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"AKI disebabkan oleh pengaruh gangguan sistemik atau lokal hemodinamik yang menyebabkan terjadinya stres atau kerusakan pada sel tubular yang dapat berlanjut menjadi gagal ginjal kronik. Pasien yang mengalami malnutrisi dengan peningkatan prevalensi kejadian AKI sebanyak 2,25 kali. Skrining pasien malnutrisi dilakukan dalam 24 hingga 48 jam pertama saat pasien masuk ke rumah sakit menggunakan alat skrining, salah satunya adalah NRS-2002. Penelitian menggunakan desain kohort prospektif pada subjek berusia ≥18 tahun yang dirawat di RSUPN dr. CIpto Mangunkusumo dan RSUI. Diperoleh 64 subjek dengan kelompok skor NRS-2002 ≥ 3 sebanyak 36 subjek dan kelompok skor NRS < 3 sebanyak 28 subjek. Jumlah pasien laki-laki sebanyak 40 (62,5%) subjek, dan perempuan sebanyak 24 (37,5%) subjek, dengan usia rerata 50,95 tahun. Berdasarkan indeks massa tubuh, kelompok IMT dengan malnutrisi adalah kelompok terbanyak dengan jumlah 21 (32,8%) subjek. Pasien dengan faktor risiko hipertensi sebanyak 18 (28,1%) subjek. Subjek dengan Skor NRS ≥ 3 didapatkan 36 subjek dengan 10 orang yang mengalami AKI. Subjek dengan skor NRS <3 didapatkan sebanyak 28 orang dengan 1 orang mengalami AKI. Hasil uji statistik menggunakan uji fischer’s exact test diperoleh nilai p 0,017 ( RR 7,78, CI 95% 1,06-57,20). Hal ini menyatakan bahwa didapatkan hubungan bermakna antara skor Nutritional Risk Screening – 2002 dengan kejadian acute kidney injury pada pasien sakit kritis

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AKI is caused by systemic or local hemodynamic disturbances that result in stress or damage to tubular cells, which can progress to chronic kidney failure. Patients experiencing malnutrition have a 2.25 times higher prevalence of AKI. Screening for malnutrition is conducted within the first 24 to 48 hours of hospital admission using screening tools such as the NRS-2002. This study used a prospective cohort design on subjects aged ≥18 years who were treated at RSUPN dr. Cipto Mangunkusumo and RSUI. A total of 64 subjects were obtained, with 36 subjects having an NRS-2002 score ≥ 3 and 28 subjects having an NRS score < 3. There were 40 male subjects (62.5%) and 24 female subjects (37.5%), with an average age of 50.95 years. Based on body mass index, the group with malnutrition was the largest group, with 21 subjects (32.8%). There were 18 subjects (28.1%) with hypertension as a risk factor. Subjects with an NRS score ≥ 3 included 36 subjects, with 10 of them experiencing AKI. Subjects with an NRS score <3 included 28 people, with 1 person experiencing AKI. The results of the statistical test using Fischer's exact test obtained a p-value of 0.017 (RR 7.78, CI 95% 1.06-57.20). This indicates a significant relationship between the Nutritional Risk Screening - 2002 score and the incidence of acute kidney injury in critically ill patients."

"Latar belakangJumlah pasien obesitas yang dirawat di unit perawatan intensif semakin meningkat. Pasien obesitas dalam kondisi sakit kritis berisiko mengalami acute kidney injury (AKI). Belum ada panduan pemberian energi dan protein yang optimal bagi pasien obesitas sakit kritis dengan AKI. Asupan energi dan protein yang tidak adekuat akan memperberat risiko malnutrisi dan sarkopenia sehingga meningkatkan komplikasi, lama rawat, dan mortalitas. Terapi medik gizi yang komprehensif diperlukan untuk mencegah progresivitas penyakit dan penurunan status gizi yang memengaruhi luaran klinis pasien.Kasus:Pasien pada serial kasus ini adalah tiga orang laki-laki dan satu orang perempuan, berusia 58-64 tahun dengan status gizi obesitas, mengalami sakit kritis, dan menderita AKI saat perawatan. Seluruh pasien mendapatkan terapi medik gizi sejak sakit kritis fase akut. Preskripsi energi berdasarkan rule of thumb sedangkan protein berdasarkan nilai imbang nitrogen. Pemberian nutrisi disesuaikan dengan kondisi klinis, hemodinamik, dan toleransi asupan pasien.Hasil:Selama perawatan, asupan energi pasien dapat mencapai 30 kkal/kgBB dengan protein 1-1,3 g/kgBB. Dua pasien mengalami imbang nitrogen negatif hingga akhir perawatan karena asupan protein tidak adekuat dan kondisi hiperkatabolisme berat. Dua pasien dengan asupan protein yang cukup (1,1–1,2 g/kgBB) memiliki imbang nitrogen yang normal. Tiga pasien mengalami komplikasi sepsis dan satu pasien menderita ulkus dekubitus. Satu pasien mengalami malnutrisi dan sarkopenia saat perawatan sakit kritis. Dua pasien dengan imbang nitrogen seimbang dapat melewati fase kritis dan pindah ke ruang rawat biasa. Dua pasien dengan imbang nitrogen negatif meninggal dunia saat perawatan di ICU.Kesimpulan:Terapi medik gizi dan pemberian protein yang adekuat pada pasien obes sakit kritis dengan AKI dapat memperbaiki kondisi klinis, meningkatkan kesintasan, dan menurunkan mortalitas.

