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"The Renal System at a Glance provides a concise and accessible introduction and revision aid for medical students. Following the familiar, easy-to-use at a Glance format, each topic is presented as a double-page spread with key Facts accompanied by diagrams encapsulating essential knowledge." "The Renal System at a Glance, formerly The Kidney at a Glance, will appeal to all medical students, junior doctors on Foundation Programmes and to those revising for final exams. The book is also suitable for those training in allied health professions, including specialist nurses working on dialysis wards."

"Latar Belakang: Periostin memainkan peran sebagai mediator proses inflamasi termasuk inflamasi dan fibrosis ginjal. Namun, data signifikansi periostin pada acute kidney injury terbatas. Kami meneliti korelasi kadar periostin urin dengan fungsi ginjal pada pasien keganasan yang mendapat terapi cisplatin dosis tinggi. Metode: Penelitian kohort prospektif ini dilakukan di n ruang rawat HOM lantai 8 gedung A, di RSCM dari November 2019 hingga jumlah sampel minimal terpenuhi dengan cara consecutive sampling. Data dianalisis menggunakan SPSS versi 23.0 sesuai tujuan penelitian. Hasil: Dari 37 responden diketahui 70,3% laki-laki, 29,7% berusia 41-50 tahun, 59,5% menderita KNF, serta 64,9% memiliki Skor Karnofsky 80. Kadar ureum dan kreatinin darah responden meningkat dari pra kemoterapi hingga 1 minggu paska kemoterapi I. Begitu juga dengan nilai eGFR yang makin menurun. Perubahan kadar periostin menurun selama kemoterapi I dan II, naik kembali 1 minggu paska kemoterapi III dengan nilai p>0,05. Pada uji korelasi kadar periostin urin dengan variabel fungsi ginjal lainnya tidak didapatkan domain yang signifikan bermakna (p>0,05) dengan nilai koefisien korelasi lemah (r = 0,017-0,254) dan beberapa domain memiliki arah korelasi negatif. Simpulan: Tidak didapatkan korelasi bermakna kadar periostin urin dengan kadar ureum darah, kreatinin darah serta laju filtrasi glomerulus pasien keganasan dengan terapi cisplatin dosis tinggi.

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Background: Periostin plays role as mediator of inflammatory processes including inflammation and kidney fibrosis. However, data on the significance of periostin in acute kidney injury are limited. We investigated the correlation of urine periostin levels with kidney function in malignant patients receiving high-dose cisplatin therapy.

Methods: This prospective cohort study was conducted in the 8th floor HOM care room in building A, in the RSCM from November 2019 until the minimum sample size was fulfilled by consecutive sampling. Data were analyzed using SPSS version 23.0 according to the purpose of study.

Results: Of the 37 respondents known to be 70.3% male, 29.7% aged 41-50 years, 59.5% suffer from NPC, and 64.9% have Karnofsky score of 80. Urea levels and blood creatinine of respondents increased from pre-chemotherapy to 1 week after chemotherapy I. Likewise, the eGFR value decreases. Changes in periostin levels decreased during chemotherapy I and II, rising again 1 week after chemotherapy III with a p value> 0.05. In the correlation test of urinary periostin levels with other kidney function variables, no significant domain was found (p> 0.05) with a weak correlation coefficient (r = 0.017-0.254) and some domains had a negative correlation direction.

Conclusion: No significant correlation was found in urine periostin levels with blood urea levels, blood creatinine and glomerular filtration rates of malignant patients with high-dose cisplatin therapy."

