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"Latar belakang Sisplatin merupakan pengobatan utama untuk karsinoma nasofaring KNF , tetapi berpotensi menimbulkan nefrotoksisitas. Selain kadar BUN dan kreatinin serum, KIM-1 dan NGAL diduga cukup sensitif untuk mendeteksi nefrotoksisitas. Penelitian ini bertujuan untuk mengevaluasi kadar KIM-1 dan NGAL dalam urin untuk mendeteksi gangguan fungsi ginjal pada pasien KNF stadium lanjut yang mendapatkan kemoterapi berbasis sisplatin.Metode: Penelitian ini merupakan penelitian kohort prospektif. Subyek penelitian dibagi dalam 3 kelompok: pasien yang belum pernah terpapar dan yang sudah pernah mendapatkan kemoterapi berbasis sisplatin 75-100 mg/m serta pasien yang belum pernah mendapatkan kemoterapi sisplatin dan kemudian diberi sisplatin 40 mg/m 2 . Kadar KIM-1, NGAL dalam urin serta kadar BUN dan kreatinin dalam serum diukur pada saat sebelum dan sesudah mendapatkan sisplatin pada ketiga kelompok. Analisis statistik yang digunakan adalah uji ANOVA, uji Pearson, Spearman, Kolmogorov-Smirnov dan SPSS versi 22,0.Hasil: Terdapat perbedaan selisih kadar BUN yang bermakna antara sebelum dan sesudah diterapi pada ketiga kelompok p=0.0001 . Perbedaan selisih kadar NGAL dalam urin pada penelitian ini juga berbeda bermakna antara sebelum dan sesudah diterapi terhadap ketiga kelompok p=0,025 , tetapi ada perbedaan rerata pada sepasang kelompok yang bermakna hanya didapatkan pada kelompok yang belum pernah dikemoterapi 40 mg/m 2 dan kelompok yang sudah pernah diberi kemoterapi 75-100 mg/m 2 p=0,02. Perbedaan selisih kadar KIM-1 tidak bermakna pada ketiga kelompok p=0,275.Kesimpulan: Sisplatin menunjukkan akumulasi nefrotoksisitas yang tergantung pada dosis dose-dependent manner . Pengukuran kadar NGAL dalam urin dapat mendeteksi nefrotoksisitas tahap dini, tetapi belum bisa menggantikan peran BUN. Pengukuran kadar KIM-1 dalam urin tidak dapat mendeteksi gangguan fungsi ginjal.

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Background: Cisplatin is the main treatment for nasopharyngeal carcinoma NPC with a potency of causing nephrotoxicity. In addition to serum BUN and creatinine levels, KIM 1 and NGAL levels is assumed to be quite sensitive in detecting nephrotoxicity. The study was aimed to evaluate urinary KIM 1 and NGAL level to detect kidney dysfunction in patients with advanced stage NPC who received cisplatin based chemotherapy.

Method: The study was a cohort prospective study. Subjects were categorized into 3 groups, i.e. patients who had never received and who had received 75 100 mg m2 cisplatin based chemotherapy as well as those who had never received any cisplatin based chemotherapy and were subsequently received 40 mg m cisplatin. The levels of urinary KIM 1, NGAL and serum level of BUN and creatinine were measured before and after receiving cisplatin in the three groups. Statistical analysis used in our study were ANOVA, Pearson, Spearman, KolmogorovSmirnov test and SPSS version 22.0.

Results: There was a significant difference of delta BUN level before and after treatment in all three groups p 0.0001 . Delta urinary NGAL level was also significantly different between before and after treatment in all groups p 0.025 however, a significant mean difference of a pair group was only found between those who never had 40 mg m 2 chemotherapy and those who had received 75 100 mg m 2 chemotherapy p 0.02 while delta KIM 1 level showed no significant difference in all three groups p 0.275.

Conclusion: Cisplatin may cause accumulated nephrotoxicity, which has dosedependent manner. Measuring urinary NGAL level can detect an early stage of kidney dysfunction however, it still cannot replace the role of BUN. Measurement of urinary KIM 1 level cannot detect kidney dysfunction."

