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"Latar Belakang: Cisplatin merupakan kemoterapi efektif dengan spektrum luas. Efek terapeutiknya bertambah bermakna pada peningkatan dosis. Namun aplikasi dosis tinggi (>50 mg/m2) dibatasi nefrotoksisitasnya yang berat.Tujuan: Mempelajari efek cisplatin terhadap aktivitas eritropoiesis, kadar eritropoietin dan fungsi ginjal pasien tumor padat ganas.Metode dan Cara : Studi pre & post sejak Nopember 2004 sampai Januari 2005 dilakukan pada 14 pasien kanker tumor solid (KNF, Osteosarkoma, Ca paru) yang mendapat rejimen kemoterapi mengandung cisplatin dosis 70-100 mg/m2. Pengambilan sampel dilakukan pra, pasta kemoterapi 1 dan II, dengan rentang 21 hari. Analisis univariat dilakukan terhadap usia, Janis kelamin, Janis tumor dan stadium klini.k Dilakukan analisis bivariat pads komponen eritropoiesis, kadar EPO dan TKK hitung..Hasil : Didapatkan tumor solid berupa karsinoma nasofaring (88,24%), osteosarkoma (5,88%) dan adenokarsinoma pare (5,88%). Di mana stadium III (70,6%) dan stadium IV (29,4%). Didapatkan penurunan nilai Hb bermakna pasca siklus 110,74% (p = 0, 029)_ Pasca siklus H, Hb turun 1% (p = 0,37). Evaluasi pasca 2 siklus, lib turun 7,7% (p 0, 035). Hasil yang sama didapatkan pada nilai Ht, pasca kemoterapi siklus I (p = 0,03) dan pasca 2 siklus (p = 0, 008). Sedangkan pasca siklus II tidak bermakna (p = 0,594). Jumlah eritrosit pasca siklus I turun 13% (p = 0,00) dan pasca siklus II turun 8,7% (p = 0,00). Jumlah eritrosit turun 20,8% pasca 2 siklus (p = 0,00). Pasca 2 siklus, indeks retikulosit turun 1,59% (p = 0,975). Kadar eritropoietin pasca siklus I turun 12,7% (p = 0,73), pasta siklus II turun 20% (p = 0,03). Pasca 2 siklus didapatkan penurunan eritropoietin 30% (p = 0,925). TKK hitung mengalami penurunan pasta siklus 112,65% (p = 0,052) dan Il 0,4% (p = 0,157). Pasca 2 siklus TKK hitung turun sebesar 13% (p = 0,052). Terdapat korelasi lemah antara eritropoietin dan jumlah eritrosit pasca siklus H. Tidak didapatkan korelasi antara eritropoietin dengan Hb, indeks retikulosit dan TKK hitung.Kesimpulan: Pemberian cisplatin dosis tinggi (70-100 mg/m2) menyebabkan penurunan eritropoiesis, TKK hitung. Penurunan kadar eritrbpoietin tidak berkorelasi gagal ginjal akut Penurunan jumlah eritrosit disebabkan pula oleh rendahnya nilai eritropoeitin.