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Background

The prevalence of obesity has increased and is reflected in the intensive care unit (ICU) population. Critically ill obese patients are at risk for acute kidney injury (AKI). There are no guidelines for optimal energy and protein delivery for critically ill obese patients with AKI. Inadequate energy and protein intake will exacerbate malnutrition and sarcopenia, thereby increasing complications, length of stay, and mortality. Comprehensive nutritional medical therapy is needed to prevent disease progression and derivation of nutritional status that affects the clinical outcome.

Case

The patients were three men and one woman, aged 58-64 years with obesity, critically ill, and AKI.

All patients received medical nutrition therapy since the acute phase of critical illness.

Energy prescription is based on the rule of thumb while protein is based on the nitrogen balance.

Nutritional administration is adjusted to the clinical condition, hemodynamic, and patient's tolerance.

Result

During treatment, the patient's energy intake reach 30 kcal/kgBW with protein of 1-1,3 g/kgBW.

Two patients experienced negative nitrogen balance at the end of treatment due to inadequate protein intake and severe hypercatabolism.

Two patients with adequate protein intake (1.1–1.2 g/kgBW) had normal nitrogen balance.

Three patients had complications of sepsis and one patient had a pressure ulcer. One patient developed malnutrition and sarcopenia during treatment.

Two patients with a normal nitrogen balance were able to pass the critical phase and step down to the ward.

Two patients with negative nitrogen balance died during intensive care treatment.

Conclusion

Medical nutrition therapy and adequate protein intake in critically ill obese patients with AKI can improve clinical conditions,increase survival, and reduce mortality."

"Latar belakang: Hiperglikemia dan AKI merupakan komorbiditas yang sering dijumpai pada anak sakit kritis. Keduanya berhubungan dengan peningkatan morbiditas dan mortalitas. Hubungan antara hiperglikemia dan AKI pada anak sakit kritis belum banyak diketahui.Tujuan: Diketahuinya perbedaan proporsi AKI pada kelompok anak sakit kritis dengan hiperglikemia dan nonhiperglikemia. Diketahuinya perbedaan rerata kadar gula darah admisi, kadar gula darah puncak, dan durasi hiperglikemia pada kelompok anak sakit kritis dengan AKI dan tanpa AKI.Metode: Penelitian kohort prospektif dilakukan pada anak sakit kritis usia 1 bulan-18 tahun di ruang resusitasi IGD dan perawatan intensif anak RSCM selama bulan Agustus-Desember 2016. Pemeriksaan kadar gula darah, kreatinin serum, dan kadar NGAL urine dilakukan pada saat admisi. Pemantauan kadar gula darah dilakukan dengan interval 2 jam pada kelompok hiperglikemia. Seluruh subyek diikuti sampai keluar ruang perawatan intensif.Hasil: Proporsi subyek anak sakit kritis yang mengalami hiperglikemia adalah 46,5 IK 95 36,8-56,2 . Proporsi subyek dengan hiperglikemia yang mengalami AKI menurut kriteria AKIN adalah 30,7 IK 95 21,8 ndash;39,6 , sedangkan proporsi subyek dengan hiperglikemia yang memiliki kadar NGAL urine >135 ng/mL adalah 21,8 IK 95 13,8 ndash;29,8 . Acute kidney injury menurut kriteria AKIN maupun kadar NGAL urine lebih banyak dijumpai pada subyek dengan hiperglikemia, namun perbedaan proporsi tersebut tidak bermakna secara statistik kriteria AKIN: RR 2,08; IK 95 0,93-4,67; P 0,072; NGAL urine >135 ng/mL: RR 1,34; IK 95 0,81-2,1; P 0,243 . Paparan hiperglikemia pada perawatan intensif dengan durasi ge;4 jam risiko AKI meningkat sebesar 2,38 kali IK 95 1,25 ndash;4,56.Simpulan: Acute kidney injury banyak dijumpai pada anak sakit kritis yang mengalami hiperglikemia. Paparan hiperglikemia ge;4 jam pada perawatan intensif berkaitan dengan peningkatan risiko AKI pada anak sakit kritis.