"Latar Belakang: Tujuan penelitian untuk melihat neutrophil gelatinase associated lipocalin (NGAL) pada pasien sepsis. Dimana NGAL merupakan biomarker yang dini untuk acute kidney injury (AKI). Metode Penelitian Penelitian kualitatif dengan desain uji diagnostik Pengambilan sampel secara cross sectional dan consecutive sampling pada 50 orang anak yang sepsis yang terdiri dari 28 sepsis, 22 sepsis berat di ruang rawat intensif anak di RS. Ciptomangunkusomo Jakarta dan RS.Wahidin Sudirohusodo Makassar. Hasil: Kadar NGAL urin pada pasien sepsis berat lebih tinggi dibandingkan sepsis. Nilai sensitifitas NGAL urin 100% dan spesifisitas 63,63%. NGAL urin meningkat lebih dulu bila dibandingkan dengan kreatinin serum. Kesimpulan NGAL dapat dipakai sebagai petanda dini terjadinya AKI.

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Introduction: The aim of this study to observe the neutrophil gelatinase associated lipocalin (NGAL) in pediatric sepsis. From previous study NGAL was early biomarker for AKI. Methods. This study is a qualitative study for diagnostic test. Sample was collected by cross sectional and consecutive sampling on 50 sepsis children, consist of 28 sepsis, 22 severe sepsis in pediatric intensive care unit Ciptomangunkusomo Hospital Jakarta and Wahidin Sudirohusodo Hospital Makassar.

Result: The value of urinary NGAL in severe sepsis is higher than sepsis. The Sensitivity and specificity is 100% and 63,63% this study suggest that urinary NGAL increase earlier than serum creatinine. Conclusion. Therefore urinary NGAL can be used as early biomarker for AKI."

"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."

"Latar Belakang: Tuberkulosis paru (TB) masih menjadi salah satu penyebab morbiditas dan mortalitas di seluruh dunia. Dalam dua dekade terakhir penyakit TB resisten obat (TBRO) telah muncul sebagai ancaman bagi kesehatan masyarakat seluruh dunia. NGAL merupakan partikel granulosit neutrofil yang mengalami pematangan dan menjadi gelatinase. NGAL terlibat dalam kekebalan bawaan untuk menghalangi bakteri mengambil zat besi untuk pertumbuhan. Pada pasien dengan komorbid anemia akan terjadi penurunan kekebalan bawaan sehingga pada TBRO dengan anemia bakteri Mtb akan mendapat zat besi dari tubuh manusia untuk bereplikasi. Namun masih belum terdapat data kadar protein serum NGAL pada pasien TBRO dengan anemia.Metode : Penelitian ini merupakan penelitian analitik observasional menggunakan desain potong lintang yang dilakukan di poliklinik dan ruang rawat inap MDR RSUP Persahabatan pada bulan Juli-September 2023. Jumlah subyek penelitian adalah 73 pasien TBRO yang belum memulai pengobatan dengan anemia dan tanpa anemia yang memenuhi kriteria inklusi dan eksklusi. Sampel darah subyek diambil sebanyak 3cc.Serum darah diambil lalu disimpan dalam lemari es suhu -200C. selanjutnya dilakukan pemeriksaan ELISA teknik sandwich dan diambil kadar protein NGAL. Variabel lainnya diambil dari rekam medis RSUP Persahabatan.Hasil : Pada penelitian ini didapatkan pasien TBRO dengan anemia memiliki IMT yang menunjukkan tingkat malnutrisi yang bermakna (p:0,026, OR 2,9(1,1-7,5). Penelitian ini juga mengidentifikasi peningkatan jumlah neutrofil (p:0,002, OR 0,2(0,06-0,5) dan penurunan jumlah limfosit (p:0,006, OR (4,2 (1,4-9,8) pada kelompok pasien anemia, yang tercermin dalam NLR yang meningkat (p:0,028, OR 0,3(0,09-0,9). Hasil yang ditemukan juga menunjukkan bahwa pasien TBRO dengan anemia memiliki lesi paru yang lebih luas secara statistik (p:0,048, OR 2,7(0,9-7,3). Kadar NGAL menunjukkan hasil median 82,76 (67,59) yang lebih tinggi dibandingkan dengan kelompok pasien TBRO anemia dan kelompok TBRO tanpa anemia 59,24(91,98) namun tidak bermakna (p: 0,26). Terdapat korelasi yang bermakna kadar NGAL dengan leukosit (r:0,295, p:0,011), neutrofil (r:0,297, p:0,011), limfosit (r:-0,343,p:0,003) dan NLR (r:0,336,p:0,004).Kesimpulan: Terdapat peningkatan kadar NGAL pada pasien TBRO dengan anemia dibandingkan tanpa anemia namun tidak bermakna secara statistik.