"ABSTRAK Analisis Praktik Residensi Keperawatan Medikal Bedah Pada Pasien Gangguan Sistem Perkemihan Dengan Kasus Gagal Ginjal Kronik Stage V Menggunakan Pendekatan Model Keperawatan Adaptasi Roy Di Rumah Sakit Umum Pusat Nasional RSUPN dr. Cipto Mangunkusumo Jakarta. Diana Rhismawati Djupri2017 AbstrakPraktek klinik Ners Spesialis Keperawatan Medikal Bedah Sistem Perkemihan adalah untuk mampu melakukan dan menganalisa asuhan keperawatan pada pasien Gagal Ginjal Kronik Stage V dan 30 pasien lain yang mengalami gangguan pada sistem perkemihan. Selain itu mampu menerapkan Evidence Based Nursing Practice EBNP dan sebagai inovator di ruang perawatan maupun di ruang rawat jalan. Peran pemberi asuhan keperawatan menggunakan Model Adaptasi Roy. Perilaku adaptasi fisiologi yang banyak mengalami gangguan adalah cairan dan masalah keperawatan yang banyak muncul adalah hipervolemia, sehingga intervensi yang diberikan adalah pencatatan secara akurat intake dan output, edukasi pembatasan cairan. Penerapan EBNP yang dilakukan adalah dengan melakukan identifikasi tingkat fatigue pada pasien Gagal Ginjal Kronik Stage V dengan menggunakan instrumen FACIT-F, sehingga dapat diketahui tingkat fatigue pasien dan dapat dilakukan asuhan keperawatan yang komprehensif. Program inovasi yang dilakukan adalah Range of Motion pada pasien intrahemodialisis untuk meningkatkan adekuasi hemodialisis dikaitkan dengan tingkat fatigue menggunakan instrumen FACIT-F Kata Kunci : fatigue, ROM exercise, gagal ginjal kronik, hemodialysis, FACIT-FABSTRACT Analysis of Medical Surgical Nursing Residency Practice on UrinarySystem Disorders with Chronic Kidney Disease CKD STAGE V Cases Using Roy Adaptation Model Approach at Cipto Mangunkusumo Hospital in Jakarta Diana Rhismawati Djupri2017 Abstract Ners Specialist Urinary System is to be able to perform and analyze nursing care in patients with Chronic Kidney Desease CKD Stage V and 30 other patients with urinary system disorders. It is also capable of implementing Evidence Based Nursing Practice EBNP and as an innovator in the treatment room as well as in the outpatient room. The role of nursing care providers uses the Roy Adaptation Model. Behavioral adaptation of many disordered physiology is fluid and nursing problems that many appear is hypervolemia, so that intervention given is accurate recording intake and output, fluid restriction education. Implementation of EBNP is done by identifying fatigue level in patients with Chronic Kidney Desease CKD Stage V using FACIT F instrument, so that can know fatigue level of patient and can be done comprehensive nursing care. The innovation program performed was the Range of Motion in intrahemodialysis patients to improve the hemodialysis adequacy associated with fatigue levels using the FACIT F instrument. Keywords fatigue, ROM exercise, Chronic Kidney Desease, hemodialysis, FACIT F"

"ABSTRAKPerdarahan merupakan salah satu penyulit dan penyebab kematian yang sering dijumpai pada penderita gagal ginjal akut maupun kronik. Angka kematian yang disebabkan karena perdarahan pada penderita gagal ginjal sekitar 10 %. Penelitian ini bertujuan untuk mengetahui jenis gangguan hemostasis pada penderita gagal ginjal terminal sehingga usaha untuk mengatasinya lebih terarah. Selain itu juga untuk mengetahui pengaruh hemodialisis terhadap gangguan hemostasis tersebut. Penelitian dilakukan terhadap 30 penderita gagal ginjal terminal yang dirawat di Bagian Penyakit Dalam Subdivisi Ginjal dan Hipertensi FKUI-RSCM Jakarta, yang terdiri dari 21 pria dan 9 wanita, berusia antara 33 sampai 62 tahun. Kelompok kontrol terdiri atas 30 orang sehat yang tidak termasuk kriteria tolakan. Pemeriksaan yang dilakukan pada penelitian ini ialah masa perdarahan, hitung trombosit, masa protrombin plasma, masa tromboplastin parsial teraktivasi, masa trombin, EDP, PF3 dan agregasi trombosit terhadap ADP 10uH, 5uM dan luM. Pengambilan bahan penelitian untuk penderita ialah sesaat sebelum dilakukan hemodialisis dan segera sesudah hemodialisis, untuk kontrol, pengambilan bahan penelitian segera setelah memenuhi kriteria. Hasil penelitian ini menunjukkan bahwa perbedaan yang bermakna antara kelompok GGX sebelum HD dengan kelompok kontrol dijumpai pada masa perdarahan, hitung trombosit faktor trombosit 3, MT dan FDP, sedangkan MP, MTPT dan agregasi trombosit tidak berbeda bermakna. Karena rata-rata hitung trombosit pada kelompok GGK masih dalam batas normal, maka disimpulkan penyebab masa perdarahan yang memanjang adalah gangguan fungsi trombosit yaitu aktivitas faktor trombosit 3, MT yang memanjang mungkin disebabkan fungsi atau kadar fibrinogen yang menurun atau mungkin karena adanya inhibitor. Dari penelitian ini ternyata efek HD tidak terlihat pada masa perdarahan maupun hitung trombosit, sedangkan terhadap tes koagulasi dan faktor trombosit 3 efek HD adalah memperburuk, mungkin ini karena efek heparin. Sebaiknya dilakukan penelitian lebih lanjut mengenai gangguan hemostasis pada gagal ginjal terminal, untuk mengetahui penyebab MT memanjang, perlu diperiksa fibrinogen baik kadar, fungsi maupun adanya inhibitor. FDP dilanjutkan dengan D. diner. Faktor von Willebrand dan adhesi trombosit untuk mengetahui fungsi trombosit. Efek heparin sebaiknya dinetralkan dengan menambah protamin sebelum pengambilan sample sesudah HD. "