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Background Hyperglycemia and AKI are common in critically ill children. Both conditions are associated with increasing mortality and morbidity. The association of hyperglycemia and AKI in critically ill children is still not well understood.

Objective To evaluate the difference in proportion of AKI between critically ill children with and without hyperglycemia. To evaluate the mean difference of initial blood glucose, peak blood glucose, and the duration of hyperglycemia between critically ill children with and without AKI.

Method A prospective cohort study was conducted in critically ill children aged 1 month to 18 years at the emergency unit and the pediatric intensive care unit at Cipto Mangunkusumo Hospital between August December 2016. Blood glucose, creatinine serum, and urine NGAL was examined at admission. Blood glucose was monitored every 2 hours in hyperglycemic subjects. All of the subjects were followed until time of discharge from the intensive care unit.

Result Hyperglycemia in critically ill children was found in 46.5 subject 95 CI 36.8 56.2. Acute kidney injury based on the AKIN criteria was found in 30.7 hyperglycemic subjects 95 CI 21,8 ndash 39,6, and hyperglycemia with an increased urine NGAL level 135 ng mL was found in 21.8 subjects 95 CI 13.8 ndash 29.8. Acute kidney injury and an increased urine NGAL were more frequently found in subjects with hyperglycemia, however, the difference in the proportion was statistically insignificant AKIN criteria RR 2,08 95 CI 0,93 4,67 P 0,072 urine NGAL level 135 ng mL RR 1,34 95 CI 0,81 2,1 P 0,243 . The duration of hyperglycemia ge 4 hours at the intensive care unit increases the risk of AKI up to 2.38 times CI 95 1.25 ndash 4.56.

Conclusion Acute kidney injury are frequently seen in hyperglycemic critically ill children. A duration of hyperglycemia of ge 4 hours in intensive care unit is associated with an increased risk of AKI in critically ill children."

"Pendahuluan: Acute kidney injury AKI merupakan komplikasi gagal organ pada sepsis yang dapat meningkatkan morbiditas dan mortalitas di ICU. Hasil dan pembahasan: Pemenuhan nutrisi pada pasien sepsis dengan AKI sangat tergantung pada keadaan klinis pasien dan terapi AKI. Pada serial kasus ini terdapat satu pasien sepsis dengan AKI klasifikasi AKIN 2 dan 3 pasien dengan AKI klasifikasi AKIN 3. Kebutuhan nutrisi pada pasien sepsis dengan AKI klasifikasi AKIN 2 maupun sepsis dengan AKI AKIN 3 selama perawatan di ICU diberikan dengan target energi 30 kkal/kg BB/hari dan protein 1,5 g/kg BB/hari. Perburukan fungsi ginjal pada pasien sepsis dengan AKI tidak disebabkan oleh pemberian nutrisi tinggi protein melainkan disebabkan oleh keadaan sepsis yang tidak teratasi. Terapi renal replacement therapy RRT dibutuhkan pada pasien sepsis dengan AKI klasifikasi AKIN 2 dan AKIN 3 agar nutrisi dapat diberikan secara optimal untuk menunjang perbaikan klinis. Terapi nutrisi optimal pada pasien sepsis dengan AKI dapat mempertahankan lean body mass, memperbaiki sistem imun, dan memperbaiki fungsi metabolik. Kesimpulan: Terapi nutrisi yang adekuat dengan energi 30 kkal/kg BB/hari dan protein 1,5 g/kg BB/hari pada pasien sepsis dengan AKI dapat menunjang perbaikan klinis.

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Introduction Acute kidney injury AKI is an organ failure complication in sepsis that increased morbidity and mortality in ICU.Results and discussion Nutrition in sepsis with AKI patients are dependent on clinical condition and AKI treatment. In this serial case displayed one case septic AKI classification AKIN 2 and three cases septic AKI classification AKIN 3.