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Background: Pulmonary tuberculosis (TB) remains one of the leading causes of morbidity and mortality worldwide. In the last two decades, drug-resistant tuberculosis (DR-TB) has emerged as a global health threat. NGAL is a neutrophil granulocyte- derived protein that undergoes maturation and becomes gelatinase. NGAL is involved in innate immunity by blocking bacteria from acquiring iron for growth. In patients with anemia, there is a reduction in innate immunity, in patient DR-TB with anemia allowing Mtb bacteria to obtain iron from the human body for replication. However, there is currently no data on serum NGAL protein levels in DR-TB patients with anemia.

Methods: This study is an observational research using a cross-sectional design conducted in the outpatient clinic and inpatient ward of MDR RSUP Persahabatan in July-September 2023. The research subjects were 73 subject DR-TB patients who not yet started treatment with or without anemia and met the inclusion and exclusion criteria. Blood samples of the subjects were collected as much as 3cc. The blood serum was separated and stored in a -20°C freezer. Furthermore, ELISA examination using the sandwich technique was performed, and NGAL protein levels were measured.

Results: In this study, DR-TB patients with anemia had BMI indicating significant malnutrition (p: 0.026, OR 2.9(1.1-7.5). This study also identified an increase in the number of neutrophils (p: 0.002, OR 0.2(0.06-0.5) and a decrease in the number of lymphocytes (p: 0.006, OR 4.2(1.4-9.8) in the anemia patient group, as reflected in the increased NLR (p: 0.028, OR 0.3(0.09-0.9). The findings also showed that DR-TB patients with anemia had statistically larger lung lesions (p: 0.048, OR 2.7(0.9-7.3). NGAL levels showed a higher median result between the DR-TB patient group with anemia 82,76 (67,59) and the group without anemia 59,24 (91,98), but it was not statistically significant (p: 0.26). NGAL have significant corelation among leukocyte (r:0,295, p:0,011), neutrophil (r:0,297,p:0,011), limphocyte (r:-0,343,p:0,003) and NLR (r:0,336,p:0,004)

Conclusion: There is a increase in NGAL levels in DR-TB patients with anemia compared to those without anemia. However, this findings do not reach statistical significance."

"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."

"Peningkatan kadar Neutrophil Gelatinase Associated Lipocalin (NGAL) dikaiktkan dengan asupan protein yang rendah pada pasien sakit kritis dewasa di ICU. Belum ada penelitian sebelumnya yang menilai hubungan tersebut. Studi ini bertujuan untuk mengetahui hubungan asupan protein dengan Neutrophil Gelatinase Associated Lipocalin (NGAL) pada pasien sakit kritis dewasa. Studi potong lintang ini dilakukan pada 40 pasien sakit kritis dewasa di ICU RS Universitas Indonesia. Subjek yang memenuhi kriteria inklusi dan eksklusi diambil darahnya untuk dilakukan pemeriksaan NGAL serta dinilai asupan proteinnya. Uji t tidak berpasangan dan uji korelasi Spearman digunakan dalam analisis data (p<0,05). Rentang asupan protein pada subjek penelitian ini adalah 13,5-110 g/hari, dengan rerata asupan protein dalam g/kgBB/hari adalah 0,82±0,29. Rentang kadar NGAL plasma pada subjek penelitian adalah 87,75-787,65 ng/mL. Tidak ditemukan adanya hubungan yang bermakna antara asupan protein dengan NGAL pada pasien sakit kritis dewasa. Hubungan bermakna didapatkan antara usia dan penyakit penyerta dengan NGAL pada pasien sakit kritis dewasa.