"Gagal Ginjal Kronik (GGK) merupakan masalah kesehatan di Indonesia. GGT (Gagal Ginjal Terminal) merupakan bentuk lanjut dari GGK GGT ditetapkan berdasarkan bersihan kreatinin dibawah 5 mL/menit. Salah satu gejala pada GGT adalah terjadinya osteodistrofi renal yang dihubungkan dengan masalah penurunan kadar Ca dan peningkatan kadar fosfat darah. Sehubungan dengan hal ini GGK pada umumnya diberikan terapi kalsitriol, diet rendah fosfat dan pengikat fosfat. GGT memerlukan terapi pengganti, seperti dialisis. Pengaturan homeostasis Ca dan fosfat darah dilakukan oleh hormon kalsitriol dan hormon paratiroid. Pada pasien GGK homeostasis tersebut terganggu oleh karena berkurangnya sintesis kalsitriol dan timbulnya retensi fosfat. Penurunan kadar kalsitriol menyebabkan penurunan absorbsi Ca dari usus. Retensi fosfat menimbulkan peningkatan kadar fosfat yang akan mengikat Ca. Kedua hal diatas menyebabkan terjadinya penurunan kadar Ca darah. Pada penderita GGT kerusakan masa gnjal menyebabkan penurunan kadar kalsitriol sehingga tetjadi gangguan homeostasis Ca darah terutama kadar ion Ca. Hal iru menyebabkan terjadinya peningkatan kadar hormon paratiroid. Pada penelitian ini akan dibuktikan bahwa pemberian kalsitriol secara oral dapat menurunkan kadar hormon paratiroid (PTH) dan menormalkan kadar ion Ca darah. Dilakukan studi experimental pada pasien GGT yang mengikuti dialisis. Pasien yang diteliti adalah pasien yang tidal( mendapat pengobatan kalsitriol, tapi mengikuti diit rendah fosfat. Pasien GGT dengan hiperparatiroid sekunder diberikan kalsitriol 0,25 ug oral, tiap hari selama 2 minggu. Pada akhir pemberian kalsitriol diperiksa ulang kadar PTH, Ca, fosfat dan alkali fosfatase. Hasil dan Kesimpulan: Setelah perlakuan terdapat penurunan kadar PTH secara bermakna p<0,015 dari 397 menjadi 149 pg/mL. Peningkatan kadar ion Ca secara bermakna p<0,020, dari 1,08 menjadi 1,16 mMoVL yang dihitung berdasarkan rumus. Penurunan fosfat bermakna dengan p<0,024, dari 4,18 mg/di, menjadi 3,65 mgldL serta penurunan alkali fosfatase bermakna dengan p<0,002, dari 250 menjadi 173 UIL."

"Penyakit ginjal merupakan masalah yang besar di seluruh dunia. Permasalahan yang timbul di negara maju berbeda dengan negara yang sedang berkembang seperti Indonesia. Jumlah penderita gagal ginjal kronik (GGK) di Indonesia khususnya Jakarta,cukup banyak dan mempunyai banyak faktor penyebab. Tindakan hemodialisis (HD) merupakan Salah satu pengobatan untuk penderita GGK disamping transplantasi ginjal. Tetapi tindakan ini dapat menimbulkan beberapa komplikasi antara lain penurunan kadar asam folat dengan segala akibatnya.Tujuan penelitian ini untuk menentukan prevalensi defisiensi Serta perubahan kadar asam folat dan vitamin B12 pada kelompok GGK dan GGK pasca HD dengan pemberian asam folat 20 mg/bari. Selain itu juga menentukan klasifikasi anemia pada GGKberdasarkan morfologi eritrosit dan melihat efektivitas pemberian aaam folat sebanyak 20 mg/hari pada penderita GGK pasca HD.Penelitian ini dilakukan terhadap 50 penderita GGK tanpa tindakan HD, 20 penderita GGK pasoa HD dengan suplementasi asam folat sebanyak 20 mg/hari dan vitamin B12 2 ug dalam tablet Unioap-M selama 24 - 36 minggu. Sebagai kelompok kontrol dipakai 20 penderita penyakit ginjal tampa gagal ginjal. Terhadap ketiga kelompok ini dilakukan pemeriksaan kadar asam folat eritrosit dan serum Serta vitamin B12 dengan cara CPB menggunakan kit Vitamin B12/falaf dual count Amersham CT_301_ Pemeriksaan parameter Hb, Ht, hitung eritrosit, VER, HER dan KHER dilakukandengan penghitung sel darah otomatis. Hitung Rt dilakukan dengan pulasan vital Brilliant cresyl blue, sedangkan sediaan hapus darah tepi dipulas dengan pewarnaan Wright.Pada penelitian ini belum dapat dipastikan adanya defisiensi asam folat pada kedua kelompok GGK (dibandingkan kontrol). Kadar asam folat eritrosit kelompok GGK (nt= 208 ng/mL) lebib rendah dari pada kontrol (nt= 504 ng/mL)(p <0,05). Hal yang sama dijumpai pada kelompok GGK pasca HD (nt= 407 ng/mL). Kadar aaam folat serum kelompok GGK (nt = 4,2 ng/mL) sama dengan kadar asam folat serum GSK pasca HD. Kadar asam folat serum pada kelompok GGK tampa HD maupun GGK pasca HD,lebih tinggi dari kelompok kontrol (nt = 2,9 ng/mL)(p > 0,05).Kadar vitamin B12 serum pada kelompok GGK (865 pg/mL) dan GGK pasea HD (1043 pg/mL} lebih tinggi dibandingkan dengan kelompok kontrol (351 pg/mL).Enam puluh persen penderita GGK, 65% GGK pasca HD- dengan suplementasi asam folat dan 90% kelompok kontrol memberikan gambaran anemia normositik normokrom. Pemeriksaan hematologi seperti Hb, Ht dan hitung eritrosit pada kedua kelompok yangditeliti memberikan basil lebih rendah dibandingkan dengan kelompok kontrol.Hipersegmentasi pada kedua kelompok GGK tidak disebabkan defisiensi asam folat dan /vitamin B12, tetapi mungkin disebabkan proses degenerasi leukosit.Kadar Hb, Ht dan hitung eritrosit pada kedua kelompok GGK lebih rendah dibandingkan kontrol (p < 0,05). Tetapi tidak terdapat perbedaan bermakna pada pemeriksaan nilai eritrosit rata-rata, dan indeks produksi Rt antara kedua kelompok GGKdibandingkan kontrol.Hitung leukosit kelompok GGK tanpa HD lebih tinggi dibandingkan kontrol (p >0,05) dan GGK pasea HD (p <0,05). Hitung trombosit kelompok GGK tampa HD lebih rendah dibandingkan dengan kontrol (p > 0,05}, tetapi lebih tinggi dibandingkan kelompok GGK pasca HD (p <0,05).Diperlukan penelitian lebih lanjut untuk mendapatkan nilai rujukan asam folat eritrosit dan serum, Serta vitamin B12 serum untuk orang Indonesia."