Nutritional requirements for sepsis with AKI classification AKIN 2 and AKI classification AKIN 3 in ICU setting were targetted at 30 kkal kg body weight day and protein 1,5 g kg body weight day. Worsening renal function in sepsis with AKI are not caused by high protein intake but caused by unresolved infection. Renal replacement therapy is required in sepsis with AKI classification AKIN 2 and AKIN 3 to maintain adequate nutritional therapy for better clinical outcomes.

The optimal nutritional therapy in sepsis with AKI aimed to maintain lean body mass, improved immune function, and metabolism.Conclusion Adequate nutritional therapy with energy 30 kkal kg body weight day and protein 1,5 g kg body weight day in sepsis with AKI can bolster better clinical outcomes."

"Latar Belakang: Acute Kidney Injury pada COVID-19 merupakan komplikasi penting dan dikaitkan dengan peningkatan risiko kematian diduga diperantarai kondisi inflamasi dan disregulasi imun, baik di awal maupun selama perawatan. Tujuan: Untuk mengetahui hubungan antara IL-6, IL-10, TNF-" dengan AKI dan memprediksi perburukan hematuria, dan kejadian AKI Metode: Studi potong lintang dan prospektif kohort melibatkan 43 pasien COVID-19 derajad sedang dan berat yang dirawat di Rumah Sakit Pertamina Pusat di Jakarta, Indonesia dari bulan November 2020 hingga Januari 2021. Selama observasi dilakukan pemeriksaan darah lengkap, serum kreatinin, urinalisis, kadar IL-6, IL-10, TNF-" pada hari pertama dan hari ketujuh pengobatan atau sebelum hari ketujuh jika pasien meninggal atau dipulangkan, dan perubahannya di analisis. Insiden AKI ditentukan ketika perubahan serum kreatinin dan urin output memenuhi kriteria pedoman Kidney Disease Improving Global Outcomes. Uji korelasi dilakukan terhadap peningkatan sitokin dengan perubahan hematuria dan kreatinin. Uji Wilcoxon dilakukan untuk mengetahui perbedaan kadar sitokin diantara status albuminuria. Selanjutnya dilakukan uji Receiver Operator Characteristic untuk melihat kemampuan prediksi IL-6, IL-10, TNF-" terhadap perburukan hematuria dan kejadian AKI, menggunakan AUC minimal 0,7 dengan batas bawah IK 95% lebih dari 0,5 dan nilai p <0,05 Hasil: Terdapat korelasi antara peningkatan kadar serum IL-10 dengan perubahan serum kreatinin (r= -0,343; p 0,024) tetapi tidak pada perubahan IL-6 dan TNF-a. Perubahan hematuria tidak berkorelasi dengan peningkatan ketiga kadar sitokin. Juga tidak ada perbedaan dalam kadar sitokin di antara kelompok albuminuria. Kadar serum TNF-" dihari pertama perawatan dapat memprediksi AKI pada hari ke tujuh, AUC 85%; p=0,045 (IK 0,737-0,963), tetapi tidak dapat memprediksi perburukan hematuria Kesimpulan: Terdapat korelasi antara peningkatan IL-10 dengan perubahan serum kreatinin. TNF-! pada hari pertama perawatan dapat memprediksi kejadian AKI di hari ketujuh perawatan pasien COVID-19 derajat sedang dan berat.

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Background: Acute Kidney Injury is an important complication and is associated with increased risk of death in COVID-19 due to inflammatory conditions and immune dysregulation, both at the beginning and during treatment. Aim: To determine the relationship between IL-6, IL-10, TNF-α with AKI and their ability to predict the worsening of hematuria, and the incidence of AKI. Methods: 43 moderate and severe COVID-19 patients treated from November 2020 to January 2021 at Pertamina Central Hospital in Jakarta, Indonesia were included in this cross-sectional and prospective cohort study. During observation, tests including complete blood count, serum creatinine, urinalysis, levels of IL-6, IL-10 and TNF-α were performed on the first and seventh day of treatment, or before day 7 if the patient died or was discharged, and the changes were analyzed. The incidence of AKI is determined when changes in serum creatinine and urine output meet the criteria in the Kidney Disease Improving Global Outcomes guidelines. Correlation test was performed on increased cytokines with changes in hematuria and creatinine. Wilcoxon test was performed to obtain differences in cytokine levels among albuminuria status. Receiver Operator Characteristic test was then carried out to see the predictive ability of IL-6, IL-10, TNF- α on the worsening of hematuria and the incidence of AKI. Results: There was a correlation between increased serum IL-10 levels with changes in serum creatinine (r= -0.343; p 0.024), but not in IL-6 and TNF-a levels. On the other hand, changes in hematuria did not correlate with an increase in the levels of the three cytokines. There was also no significant difference in the levels of cytokines among albuminuria groups. Serum TNF-! levels on the first day of treatment were able to predict AKI on the seventh day (AUC 85%; p=0.045; 95%CI 0.737-0.963), but did not predict the worsening of hematuria. Conclusion: There was a correlation between increased serum IL-10 with changes in serum creatinine. TNF-! on the first day of treatment can predict the incidence of AKI on the seventh day of treatment for moderate and severe COVID-19 patients."