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Elevated Neutrophil Gelatinase Associated Lipocalin (NGAL) levels are associated with low protein intake in adult critically ill patients in the ICU. No previous studies have evaluated this relationship. This study aimed to determine the association of protein intake with Neutrophil Gelatinase Associated Lipocalin (NGAL) in adult critically ill patients. This cross-sectional study was conducted on 40 adult critically ill patients in the ICU of Universitas Indonesia Hospital. Subjects who met the inclusion and exclusion criteria had their blood drawn for NGAL and protein intake assessed. Independent t-test and Spearman’s correlation test were used to examine the data (p<0.05). The range of protein intake in the subjects of this study was 13.5-110 g/day, with the mean protein intake in g/kgBB/day being 0.82±0.29. The range of plasma NGAL levels in the study subjects was 87.75-787.65 ng/mL. There was no significant association between protein intake and NGAL in adult critically ill patients. Significant association was found between age and comorbidities with NGAL in adult critically ill patients."

"Latar belakang: Tingkat keparahan cedera ginjal iskemia-reperfusi (I/R) berhubungan erat dengan tingginya angka kesakitan dan kematian. Hasil penelitian terdahulu pada manusia dan hewan telah mebuktikan bahwa Neutrophil Gelatinase Associated Lipocalin (NGAL) dapat mendeteksi dan memprediksi terjadinya cedera ginjal I/R dini. Tujuan penelitian ini adalah untuk membuktikan bahwa peningkatan kadar NGAL serum dan urin berhubungan dengan kerusakan epitel tubuli ginjal pada tikus yang mengalami iskemia reperfusi dini.Metode: Peneltian ini menggunakan 28 ekor tikus Sprague-Dawley jantan sebagai hewan model, dikelompokkan dalam 4 kelompok: sham 4 jam (Sham 4), sham 8 jam (Sham 8), iskemia 10 menit reperfusi 4 jam (I/R 4), dan iskemia 10 menit reperfusi 8 jam (I/R 8). Analisis kadar kreatinin serum diperiksa dengan metode Jaffe, sedangkan NGAL serum dan urin menggunakan metode ELISA Direct Sandwich. Evaluasi tingkat kerusakan jaringan ginjal dilakukan secara semi kuantitatif pada sediaan histologi dengan pulasan HE. Deskripsi kelainan tingkat seluler ginjal diperjelas melalui evaluasi menggunakan mikroskop elektron dan Imunohistokimia (IHK).Hasil: Kadar NGAL serum berkorelasi bermakna dengan tingkat kerusakan ginjal (ρSpearman NGAL serum = 0,701, p < 0,001), juga kadar NGAL urin berkorelasi bermakna dengan tingkat kerusakan ginjal (ρSpearman = 0,689, p < 0,001). Tingkat ekspresi NGAL lebih tinggi pada kelompok I/R dibanding sham (t-test, t = -26635,046, p < 0,001), juga tingkat kerusakan ginjal tikus (t-test, t = -5,028, p < 0,001), dan kadar NGAL serum dan urin pada kelompok I/R berbeda nyata dibanding sham (Mann-Whitney, U = 0, p < 0,001). Pada cutoff point 136,95 ng/mL dan 58,69 ng/mL berturut ? turut untuk NGAL serum dan urin diperoleh sensitivitas = 1, spesifisitas = 1.Kesimpulan: Peningkatan kadar NGAL serum dan urin berkorelasi dengan kerusakan epitel tubuli ginjal pada tikus yang mengalami cedera ginjal iskemia reperfusi dini.

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Background: The severity of ischemia-reperfusion (I/R) kidney injury is highly correlated with mortality and morbidity rate. Research on human and animal prove that NGAL predicts kidney injury at early phase. The objective of this study is to prove that the increase in serum and urinary NGAL are correlated with kidney tubular epithelial damage, and this increase has occurred in initiation phase, indicated by rat kidney histopathology in an early I/R model.

Methods: Twenty eight male Sprague-Dawley rats were divided into 4 groups: 4 hour sham (Sham 4), 8 hour sham (Sham 8), 10 minute ischemia 4 hour reperfusion (I/R 4) and 10 minute ischemia 8 hour reperfusion (I/R 8). Blood, urine and kidney samples were collected. Serum creatinine level was analyzed with Jaffe method, while serum and urinary NGAL level were analyzed with direct sandwich ELISA method. Evaluation of kidney damage were measured semi quantitatively in tissue stained with HE. Further evaluation to confirm cellular changes on kidney was performed by electron microscope and immunohistochemistry.