"Penyakit ginjal dengan berbagai manifestasinya memerlukan berbagai pemeriksaan penunjang untuk melengkapi data penderita. Pada umumnya pemeriksaan penunjang ini digunakan sebagai alat bantu diagnostik, untuk melihat hasil penanggulangan/pengobatan penderita, dan untuk mengikuti perjalanan penyakit. Salah satu pemeriksaan penunjang untuk membedakan kelainan ginjal glomeruler dan tubular adalah analisa protein urin menggunakan tehnik sodium dodecyl sulfate polyacrylamid gel electrophoresis (SDS-PAGE). Dengan pemeriksaan ini dapat dibedakan pola ekskresi protein pada kelainan ginjal glomeruler, tubuler, atau campuran keduanya. β-N-acetylglucosaminidase (β-NAG) adalah enzim yang dibentuk oleh lisosom sel tubulus proksimal dan dilepaskan ke dalam urin. Karena itu dianggap lebih spesifik untuk menentukan adanya kelainan tubulus dibandingkan dengan tes lainnya seperti β2-mikroglobulin.Pada penelitian ini kami mencari hubungan antara pola ekskresi protein dan aktivitas β-NAG dalam urin penderita dengan berbagai kelainan ginjal. Hasil menunjukkan adanya peningkatan β-NAG pada kasus-kasus dengan pola ekskresi protein tubuler dan campuran. Dua kasus (4,17%) dengan pola glomeruler memberikan hasil aktivitas β-NAG yang meningkat; kasus ini adalah sindroma nefrotik dan hipertensi. Pada sindroma nefrotik dengan proteinuria glomeruler non-selektif memang pernah dilaporkan adanya peningkatan β-NAG yang diduga berasal dari serum. Peningkatan β-NAG pads kasus hipertensi pada penelitian ini, tidak diketahui mekanismenya.

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Protein Pattern And Β-Nag Activity In The Urine From Patients With Several Different Kidney AbnormalitiesKidney disease and its manifestation require different kind of laboratory tests to complete the data of the patients. In general, these tests are used as a diagnostic aid, and also in monitoring the therapy and the progress of the disease. It is important to differentiate between glomerular and tubular disorders. Sodium dodecyl sulfate polyacrylanude gel electrophoresis (SDS-PAGE) is one of the techniques that can be used to differentiate these abnormalities by looking at the protein excretion pattern in the urine. For renal tubular disorder, the determination of β-N-acetylglucosaminidase (β-NAG) is a useful test to detect the alteration of the tubular apparatus. This test is more specific than the others, such as β2-microglobulin, because β-NAG is produced by the lysosomes of the cells of proximal tubules.The aims of our study is to find a correlation between urine protein excretion pattern and β-NAG activity, and the abnormalities of the kidney. We found that β-NAG activity was increased in patients with tubular and mixed type pattern of proteinuria. The increased activity of this enzyme was also seen in 2 patients (4.7%) with glomerular pattern; one with nephrotic syndrome and the other with hypertension. In nephrotic syndrome with non-selective proteinuria, it is conceivable that some of the urine β-NAG was plasma origin. In hypertension, the mechanisme of the increasing of β-NAG activity in the urine is still unknown."

