podosit dan Penyakit Ginjal Diabetes Bandiara, Ria
Jurnal Kedokteran Maranatha Vol 11, No 1 (2011)
Publisher : Universitas Kristen Maranatha

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Abstract

Penyakit ginjal diabetes (PGD) merupakan salah satu komplikasi serius dari diabetes dan penyebab paling sering penyakit gagal ginjal tahap akhir, terjadi pada 15-25% penderita diabetes tipe 1 dan 30-40% penderita diabetes tipe 2. PGD ditandai dengan perubahan yang spesifik baik morfologi dan fungsional ginjal. Gambaran awal perubahan ginjal akibat diabetes adalah hiperfiltrasi glomerulus, hipertrofi glomerulus dan ginjal, peningkatan ekskresi albumin urin, peningkatan penebalan membran basal dan ekspansi mesangial dengan akumulasi protein matriks ekstraseluler seperti kolagen, fibronektin dan laminin. PGD tahap lanjut ditandai dengan proteinuria, penurunan fungsi ginjal, penurunan klirens kreatinin, glomerulosklerosis dan fibrosis interstisial. Injuri podosit berperan penting dalam pengembangan PGD. Telaah pustaka ini akan mengemukakan mekanisme injuri podosit pada diabetes dan terkait dengan perubahan fungsi barier filtrasi glomerulus, antara lain pengaruh hiperglikemia pada podosit termasuk interaksi sel, perlekatan membran basal glomerulus dan apoptosis podosit yang telah dijelaskan melalui penelitian sel kultur maupunin vivo. Podosit juga telah menjadi target kerja insulin dan hormon pertumbuhan dimana kedua hormon tersebut berperan bermakna di dalam perubahan homeostasis diabetes melitus. Pengertian mengenai seluler dan molekuler di dalam perubahan struktur dan fungsi podosit pada diabetes melitus diharapkan menjadi alat diagnostik dan strategi pengelolaan penyakit ginjal diabetes.
Sclerostin Serum Concentration in Patients with Predialysis Ckd Stage 3-5 Pura, Lukman; Bandiara, Ria; Gondodiputro, Rubin S
Indonesian Journal of Kidney and Hypertension Vol 1 No 1 (2018): September - December 2018
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (706.769 KB) | DOI: 10.32867/inakidney.v1i1.3