"Acute Kidney Injury (AKI) adalah salah satu permasalahan kesehatan global. AKI didefinisikan KDIGO (Kidney Disease Improving Global Outcome) sebagai penurunan fungsi ginjal secara tiba-tiba yang ditandai dengan peningkatan serum kreatinin dan oliguria. AKI memiliki prevalensi yang tinggi terutama pada pasien geriatri yang dirawat di rumah sakit, dan umumnya disebabkan oleh sepsis, obat-obatan atau tindakan invasif. Penggunaan obat nefrotoksik merupakan salah satu etiologi dari AKI dan merupakan penyebab dari 14-26% kasus AKI pada pasien kritis. Pemantauan khusus perlu dilakukan pada pasien yang menerima obat berpotensi menyebabkan Drug Induced AKI (DI-AKI). Pada tugas khusus ini, dilakukan identifikasi obat penyebab DI-AKI dan analisa kasus DI-AKI pada pasien rawat inap Rumah Sakit Universitas Indonesia yang menggunakan regimen terapi ramipril pada periode bulan April 2023. Penelitian dilakukan dengan penelusuran literatur dan pengambilan data retrospektif dari data AYFA RSUI untuk memperoleh nilai laboratorium dan Catatan Pelayanan Pasien Terintegrasi (CPPT) pasien. DI-AKI dapat disebabkan oleh obat bersifat nefrotoksik atau memiliki efek langsung terhadap hemodinamika ginjal. Studi kasus yang dilakukan terhadap salah satu pasien yang menerima ramipril sebagai agen antihipertensi yang menyebabkan fluktuasi serum kreatinin dan eGFR, sehingga diduga berpotensi untuk menyebabkan DI-AKI. Pemantauan terapi obat pada pasien risiko tinggi perlu dilakukan secara rutin untuk menilai keamanan regimen terapi pasien.

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Acute Kidney Injury (AKI) is a global health problem. AKI is defined as KDIGO (Kidney Disease Improving Global Outcome) as a sudden decrease in kidney function characterized by an increase in serum creatinine level and oliguria. AKI has a high prevalence, especially in geriatric patients who are hospitalized, and is generally caused by sepsis, drugs or invasive procedures. The use of nephrotoxic drugs is one of the etiologies of AKI and is the cause of 14-26% of AKI cases in critical patients. Comprehensive monitoring needs to be carried out in patients receiving drugs with the potential to cause Drug Induced AKI (DI-AKI). In this report, identification drugs that cause DI-AKI and analysis of DI-AKI cases in hospitalized patients at the University of Indonesia Hospital receiveing ramipril in their therapy regimen in April 2023 was conducted. The study was conducted by literature search and retrospective data collection from AYFA RSUI data. to obtain laboratory values and the patient's Integrated Patient Service Record (CPPT). Results indicated that DI-AKI can be caused by drugs that are nephrotoxic or have a direct effect on renal hemodynamics. In a case study whereby an inpatient receiving ramipril as an antihypertensive agent, fluctuations in serum creatinine and eGFR were observed which led to a possibility of ramipril being the potential cause of DI-AKI. Monitoring of drug therapy in high-risk patients needs to be carried out frequently to assess the safety of the patient's therapy regimen."