Results: Serum NGAL was found significantly correlated with degree of kidney tissue damage (ρSpearman NGAL serum = 0.701, p < 0.001), also urinary NGAL (ρSpearman = 0.689, p < 0.001). NGAL expression differs significantly between I/R group and sham (t-test, t = -26635.056, p < 0.001), also kidney damage (t-test, t = -5.028, p < 0.001), and serum and urinary NGAL levels (Mann-Whitney, U = 0, p < 0.001). With cutoff points of 136.95 ng/mL and 58.69 ng/mL subsequently for serum and urinary NGAL , it is found that sensitivity = 1, specificity = 1.

Conclusion: Elevation of serum and urinary NGAL are significantly correlated with epithelial tubular kidney damage on rat undergoing early ischaemia reperfusion."

"ABSTRAKLatar belakang: Sepsis merupakan masalah kesehatan penting yang dapat menyebabkan insidens kematian sampai 50% pada pasien dengan sepsis berat. Antibiotik aminoglikosidaterutama amikasin semakin banyak digunakan untuk mengobati infeksi kuman Gram negatif pada pasien sepsis di ICU, meskipun penggunaan obat tersebut pada dosisterapi dapat meningkatkan risiko kerusakan ginjal sekitar 10-25%. Pemantauan kadar lembah amikasin serta biomarker dini diperlukan untuk mencegah kerusakan ginjal pada pasien sepsis yang dirawat di ICU. Penelitian ini dilakukan untuk mengetahui hubungan kadar lembah amikasin pada pasien ICU dewasa yang dirawat di Rumah Sakit Cipto Mangunkusumo yang diberikan amikasin 1000 mg/hari denganpeningkatan kadar KIM-1 normalisasi dalam urin yang merupakan biomarker dini nefrotoksisitas.Metode:Penelitian ini merupakan penelitian pendahuluan yang dilakukan pada 12 pasien sepsis dewasa yang dirawat di ICU RSCM dan diberikan amikasin 1000 mg/hari pada bulan Mei-September 2015. Kadar lembah amikasin dosis ketiga dihubungkan dengan peningkatan kadar KIM-1 normalisasi yang diukur melalui urin 24 jam setelah pemberian amikasin dosis pertama/kedua dan dosis ketiga.Hasil:Dari 12 subyek penelitian, didapatkan 3 subyek penelitian dengan kadar lembah amikasin di atas 10 g/mL, sedangkan 9 subyek penelitian kadar lembahnya ada dalam batas aman (di bawah 10 g/mL). Delapan dari 12 subyek penelitian (66,7%) mengalami peningkatan kadar KIM-1 normalisasi dalam urin hari ketiga dibandingkan hari pertama. Tidak ada hubungan antara kadar lembah amikasin dengan peningkatan kadar KIM-1 normalisasi dalam urin (p=0,16; r=0,43).Kesimpulan:Pasien sepsis yang mendapat amikasin 1000 mg/hari di ICU RSCM selama 3 hari memperlihatkan kadar lembah amikasin plasma dalam batas aman untuk ginjal.

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ABSTRACT

Background: Sepsis is a common caused of mortality which may account for up to 50% death rate in patients with severe sepsis. Aminoglycoside antibiotics, especially amikacin, are the most commonly used antibiotics in the septic patients with Gram-negative bacterial infections, despite these drugs may induce nephrotoxicity in 10-25%

patients. Hence, it is essential to monitor amikacin trough plasma concentration and to detect nephrotoxicity as early as possible. The aim of this study is to find out the correlation between amikacin trough plasma concentration with normalized KIM-1 concentration in the urine as a sensitive and specific biomarker.

Methods:

This is a pilot study conducted in 12 septic patients treated with amikacin 1000 mg/day from May, 2015 to September, 2015. The correlation between amikacin

trough plasma concentrations measured at the third doses with the elevation of urine normalized KIM-1 concentrations measured at the first/second and the third doses were evaluated.

Results:

We observed 3 patients with amikacin trough plasma concentration above the safe level (>10 g/mL), while 9 patients had amikacin concentrations within the safe

plasma level (<10 g/mL). Furthermore, we observed 8 out of 12 patients with higher normalized KIM-1 concentrations measured at third doses compared to normalized KIM-1 concentrations measured at first/second doses. There was no correlation between amikacin trough concentration with elevated urine normalized KIM-1

concentration (p=0,16; r=0,43).

Conclusion:

Septic patients treated with amikacin 1000 mg/day hospitalized in ICU RSCM for 3 days have amikacin safe trough plasma concentration."

"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."