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Background: Cisplatin (Cis diaminodichloro Platinum II) is known as an effective broad spectrum anti tumor. Even though, the nephrotoxicity is one of serious side effects. The accumulation of toxic effects against to tubules area, where erythropoietin is produced, causes acute renal failure and anemia.Purpose: To study the effect of 2 cycles cisplatin against erythropoiesis, erythropoietin level and creatinine clearance at patients with solid tumor cancer.Methods: Pre and post study was done to 14 solid tumor cancer patients that receive high dose cisplatin regiment (70-100 mglm2). Hb, Ht, erythrocyte count, erythropoietin level and calculated creatinin clearance test were determined before each cycle. Age, sex, tumor type, clinical stages were evaluated Statistical analysis was done with student T and Wilcoxon Rank and Pearson correlation.Results: Tumors were NPC 88.24%, Adeno Ca 5.88% and Osteosarcoma 5.88%. Clinical stage Ili 70.6% and IV 29.4%. There were decline level among groups after 1" cycle in Hb (10.74%, p=O.029), Ht (7.6%, p=0.03), erythrocyte count (13%, p=0.OO), erythropoietin level (12.7%, p=4.73) and creatinin clearance (12.65%, p4'.1052). After 2°d cycle, there were decline in Hb (1%, pl.37), Ht (1.46%, p 4l.59), erythrocyte count (8.7%, p=0.00), erythropoietin level (20%, p.03) and creatinin clearance (0.4%, p 0.15).Reticulocyte index was not reduce after 1" and 2"d cycle. After 2 cycles assessment, there were decline level in Hb (7.7%, p=0.035), Ht (48.7%, p=0.008), erythrocyte count (20.8%, p=0.00), erythropoietin level (30%, p4.).92) and creatinin clearance (13%, p=0.022).There is a low correlation between erythropoietin level and erythrocyte count after 1 s` (r-0,397, p=0,159) and 2nd cycle (r x.46, p l.09). Variable's correlation between erythropoietin level and Hb, reticulocyte index, erythrocyte count did not reach statistical significance.Conclusion: High dose cisplatin (70-100 mglm2) cause decrease in eritropoiesis process and creatinin clearance. Decreasing erythropoietin level is not affected by acute renal failure. Low erythrocyte count is also caused by low level of erythropoietin."

"ABSTRAKTujuan: Meninjau status faktor-faktor prognostik tumor ginjal. Metode: Jenis penelitian ini adalah studi deskriptif analitik pada seluruh pasien tumor ginjal yang berobat ke RSUP H. Adam Malik tahun 2011 hingga 2015. Hasil: Jumlah sampel pada penelitian ini adalah 38 pasien. Dijumpai tujuh pasien hidup. Dari hasil uji multivariat, tindakan nefrektomi merupakan satu-satunya faktor prognostik pada pasien tumor ginjal. Tingkat mortalitas 0.056x lebih rendah pada pasien yang dilakukan nefrektomi dibanding pasien yang tidak dilakukan nefrektomi. Kesimpulan: Tindakan nefrektomi masih memiliki tempat dalam penanganan tumor ginjal, bahkan pada pasien yang berobat dengan stadium lanjut.

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ABSTRACTObjective To review the status of prognostic factors in kidney cancer. Methods This is an analytic descriptive study of all kidney cancer patients treated at Haji Adam Malik Hospital between 2011 and 2015. Results The number of samples analyzed in this study were 38 patients. We found seven patients remain alive. From the results of multivariate analysis, nephrectomy is the only prognostic factor in patients with kidney cancer. Mortality rate was 0.056x lower in patients who underwent nephrectomy compared with patients who did not underwent nephrectomy. Conclusion Nephrectomy still has a place in kidney cancer management, even in patients with advanced stage. "

"Tujuan: untuk mengetahui profil dan faktor-faktor apa saja yang memepengaruhi kesintasan pada pasien-pasien paska radikal nefrektomi di Rumah Sakit Kanker Dharmais. Metode Penelitian: Semua pasien keganasan ginjal paska operasi radikal nefrektomi di Rumah Sakit Kanker Dharmais pada periode Juni 2009- September 2016 diinklusikan, dan data diambil secara retrospektif melalui rekam medis pasien. Variabel yang dinilai dalam studi ini meliputi: jenis kelamin, usia, stadium, histopatologi subyek, tindakan pembedahan, tindakan sistemik setelah tindakan pembedahan, ureum dan kreatinin sebelum dan sesudah operasi, metastais, pemeriksaan penunjang setelah tindakan pembedahan. Hasil Penelitian: Pada penelitian ini, distribusi Fuhrman grade pada subjek adalah grade I 6,1 ; grade II 37,9 ; grade III 43,9 ; dan grade IV 12,1 . Fuhrman grade 3-4 mempunyai prognosis yang lebih buruk dibandingkan grade 1-2. Fuhrman stage 3-4 memiliki hazard risk 2,829x terhadap Fuhrman grade 1-2 p:0,011 .Selain itu, T3-T4 mempunyai prognosis yang lebih buruk dibandingkan dengan T1-2, TNM stage 3 dan 4 memiliki hazard risk masing-masing 13,076x dan 113x dibandingkan TNM stage 1 P