"Latar belakang: Gagal ginjal akut (GGA) menjadi salah satu komplikasi serius yang dapat terjadi setelah prosedur bedah pintas arteri koroner (BPAK). GGA paskaoperasi jantung secara independen berhubungan dengan peningkatan 3-8 kali lipat angka morbiditas dan mortalitas serta memperpanjang durasi perawatan (hospitalisasi) sehingga dapat meningkatkan biaya kesehatan. Untuk menurunkan insidensi GGA ini, dibutuhkan modalitas pemeriksaan sebelum operasi yang berhubungan dengan kejadian GGA paska BPAK sehingga dapat digunakan sebagai prediktor nantinya untuk tindakan pencegahan. Indeks resistif renal (IRR) diketahui dapat menggambarkan kondisi resistensi dan komplians pembuluh darah yang berhubungan dengan patofisiologi GGA paska BPAK. Namun hingga saat ini belum ada penelitian yang menilai hubungan langsung antara nilai IRR dan kejadian GGA paska BPAK. Tujuan: Mengetahui hubungan nilai IRR terhadap kejadian GGA paska BPAK Metode: Pasien yang akan dilakukan prosedur BPAK akan menjalani pemeriksaan dupleks renalis untuk mendapatkan nilai IRR. Luaran gagal ginjal akut dinilai dengan pemeriksaan kadar kreatinin darah selama 48 jam paska BPAK Hasil: Terdapat 96 pasien yang menjadi subjek penelitian. Median nilai IRR pada subjek penelitian ini ialah 0.71 (0.57-0.87). Terdapat perbedaan median nilai IRR antara kelompok GGA dan non GGA (0.73, rentang 0.57-0.87 dan 0.65, rentang 0.58-0.72). Nilai IRR memiliki korelasi yang cukup baik terhadap kejadian GGA paska BPAK (nilai koefisien korelasi r = 0.66, p < 0,001) dengan titik potong padanilai IRR 0.685 (sensitivitas 82.40%, spesifisitas 73.30%). Faktor-faktor lain seperti usia, diabetes melitus, hipertensi, nilai kreatinin serum pre operatif, klirens kreatinin pre operatif, fraksi ejeksi, durasi mesin pintas kardiopulmonal dan durasi klem silang aorta secara statistika berbeda bermakna berhubungan terhadap kejadian GGA paska BPAK. Namun dari analisis multivariat, hanya faktor fraksi ejeksi, durasi mesin pintas kardiopulmonal, nilai IRR, dan diabetes mellitus terbukti bermakna Kesimpulan: Terdapat hubungan antara IRR dengan kejadian gagal ginjal akut paska BPAK. Nilai IRR 0.685 merupakan titik potong optimal (sensitivitas 82,40% dan spesifisitas 73.30%)

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Background: Acute kidney injury (AKI) still become one of the serious complications that can occur after a coronary artery bypass graft (CABG) procedure. Post-operative AKI is independently associated with a 3-8 fold increase in morbidity and mortality and extending the duration of treatment (hospitalization) thereby increasing health costs. To reduce the incidence of AKI, a modality of examination prior surgery which is related to the incidence of post-operative AKI is needed so that it can be used as a predictor later for preventive action. The renal resistive index (RRI) is known to be able to describe the condition of resistance and vascular compliance which are related to the pathophysiology of post-operative AKI. However, there has been no research that assesses the direct relationship between RRI values and the incidence of post-operative AKI Objectives: To investigate the relationship between RRI value and incidence of post-operative AKI in patients underwent CABG procedure. Methods: CABG candidates patients will undergo duplex renalis examination to obtain an RRI score. Outcome of renal impairment was assessed by blood creatinine examination within 48 hours after CABG procedure. Results: There were 96 patients who became the subject of the study. The median of RRI value in this study subjects was 0.71 (0.57-0.87). There were differences in median of RRI values between groups with post-operative AKI and those not (0.73, range 0.57-0.87 dan 0.65, range 0.58-0.72). There was quite good correlation between RRI and post-operative AKI (p < 0.001 with correlation coefficient r = 0.66) with cut off point of IRR value was 0.685 (sensitivity 82.40%, specificity 73.30%). Other factors such as age, diabetes mellitus, hypertension, ejection fraction, CPB duration, and aortic cross clamp duration are associated with incidence of post-operative AKI. However, multivariat analysis showed only ejection fraction, cardiopulmonary bypass duration, RRI, and diabetes mellitus significantly related to post-operative AKI Conclusion: RRI values has relationship with post-operative AKI. The optimal cut off value of RRI retrieved by this study is 0.685 (sensitivity 82.40%, specificity 73.30%)"