"ABSTRAKLatar Belakang. Sindrom nefrotik resisten steroid (SNRS) jarang ditemukan pada anak. Kesintasan kehidupan anak SNRS pada umumnya baik. Akan tetapi, anak SNRS sering mengalami penurunan fungsi ginjal dan pada perjalanan penyakitnya dapat mengalami end stage renal disease (ESRD). Tujuan. Mengetahui kesintasan kehidupan dan fungsi ginjal anak SNRS pada tahun ke-1, 2, 3, 4, dan 5. Mengetahui pengaruh usia, fungsi ginjal, dan hipertensi saat awitan serta tipe resistensi terhadap kesintasan kehidupan dan fungsi ginjal anak SNRS.Metode. Penelitian kohort retrospektif dengan menggunakan data sekunder berupa rekam medis anak SNRS yang datang berobat ke Poliklinik Nefrologi Departemen Ilmu Kesehatan Anak dan praktik swasta konsultan Divisi Nefrologi dalam periode Januari 2000-Januari 2011. Kesintasan fungsi ginjal yang dinilai pada penelitian ini adalah kenaikan kreatinin ≥2 kali dan ESRD.Hasil. Sebanyak 45 anak SNRS diikutsertakan dalam penelitian. Lama sakit adalah 24 (rentang 3-95) bulan. Sebanyak 20% anak meninggal dunia, 31,1% anak mengalami kenaikan kreatinin ≥2 kali, dan 13,4% anak menjadi ESRD pada akhir penelitian. Kesintasan kehidupan anak SNRS pada tahun ke-1, 2, 3, 4, dan 5 berturut-turut adalah 93, 84, 80, 72, dan 61%. Kesintasan anak SNRS terhadap terjadinya kenaikan kreatinin ≥2 kali pada tahun ke-1, 2, 3, 4, dan 5 berturut-turut adalah 92, 72, 56, 42, dan 34%. Kesintasan anak SNRS terhadap terjadinya ESRD pada tahun ke-1, 2, 3, 4, dan 5 berturut-turut adalah 97, 88, 81, 70, dan 58%. Usia, fungsi ginjal, hipertensi saat awitan dan tipe resistensi tidak berpengaruh terhadap kesintasan kehidupan, kenaikan kreatinin ≥2 kali, maupun terjadinya ESRD (semua nilai p>0,05).Simpulan. Penelitian ini mendapatkan hasil bahwa anak SNRS rentan untuk mengalami kenaikan kreatinin ≥2 kali dan ESRD. Faktor-faktor prognostik yang dipikirkan mempengaruhi kesintasan kehidupan dan fungsi ginjal seperti usia, fungsi ginjal dan hipertensi saat awitan serta tipe resistensi tidak terbukti berperan dalam kesintasan.

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ABSTRACTBackground: Steroid resistant nephrotic syndrome (SRNS) is seldom found in children. Children with SRNS generally have good survival although during the course of the disease may develop decreased kidney function, leading to end stage renal disease (ESRD). Data on survival of children with SRNS is still scarce. Objective: To determine survival in children with SRNS on the first, second, third, fourth and fifth year; to study the effect of age at onset, initial kidney function, hypertension and type of resistance towards the survival of children with SRNS.Method: A retrospective cohort is performed using secondary data obtained from medical record of outpatient and inpatient clinic from Division of Nephrology, Department of Child Health, Cipto Mangunkusumo Hospital as well as private clinic of the Pediatric Nephrology consultant from January 2000-January 2011. Kidney survival was determined as doubling of base creatinine levels and ESRD.Results: This study includes 45 children with SRNS. Median time of illness was 24 (range 3-95) months. Twenty percent died due to various reasons; 31.1% had a doubling of base creatinine levels and 13.4% develop ESRD. Survival on the first, second, third, fourth and fifth year are 93, 84, 80, 72 and 61% respectively. Kidney survival on the first, second, third, fourth and fifth year towards doubling of base creatinine levels are 92, 72, 56, 42 and 34%, whereas towards ESRD are 97, 88, 81, 70 and 58% respectively. Age at onset, initial kidney function, hypertension and type of resistance does not affect the survival of children with SRNS (all P>0.05).Conclusion: Children with SRNS is prone to develop a doubling of base creatinine levels and ESRD. Factors such as age at onset, initial kidney function, hypertension and type of resistance does not affect the survival of children with SRNS."