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Objective to find out the profiles and factors that influence survival in post radical nephrectomy patients at the Dharmais Cancer Hospital. Methods All patients of post operative renal malignancy of nephrectomy at Dharmais Cancer Hospital from June 2009 to September 2016 were included, and the data were retrospectively retrieved through the patient 39 s medical record. The variables assessed in the study included sex, age, stage, histopathology of the subjects, surgical action, systemic action after surgery, urea and creatinine before and after surgery, metastasis, investigation after surgery. Results In this study, the distribution of Fuhrman grade on the subject was grade I 6.1 grade II 37.9 grade III 43.9 and grade IV 12.1 . Fuhrman grade 3 4 has a worse prognosis than grade 1 2. Fuhrman stage 3 4 has a hazard risk of 2.829x against Fuhrman grade 1 2 p 0.011 . In addition, T3 T4 has a worse prognosis compared to T1 2, TNM stage 3 and 4 have a respective hazard risk 13.076x and 113x compared to TNM stage 1 P "

"Penyakit ginjal kronis pada anak merupakan kondisi kerusakan ginjal yang permanen pada struktur atau fungsi ginjal anak. Hemodialisis merupakan salah satu terapi pengganti ginjal sebagai jembatan sebelum tindakan transplantasi ginjal dilakukan, untuk dapat meningkatkan kondisi klinis anak. Penerimaan diri terhadap penyakit merupakan fase penting yang akan menentukan keberhasilan program terapi. Tujuan penulisan karya ilmiah ini untuk melakukan analisis terhadap penerapan teori kenyamanan Kolcaba dalam asuhan keperawatan anak dengan penyakit ginjal kronis tahap akhir yang menjalani hemodialisis. Penulis melakukan analisis terhadap lima kasus anak yang menjalani hemodialisis dan telah diberikan asuhan keperawatan menggunakan pendekatan teori kenyamanan Kolcaba. Aplikasi teori kenyamanan Kolcaba terbukti efektif memberikan kenyamanan pada anak yang menjalani hemodialisis. Acceptance of Illness Scale (AIS) berbasis sistem informasi yang digunakan dalam penilaian penerimaan penyakit terbukti valid dan reliabel. Proyek inovasi menggunakan AIS berbasis sistem informasi pada anak dengan penyakit ginjal kronis yang menjalani hemodialisis efektif dilakukan untuk menilai penerimaan penyakit anak. Edukasi suportif yang diberikan juga terbukti berpengaruh pada peningkatan penerimaan penyakit anak.

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Chronic disease in children is a condition of permanent kidney damage to the structure or function of the child's kidneys. Hemodialysis is one of the renal replacement therapies as a bridge before a kidney transplant is carried out, to improve the clinical condition of children. Self-acceptance of the disease is an important phase that will determine the success of program therapy. The purpose of writing this scientific paper is to analyze the application of Kolcaba's theory of comfort in the care of children with end-stage chronic diseases undergoing hemodialysis. The author conducted an analysis of five cases of children who underwent hemodialysis and were given nursing care using the Kolcaba comfort approach. The application of Kolcaba's theory of comfort has proven to be effective in providing comfort to children undergoing hemodialysis. The Information System-based Disease Acceptance Scale (AIS) used in the assessment of disease acceptance has been proven to be valid and reliable. An innovation project using AIS based on an information system in children with chronic diseases undergoing effective hemodialysis was carried out to assess the acceptance of children's disease. The supportive education provided has also been shown to have an effect on increasing the acceptance of children's illnesses."