"Gangguan fungsi ginjal merupakan salah satu komplikasi yang sering terjadi pada pasien diabetes melitus tipe 2. Pendeteksian dini dengan menggunakan senyawa 8-iso-Prostaglandin F2α dan KIM-1 diperlukan untuk mencegah progresifitasnya. Dalam penelitian ini dilakukan analisis hubungan antara kadar 8-iso-Prostaglandin F2α dan KIM-1 urin dengan estimasi laju filtrasi glomerulus (eLFG). Sampel yang dianalisis adalah 40 orang pasien diabetes melitus tipe 2 di Puskesmas Pasar Minggu, dengan teknik total sampling. Nilai eLFG diperoleh berdasarkan nilai kreatinin serum yang diukur menggunakan metode kinetik Jaffe, sedangkan kadar 8-iso-Prostaglandin F2α dan KIM-1 diukur dengan menggunakan metode ELISA (Enzyme Linked Immunosorbent Assay). Kadar 8-iso-Prostaglandin F2α diperoleh 6633,87 ± 1292,62 pg/mg kreatinin, kadar KIM-1 diperoleh 8,23 ± 3,23 ng/mL dan nilai eLFG diperoleh 99,65 ± 41,12 (Cockroft-Gault); 96,59 ± 41,90 (MDRD study); dan 100,79 ± 40,07 (CKD-EPI). Hubungan antara kadar 8-iso-Prostaglandin F2α dengan nilai eLFG berdasarkan persamaan Cockroft-Gault (r = 0,520; p = 0,001), MDRD (r = 0,477; p = 0,004) dan CKD-EPI (r = 0,403; p = 0,013), serta setelah perokok dieksklusi, berdasarkan ketiga persamaan, yaitu Cockroft-Gault (r = 0,595; p = 0,001), MDRD (r = 0,554; p = 0,003) dan CKD-EPI (r = 0,559; p = 0,003). Hubungan antara kadar KIM-1 dengan nilai eLFG berdasarkan persamaan Cockroft-Gault (r = -0,155; p = 0,339), MDRD (r = -0,173; p =0,285) dan CKD-EPI (r = -0,024; p = 0,883). Sehingga diketahui terdapat hubungan yang bermakna antara kadar 8-iso-Prostaglandin F2α dengan nilai eLFG dan tidak terdapat hubungan yang bermakna antara KIM-1 dengan nilai eLFG.

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Renal dysfunction is one of complication that most common in type 2 diabetes mellitus patients. The earlier detection is needed to prevent its progression with 8-iso-Prostaglandin F2α and KIM-1. The aim of this study was to analyze concentration of 8-iso-Prostaglandin F2α and KIM-1urine and its correlation with estimated glomerular filtration rate (eGFR). Samples analyzed were 40 type 2 diabetes mellitus patients at Pasar Minggu Local Government Clinic, used total sampling method.

eGFR was obtained based on the measurement of serum creatinine on kinetic Jaffe method, 8-iso-Prostaglandin F2α and KIM-1 was measured by ELISA (Enzyme Linked Immunosorbent Assay) method. Concentration of 8-iso-Prostaglandin F2α was 6633,87 ± 1292,62 pg/mg creatinine, concentration of KIM-1 was 8,23 ± 3,23 ng/mL and the eGFR values were 99,65 ± 41,12 (Cockroft-Gault); 96,59 ± 41,90 (MDRD study); and 100,79 ± 40,07 (CKD-EPI).

The correlation between 8-iso-Prostaglandin F2α concentration and eGFR is based on Cockroft-Gault (r = 0,520; p = 0,001), MDRD (r = 0,477; p = 0,004) and CKD-EPI (r = 0,403; p = 0,013), and the correlation between 8-iso-Prostaglandin F2α concentration after smoker exclution and eGFR based on Cockroft-Gault (r = 0,595; p = 0,001), MDRD (r = 0,554; p = 0,003) and CKD-EPI (r = 0,559; p = 0,003). But the correlation between KIM-1 concentration and eGFR based on Cockroft-Gault (r = -0,155; p = 0,339), MDRD (r = -0,173; p =0,285) and CKD-EPI (r = -0,024; p = 0,883). So there was a significant correlation between 8-iso-Prostaglandin F2α concentration and eGFR, and also there were no significant correlation between KIM-1 concentration and eGFR."