Abstract

Sclerostin is a glycoprotein expressed by osteocytes and plays a role in bone turnover in themetabolism of the bone. Sclerostin blocks the formation of a ligand with its receptor on theWnt/β-catenin pathway, and influences the activity of osteoblasts. Sclerostin also influencesmineral and bone disturbances in CKD via the interaction between kidney, bone and vascularaxis. The concentration of sclerostin will rise especially in patients with ESRD undergoingdialysis. Concentration of sclerostin has not been reported yet in non-dialysis CKD patientstage 3-5 and the aim of this study is to see sclerostin concentration on those population. Methods This is a descriptive and cross-sectional study designed to measure sclerostinconcentration in non dialysis patients with CKD stage 3-5. The sclerostin concentration ismeasured using an enzyme-linked immunosorbent assay kit. CKD stages are diagnosed usingthe KDIGO-2012 criteria which measures the estimated GFR (eGFR) with the formulation of EPICKD. Fifty six patients with CKD stage 3-5 were enrolled in this study and one way ANOVA comparative test followed with a post hoc analysis using Benferroni test to analysethe data. Results The mean concentration level of serum sclerostin in this population is (79.7+ 41.2) pmol/L, and in patients with CKD stage 3, CKD stage 4, and CKD stage 5 are (59.6 +28.5) pmol/L, (71.9 + 42.2) pmol/L and (96.7 + 39.8) pmol/L respectively. The comparativetest of mean concentrations of the serum sclerostin between stages of CKD are statisticallysignificant with a p=0.022. The post hoc analysis of serum sclerostin concentration betweenCKD stage 3 and CKD stage 5 have a significant difference with a mean of 37 pmol/L andp=0.037. Conclusion, The serum sclerostin concentration rise in accordance with the declineof kidney function in patients with pre-dialysis CKD stage 3-5.
HUBUNGAN LAJU FILTRASI GLOMERULUS DENGAN STATUS NUTRISI PADA PENDERITA PENYAKIT GINJAL KRONIK PREDIALISIS Pura, Lukman; Supriyadi, Rudi; Nugraha, Gaga Irawan; Bandiara, Ria; Soelaeman, Rachmat
Majalah Kedokteran Bandung Vol 41, No 1 (2009)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Malnutrisi banyak terjadi pada penderita penyakit ginjal kronik (PGK). Prevalensi malnutrisi pada penderita predialisis sekitar 44%. Penyebab malnutrisi pada penderita PGK predialisis bersifat multifaktorial. Hubungan laju filtrasi glomerulus (LFG) dengan status nutrisi gabungan menggunakan albumin serum, indeks massa tubuh (IMT) dan subjective global assessment (SGA) masih belum banyak diteliti. Penelitian ini bertujuan mencari hubungan LFG dengan parameter nutrisi gabungan pada subjek PGK predialisis yang berkunjung ke poliklinik ginjal hipertensi RS Hasan Sadikin Bandung dari bulan September sampai Oktober 2008. Data sekunder dan primer dikumpulkan secara konsekutif. Pemeriksaan meliputi penilaian klinis, laboratorium, dan LFG dengan metode in vivo. Analisis statistik menggunakan uji Mann-Whitney untuk melihat hubungan LFG dengan status nutrisi gabungan dengan multiple utility assessment criteria (MUAC). Tujuh puluh dua subjek terdiri dari 48 laki-laki dan 24 perempuan memenuhi kriteria penelitian. Sebanyak 79,2% subjek dengan usia di atas 50 tahun dan 54,2% dengan penyebab sakit hipertensi. Rata-rata LFG 32,62 mL/mnt, albumin serum 4,10 g/dL dan IMT 23,87 kg/m2 . Terdapat 80,6% subjek dengan status gizi buruk dan 19,4% dengan gizi baik. Menggunakan metode MUAC, 70 subjek dengan kategori gizi baik dan 2 subjek dengan gizi buruk. Hubungan LFG terhadap parameter nutrisi ditentukan dengan uji Rank-Spearman dan hasil tidak bermakna terhadap semua variabel nutrisi (p >0,05). Hubungan LFG terhadap parameter nutrisi gabungan memberikan hasil tidak bermakna (p> 0,05). Kesimpulan: terdapat hubungan yang sangat kecil antara LFG terhadap perubahan parameter nutrisi gabungan, dengan jumlah sampel 72 subjek tidak dapat mendeteksi adanya hubungan yang bermakna.Kata kunci: PGK, LFG, albumin serum, IMT, SGATHE CORRELATION BETWEEN GLOMERULAR FILTRATION RATE (GFR) AND NUTRITIONAL STATUS INPEDIALYTIC CHRONIC KIDNEY DISEASE PATIENTSProtein-energy malnutrition (PEM) is common in chronic kidney disease (CKD) patients. The prevalence of malnutrition in predialytic patients was approximately 44%. The causes of malnutrition in CKD patients are multifactorial. The correlation of glomerular filtration rate (GFR) and combined nutritional parameter such as serum albumin, body mass index (BMI) and subjective global assessment (SGA) is more need to study. The study aimed to find the correlation GFR and the combined nutritional parameter in predialytic CKD patients who attended the Nephrology-Hypertension Clinic of Hasan Sadikin Hospital between September and October 2008. The secondary and primary data were collected consecutively. The evaluation consisted of clinical assessment of nutritional status, laboratory values, and GFR by in vivo method. The combined nutritional parameter was classified into two groups using multiple utility assessment criteria (MUAC). Statistical analysis with Mann-Whitney test was used to find the correlation. Seventy two subjects (48 men and 24 women) fulfilled the criteria. The majority (79.2%) were older than 50 years old and 54.2% the causes of CKD were hypertension. The median GFR was 32.62 mL/mnt, serum albumin was 4.10 g/dL, and BMI was 23.87 kg/m2 . There were 80.6% subjects with malnourished status, 19.4% with normal status. Using MUAC assessment, 70 subjects with normal nutritional status and 2 with severe malnutrition.We found no significant correlation between GFR and any nutritional parameter (p>0.05). The correlation of GFR and combined nutritional parameter was not significant (p>0.05). Conclusion: There is minimal correlation of GFR and combined nutritional parameter, with 72 samples size the correlation cannot be detectedsignificantly.Key words: CKD, GFR, serum albumin, BMI, SGA DOI: http://dx.doi.org/10.15395/mkb.v41n1.180