"[ABSTRAKPola sirkadian tekanan darah (TD) adalah gambaran TD 24 jam berupa kurva TD yang meningkat pada pagi hari, menurun pada siang / sore hari dan terendah pada malam hari / waktu tidur. 24 hours Ambulatory Blood Pressure Monitoring (24 hrs ABPM) merupakan alat pengukur TD yang lebih akurat dan dapat memperlihatkan pola sirkadian TD 24 jam. Turunnya TD 10 - 20% pada malam hari disebut dipper, jika turun < 10% disebut nondipper. Meningkatnya TD 24 jam dan nondipper merupakan faktor risiko morbiditas dan mortalitas kardiovaskular. Prevalensi hipertensi dan nondipper pada Penyakit Ginjal Kronik Stadium 5 dalam Terapi Dialisis (PGK 5D) masih sangat tinggi. Faktor utama penyebab hipertensi pada PGK 5D adalah menurunnya Laju Filtrasi Glomerulus (LFG) dan meningkatnya cairan ekstraselular. Transplantasi ginjal akan memperbaiki TD dan nondipper dengan membaiknya LFG, meningkatnya produksi urin dan menurunnya cairan ekstraseluler. Namun demikian satu bulan Pasca Transplantasi Ginjal kebutuhan dosis obat imunosupresan masih cukup tinggi yang dapat mengakibatkan hambatan penurunan TD.Tujuan : Mengetahui perbedaan pola sirkadian TD, data dipper / nondipper dan rerata TD 24 jam pada pasien PGK Pra dan satu bulan Pasca Transplantasi Ginjal. Metode Penelitian : Studi Pre experimental dengan before and after design. Subjek penelitian pasien PGK 5D / Pra Transplantasi Ginjal berusia 18 ? 60 tahun, dilakukan di RSCM pada bulan Oktober sampai dengan Desember 2014. Jumlah subjek sebanyak 15 orang. Dilakukan pengumpulan urin 24 jam, pemeriksaan LFG, pengukuran TD 24 jam dengan 24 hrs ABPM, Pra dan satu bulan Pasca Transplantasi Ginjal. Analisis statistik dengan uji McNemar dan uji t dependen.Hasil : Terdapat 12 subjek nondipper dan 3 subjek dipper pada pasien PGK Pra Transplantasi Ginjal. Satu bulan Pasca Transplantasi Ginjal seluruh subjek (15 orang) memperlihatkan keadaan nondipper. Uji McNemar tidak dapat dilakukan karena seluruh subjek PGK satu bulan Pasca Transplantasi Ginjal nondipper (homogen). Terdapat penurunan rerata TD sistolik 24 jam pasien PGK satu bulan Pasca Transplantasi Ginjal yang tidak signifikan (p > 0,05) dan penurunan rerata TD diastolik 24 jam yang signifikan (p < 0,05).Simpulan : Belum terdapat perbaikan nondipper pada pasien satu bulan Pasca Transplantasi Ginjal. Terdapat penurunan rerata TD sistolik 24 jam yang tidak signifikan dan penurunan rerata TD diastolik 24 jam yang signifikan pada pasien satu bulan Pasca Transplantasi Ginjal.