"Latar Belakang : Acute kidney injury (AKI) adalah komplikasi tersering pada pasien luka bakar. Disfungsi renal akut adalah komplikasi mayor yang disebabkan oleh trauma panas akibat luka bakar dan dikaitkan dengan tingginya angka mortalitas terutama pada pasien anak. Patofisiologi dari AKI pada luka bakar masih sedikit dibahas dalam studi. Faktor yang mempengaruhi terjadinya AKI adalah berkurangnya perfusi ginjal dan inflamasi. Managemen awal pada luka bakar merupakan hal yang penting dan kritis. Penggantian cairan pada pasien luka bakar memiliki efek protektif melawan gagal ginjal. Pada studi ini, kami mencoba mengevaluasi angka kejadian AKI dihubungkan dengan resusitasi cairan 24 jam pertama pada pasien luka bakar anak. Metode : Penelitian ini merupakan studi retrospektif pada pasien luka bakar anak yang dirawat di Unit Luka Bakar RSCM Jakarta dari Januari 2012 hingga Desember 2013. Kami bagi menjadi dua kelompok, kelompok AKI dan non-AKI dengan menggunakan kriteria pRIFLE. Dilakukan penghitungan Parkland Score pada masing-masing kelompok dan dibandingkan menggunakan analisa t-test. Hasil : Terdapat 43 pasien luka bakar anak yang memenuhi kriteria dan pencatatan rekam medis yang lengkap. Angka kejadian AKI adalah 18.6% (8 pasien), sedangkan non-AKI 81.4% (35 pasien). Median dari usia pasien adalah 36 bulan (min-maks 6-192 bulan), berat badan pasien 14 kg (7-60 kg), total area luka bakar (%TBSA) adalah 18% (10-60%), waktu masuk ke RS pasca-trauma adalah 5 jam (1-20 jam), dan lama waktu rawat 11 hari (3-47 hari). Rerata Parkland Score dari kelompok AKI adalah 0.79, sedangkan kelompok non-AKI adalah 0.94. Dengan analisa t-test didapatkan hasil tidak terdapat perbedaan bermakna diantara kedua kelompok (p=0.33). Kemudian dilakukan analisa karakteristik pasien antar kelompok, tidak terdapat perbedaan nilai yang bermakna pada karakteristik pasien antar kelompok (p value > 0.05). Simpulan : Tidak terdapat perbedaan bermakna antara angka kejadian AKI dengan resusitasi cairan pada 24 jam pertama. Hal tersebut kemungkinan disebabkan karena terdapat faktor lain yang mempengaruhi terjadinya AKI pada luka bakar anak. Iskemia ginjal yang dapat menyebabkan terjadinya AKI kemungkinan hal yang kurang bermakna pada fase akut seperti yang diduga sebelumnya, melainkan inflamasi dan apoptosis sel ginjal yang memegang peranan penting terjadinya AKI.

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Background : Acute kidney injury (AKI) is a frequent complication in patients with severe burn injury. Acute renal dysfunction is a major complication affecting the thermally injured individual and is commonly associated with a high mortality rate especially among children patients. The pathophysiology of AKI in burn injury is less well studied. Contributing factors for the development of AKI are decreased renal perfusion and inflammation. Initial management of the burn individual to be critically important to overall survival. Fluid replacement therapy was demonstrated to have a protective affect against acute renal failure. In this study, we try to evaluate volume of fluid resuscitation in first 24 hours with acute kidney injury following pediatric major burn injury.

Method : This research is retrospective study evaluating the relationship between fluid resuscitation in first 24 hours and acute kidney injury (AKI) in pediatric major burn injury patients admitted to Burn Unit Cipto Mangunkusumo Hospital Jakarta from January 2012 untill December 2013. We divided into two groups, AKI group and non-AKI group using pRIFLE criteria, then we compared actual volume resuscitation with volume resuscitation in Parkland formula (Parkland score) between groups.

Results : There was 43 pediatric major burn patients with complete fluid and laboratory result data. The incidence of Acute Kidney Injury (AKI) among all patients was 18.6% (8 patients), while non-AKI was 81.4% (35 patients). The median of patient age was 36 months (min-max 6-192 months), patient weight was 14 kgs (7-60 kgs), total body surface area burned (%TBSA) was 18% (10-60%), time to hospital admission was 5 hours after injury (1-20 hours), and length of stay was 11 days (3-47 days). The mean Parkland Score from AKI group was 0.79, while in non-AKI group was 0.94. With independent t-test analysis, there was no significant difference between groups (p=0.33). Then we analyzed patients characteristics between group. We found there was no significant value between patients characteristics in both groups (p value > 0.05).

Conclusions : Parkland Score that we used to estimate total fluid resuscitation in first 24 hours did not shown significant difference between groups. This could be indicated that fluid resuscitation in our burn unit is sufficient for resuscitation or there was other factor influence the incidence of AKI. Renal ischemia that can lead to acute kidney injury is probably less important in the acute phase of burn injury than originally presumed. Instead, inflammation and apoptosis are probably playing an important role."