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ABSTRACTThe circadian pattern of blood pressure (BP) is a 24 hours bloodpressure (24hrs BP) curve which increases in the morning, decreases in theafternoon/evening and the lowest state is at night/bedtime. 24 hrs AmbulatoryBlood Pressure Monitoring (ABPM) is a BP measuring device that isaccurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%at night is called as a dipper, while less than 10% is called as a nondipper. Theincreasing of 24 hrs BP and nondipper are the risk factor forcardiovascular morbidity and mortality. The prevalence ofhypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis(CKD 5D) are still very high. The main factors causing hypertension in CKD 5Dare decreased Glomerular Filtration Rate (GFR) and increased extracellularfluid. Kidney transplantation will improve BP and nondipperby GFR improvement, increases urine production and decreases extracellularfluid. However, one month after kidney transplantation, the doseof immunosuppressant drugs is relatively high, which is an obstacle to decreaseBP.Aim: To determine differences in the circadian pattern of BP, the dataof dipper and nondipper, and the mean of 24 hrs BP in CKD before, and onemonth after kidney transplantation.Methods: Design of the study is before and after design. Subjects of the studywere patients with CKD 5D before kidney transplantation, aged 18-60 years,were conducted in Cipto Mangunkusumo Hospital during October toDecember 2014. 15 subjects were included in the study. 24 hrs urinecollection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in allsubjects, before and one month after kidney transplantation. McNemar test and tdependent test were used in statistical analysis.Results: Before kidney transplantation, 12 of 15 subjects were nondippers whilethe others 3 subjects were dippers. After kidney transplantation, all subjects (15patients) were nondippers. McNemar test can not be used because all subjects onemonth after kidney transplantation were nondippers (homogeneous). Thedecreasing of the mean of 24 hrs systolic BP was found in all CKD onemonth after kidney transplantation, but statistically not significant (p>0.05),while decreasing of the mean of 24 hrs diastolic BP was statistically significant(p<0.05).Conclusion: There were still no improvement in nondipper patientsone month after kidney transplantation. There were a decrease in the mean of 24hrs systolic BP but statistically not significant and a decrease in the mean of 24hrs diastolic BP which is statistically significant in patients one month afterkidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours bloodpressure (24hrs BP) curve which increases in the morning, decreases in theafternoon/evening and the lowest state is at night/bedtime. 24 hrs AmbulatoryBlood Pressure Monitoring (ABPM) is a BP measuring device that isaccurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%at night is called as a dipper, while less than 10% is called as a nondipper. Theincreasing of 24 hrs BP and nondipper are the risk factor forcardiovascular morbidity and mortality. The prevalence ofhypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis(CKD 5D) are still very high. The main factors causing hypertension in CKD 5Dare decreased Glomerular Filtration Rate (GFR) and increased extracellularfluid. Kidney transplantation will improve BP and nondipperby GFR improvement, increases urine production and decreases extracellularfluid. However, one month after kidney transplantation, the doseof immunosuppressant drugs is relatively high, which is an obstacle to decreaseBP.Aim: To determine differences in the circadian pattern of BP, the dataof dipper and nondipper, and the mean of 24 hrs BP in CKD before, and onemonth after kidney transplantation.Methods: Design of the study is before and after design. Subjects of the studywere patients with CKD 5D before kidney transplantation, aged 18-60 years,were conducted in Cipto Mangunkusumo Hospital during October toDecember 2014. 15 subjects were included in the study. 24 hrs urinecollection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in allsubjects, before and one month after kidney transplantation. McNemar test and tdependent test were used in statistical analysis.Results: Before kidney transplantation, 12 of 15 subjects were nondippers whilethe others 3 subjects were dippers. After kidney transplantation, all subjects (15patients) were nondippers. McNemar test can not be used because all subjects onemonth after kidney transplantation were nondippers (homogeneous). Thedecreasing of the mean of 24 hrs systolic BP was found in all CKD onemonth after kidney transplantation, but statistically not significant (p>0.05),while decreasing of the mean of 24 hrs diastolic BP was statistically significant(p<0.05).Conclusion: There were still no improvement in nondipper patientsone month after kidney transplantation. There were a decrease in the mean of 24hrs systolic BP but statistically not significant and a decrease in the mean of 24hrs diastolic BP which is statistically significant in patients one month afterkidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours bloodpressure (24hrs BP) curve which increases in the morning, decreases in theafternoon/evening and the lowest state is at night/bedtime. 24 hrs AmbulatoryBlood Pressure Monitoring (ABPM) is a BP measuring device that isaccurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%at night is called as a dipper, while less than 10% is called as a nondipper. Theincreasing of 24 hrs BP and nondipper are the risk factor forcardiovascular morbidity and mortality. The prevalence ofhypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis(CKD 5D) are still very high. The main factors causing hypertension in CKD 5Dare decreased Glomerular Filtration Rate (GFR) and increased extracellularfluid. Kidney transplantation will improve BP and nondipperby GFR improvement, increases urine production and decreases extracellularfluid. However, one month after kidney transplantation, the doseof immunosuppressant drugs is relatively high, which is an obstacle to decreaseBP.Aim: To determine differences in the circadian pattern of BP, the dataof dipper and nondipper, and the mean of 24 hrs BP in CKD before, and onemonth after kidney transplantation.Methods: Design of the study is before and after design. Subjects of the studywere patients with CKD 5D before kidney transplantation, aged 18-60 years,were conducted in Cipto Mangunkusumo Hospital during October toDecember 2014. 15 subjects were included in the study. 24 hrs urinecollection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in allsubjects, before and one month after kidney transplantation. McNemar test and tdependent test were used in statistical analysis.Results: Before kidney transplantation, 12 of 15 subjects were nondippers whilethe others 3 subjects were dippers. After kidney transplantation, all subjects (15patients) were nondippers. McNemar test can not be used because all subjects onemonth after kidney transplantation were nondippers (homogeneous). Thedecreasing of the mean of 24 hrs systolic BP was found in all CKD onemonth after kidney transplantation, but statistically not significant (p>0.05),while decreasing of the mean of 24 hrs diastolic BP was statistically significant(p<0.05).Conclusion: There were still no improvement in nondipper patientsone month after kidney transplantation. There were a decrease in the mean of 24hrs systolic BP but statistically not significant and a decrease in the mean of 24hrs diastolic BP which is statistically significant in patients one month afterkidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours bloodpressure (24hrs BP) curve which increases in the morning, decreases in theafternoon/evening and the lowest state is at night/bedtime. 24 hrs AmbulatoryBlood Pressure Monitoring (ABPM) is a BP measuring device that isaccurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%at night is called as a dipper, while less than 10% is called as a nondipper. Theincreasing of 24 hrs BP and nondipper are the risk factor forcardiovascular morbidity and mortality. The prevalence ofhypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis(CKD 5D) are still very high. The main factors causing hypertension in CKD 5Dare decreased Glomerular Filtration Rate (GFR) and increased extracellularfluid. Kidney transplantation will improve BP and nondipperby GFR improvement, increases urine production and decreases extracellularfluid. However, one month after kidney transplantation, the doseof immunosuppressant drugs is relatively high, which is an obstacle to decreaseBP.Aim: To determine differences in the circadian pattern of BP, the dataof dipper and nondipper, and the mean of 24 hrs BP in CKD before, and onemonth after kidney transplantation.Methods: Design of the study is before and after design. Subjects of the studywere patients with CKD 5D before kidney transplantation, aged 18-60 years,were conducted in Cipto Mangunkusumo Hospital during October toDecember 2014. 15 subjects were included in the study. 24 hrs urinecollection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in allsubjects, before and one month after kidney transplantation. McNemar test and tdependent test were used in statistical analysis.Results: Before kidney transplantation, 12 of 15 subjects were nondippers whilethe others 3 subjects were dippers. After kidney transplantation, all subjects (15patients) were nondippers. McNemar test can not be used because all subjects onemonth after kidney transplantation were nondippers (homogeneous). Thedecreasing of the mean of 24 hrs systolic BP was found in all CKD onemonth after kidney transplantation, but statistically not significant (p>0.05),while decreasing of the mean of 24 hrs diastolic BP was statistically significant(p<0.05).Conclusion: There were still no improvement in nondipper patientsone month after kidney transplantation. There were a decrease in the mean of 24hrs systolic BP but statistically not significant and a decrease in the mean of 24hrs diastolic BP which is statistically significant in patients one month afterkidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours bloodpressure (24hrs BP) curve which increases in the morning, decreases in theafternoon/evening and the lowest state is at night/bedtime. 24 hrs AmbulatoryBlood Pressure Monitoring (ABPM) is a BP measuring device that isaccurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%at night is called as a dipper, while less than 10% is called as a nondipper. Theincreasing of 24 hrs BP and nondipper are the risk factor forcardiovascular morbidity and mortality. The prevalence ofhypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis(CKD 5D) are still very high. The main factors causing hypertension in CKD 5Dare decreased Glomerular Filtration Rate (GFR) and increased extracellularfluid. Kidney transplantation will improve BP and nondipperby GFR improvement, increases urine production and decreases extracellularfluid. However, one month after kidney transplantation, the doseof immunosuppressant drugs is relatively high, which is an obstacle to decreaseBP.Aim: To determine differences in the circadian pattern of BP, the dataof dipper and nondipper, and the mean of 24 hrs BP in CKD before, and onemonth after kidney transplantation.Methods: Design of the study is before and after design. Subjects of the studywere patients with CKD 5D before kidney transplantation, aged 18-60 years,were conducted in Cipto Mangunkusumo Hospital during October toDecember 2014. 15 subjects were included in the study. 24 hrs urinecollection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in allsubjects, before and one month after kidney transplantation. McNemar test and tdependent test were used in statistical analysis.Results: Before kidney transplantation, 12 of 15 subjects were nondippers whilethe others 3 subjects were dippers. After kidney transplantation, all subjects (15patients) were nondippers. McNemar test can not be used because all subjects onemonth after kidney transplantation were nondippers (homogeneous). Thedecreasing of the mean of 24 hrs systolic BP was found in all CKD onemonth after kidney transplantation, but statistically not significant (p>0.05),while decreasing of the mean of 24 hrs diastolic BP was statistically significant(p<0.05).Conclusion: There were still no improvement in nondipper patientsone month after kidney transplantation. There were a decrease in the mean of 24hrs systolic BP but statistically not significant and a decrease in the mean of 24hrs diastolic BP which is statistically significant in patients one month afterkidney􀀃transplantation., Background: The circadian pattern of blood pressure (BP) is a 24 hours bloodpressure (24hrs BP) curve which increases in the morning, decreases in theafternoon/evening and the lowest state is at night/bedtime. 24 hrs AmbulatoryBlood Pressure Monitoring (ABPM) is a BP measuring device that isaccurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%at night is called as a dipper, while less than 10% is called as a nondipper. Theincreasing of 24 hrs BP and nondipper are the risk factor forcardiovascular morbidity and mortality. The prevalence ofhypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis(CKD 5D) are still very high. The main factors causing hypertension in CKD 5Dare decreased Glomerular Filtration Rate (GFR) and increased extracellularfluid. Kidney transplantation will improve BP and nondipperby GFR improvement, increases urine production and decreases extracellularfluid. However, one month after kidney transplantation, the doseof immunosuppressant drugs is relatively high, which is an obstacle to decreaseBP.Aim: To determine differences in the circadian pattern of BP, the dataof dipper and nondipper, and the mean of 24 hrs BP in CKD before, and onemonth after kidney transplantation.Methods: Design of the study is before and after design. Subjects of the studywere patients with CKD 5D before kidney transplantation, aged 18-60 years,were conducted in Cipto Mangunkusumo Hospital during October toDecember 2014. 15 subjects were included in the study. 24 hrs urinecollection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in allsubjects, before and one month after kidney transplantation. McNemar test and tdependent test were used in statistical analysis.Results: Before kidney transplantation, 12 of 15 subjects were nondippers whilethe others 3 subjects were dippers. After kidney transplantation, all subjects (15patients) were nondippers. McNemar test can not be used because all subjects onemonth after kidney transplantation were nondippers (homogeneous). Thedecreasing of the mean of 24 hrs systolic BP was found in all CKD onemonth after kidney transplantation, but statistically not significant (p>0.05),while decreasing of the mean of 24 hrs diastolic BP was statistically significant(p<0.05).Conclusion: There were still no improvement in nondipper patientsone month after kidney transplantation. There were a decrease in the mean of 24hrs systolic BP but statistically not significant and a decrease in the mean of 24hrs diastolic BP which is statistically significant in patients one month afterkidney􀀃transplantation.]"