"Tetralogy of Fallot (TOF) merupakan salah satu kelainan jantung kongenital sianotik paling umum, dengan insiden sekitar empat dari setiap 10.000 kelahiran hidup. Operasi koreksi TOF dapat diperberat dengan cedera ginjal akut yang berkaitan dengan morbiditas dan mortalitas yang signifikan. Prevalensi cedera ginjal akut pada populasi pasien pascaoperasi koreksi TOF belum banyak diketahui. Penelitian ini menggunakan metode kohort restrospektif. Data diambil secara sekunder dari rekam medis RSPJNHK terhadap semua pasien TOF yang di lakukan koreksi TOF pada tahun 2019 -2023.Terdapat 520 pasien yang dianalisis dalam penelitian ini. Terdapat hubungan bermakna antara kelompok cedera ginjal akut dan kelompok tidak cedera ginjal akut pada variabel lama CPB (p=0.000; MD =-35.78; IK 95% -51.21 - -20.35) dan lama klem silang aorta (p=0.000;MD =-13.68(IK 95% -21.42 - -5.94). Terdapat hubungan bermakna secara antara lesi residual pulmonary regurgitation (p=0.024; RR=1.56; IK 95% 1.07 – 2.28, dan lesi residual pulmonary stenosis dan kejadian cedera ginjal akut (p=0.035; RR =1.49; IK 95% 1.03 – 2.15). Dapat disimpulkan bahwa lama CPB, klem silang aorta dan adanya lesi residual yakni pulmonary regurgitation dan pulmonary stenosis berhubungan dengan kejadian cedera ginjal akut pada pasien yang menjalani koreksi TOF.

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Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart defects, with an incidence of approximately four per 10,000 live births. Corrective surgery for TOF is often complicated by acute kidney injury (AKI), which is associated with significant morbidity and mortality. The prevalence of AKI in patients undergoing postoperative TOF correction is not well established. A retrospective cohort study was conducted using medical records from PJNHK Hospital. Data was collected for TOF patients who underwent corrective surgery between 2019 and 2023. A total of 520 patients were analysed. There was a significant difference between the AKI group and the non-AKI group in terms of cardiopulmonary bypass (CPB) duration (p = 0.000; MD = -35.78; 95% CI: -51.21 to -20.35) and aortic cross-clamp time (p = 0.000; MD = -13.68; 95% CI: -21.42 to -5.94). Residual pulmonary regurgitation lesions were significantly associated with AKI incidence (p = 0.024; RR = 1.56; 95% CI: 1.07–2.28), as were residual pulmonary stenosis lesions (p = 0.035; RR = 1.49; 95% CI: 1.03–2.15). In conclusion, CPB duration, aortic cross-clamp time, and the presence of residual lesions, such as pulmonary regurgitation and pulmonary stenosis, are significantly associated with the incidence of acute kidney injury in patients undergoing TOF corrective surgery."

"Pendahuluan: Acute Kidney Injury (AKI) pasca SC yang disebabkan preeklampsia berat jarang terjadi namun merupakan komplikasi yang serius. Hasil dan pembahasan: Kebutuhan energi pasien AKI diberikan sesuai kebutuhan diawali kebutuhan energi basal dengan komposisi rendah protein 0,8 g/kgBB/hari. Kebutuhan protein ditingkatkan saat terapi hemodialisa 1,2 g/kgBB/hari dan 1,5 g/kg BB/hari setelah kadar ureum dan kreatinin serum normal. Pasien oligouria dan anuria disertai peningkatan kadar ureum dan kreatinin menjalani terapi hemodialisa sewaktu guna memperbaiki fungsi ginjal. Kesimpulan: Dukungan nutrisi adekuat dengan edukasi setiap hari. dapat mencegah pemakaian energi berlebihan dari protein yang memperburuk prognosis pasca perawatan dan meningkatkan kualitas hidup pasien.

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Introduction: Acute Kidney Injury (AKI) post-SC caused severe preeclampsia is a rare but serious complication.

Results and discussion: Energy needs AKI patients are given accordingly begins with a composition of basal energy needs of low-protein 0.8 g/kg/day. Increased protein requirements when hemodialysis therapy of 1.2 g/kg/day and 1.5 g/kg/day after serum urea and creatinine levels normal. Patient with oliguria or anuria accompanied by increased levels of urea and creatinine during hemodialysis therapy to improve renal function.

Conclusion: Support adequate nutrition with education every day can prevent the excessive energy consumption of protein post-treatment worsens the prognosis and quality of life of patients."