"Latar Belakang. Pasien kanker usia lanjut sering mendapatkan terapi substandar sehingga memiliki luaran lebih buruk dibandingkan usia yang lebih muda namun di lain pihak kemungkinan untuk terjadinya komplikasi dan toksisitas terkait pengobatan juga meningkat. Comprehensive Geriatric Assessment (CGA) merupakan metode yang paling tepat untuk mendapatkan gambaran status kesehatan umum pada usia lanjut namun tidak selalu mampu laksana untuk diterapkan pada praktik klinik rutin sehingga diperlukan pemeriksaan penapis yang lebih singkat dan mudah digunakan. Skor G8 adalah instrumen penapis yang direkomendasikan untuk populasi kanker usia lanjut namun belum pernah diteliti di Indonesia.Tujuan. Mengetahui bagaimana performa skor G8 sebagai pemeriksaan penapis dalam menilai frailty pada pasien kanker usia lanjutMetode. Studi ini merupakan studi potong lintang yang dilakukan selama bulan Maret-Juni 2020. Subyek penelitian adalah pasien kanker berusia > 60 tahun yang berobat ke Poliklinik Hematologi Medik RSUPN Cipto Mangunkusumo, Jakarta. CGA dinilai pada 7 domain yaitu domain status fungsional, nutrisi, kognitif, gangguan mood, mobilitas, polifarmasi dan komorbiditas. CGA dianggap terganggu apabila terdapat gangguan pada 2 domain atau lebih.Hasil. Sejumlah 168 pasien kanker usia lanjut mengikuti studi ini dengan median usia 64 tahun. Didapatkan AUC (Area Under Curve) sebesar 0,76 (p < 0,001 dengan 95% CI 0,685-0,835). Pada nilai titik potong 11,25 didapatkan sensitivitas 78,5%, spesifisitas 56%, nilai duga positif 56,3% dan nilai duga negatif 78,4%. Akurasi diagnostik skor G8 adalah sebesar 67,75%.Simpulan. Skor G8 memiliki performa yang cukup baik sebagai alat penapis frailty pada pasien kanker usia lanjut sehingga dapat diterapkan pada praktik klinik sehari-hari. Masih diperlukan studi lebih lanjut untuk mencari pemeriksaan tambahan untuk meningkatkan sensitivitas G8 pada pasien kanker usia lanjut.

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Background. Elderly cancer patients are at increased risk of undertreatment or overtreatment, therefore they may have worse outcome compared to their younger counterparts. Currently Comprehensive Geriatric Assessment (CGA) remains the most appropriate method to assess frailty in elderly patients but not always feasible in routine clinical practice. A screening tool is needed to make a quick assessment to recognize the patients who need a CGA. G8 score is the screening tool recommended for elderly cancer patients, but it’s performance has never been assessed in Indonesia.

Objectives. To assess the performance of G8 Score as frailty screening tool assessment in Elderly Cancer Patients

Methods. A cross-sectional study on elderly cancer patients (> 60 years old) was conducted in Hematology and Medical Oncology outpatient clinic, Cipto Mangunkusumo Hospital from March to June 2020. The CGA domain assessed was functional status, nutrition, cognitive, mood disturbance, mobility, polypharmacy and comorbidity. CGA considered abnormal if there was abnormality in 2 or more domains.

Results. In 168 subjects aged 60-82 (median 64) years old, the AUC was 0.76 (p < 0.001; 95% CI 0.685-0.835). At cutoff point 11.25 the G8 score has sensitivity 78.5%, specificity 56%, positive predictive value 56.3% and negative predictive value 78.4% with diagnostic accuracy 67.75%.

Conclusion. The G8 score has a moderate performance as a screening tool for frailty assessment in elderly cancer patients and may be used in daily clinical practice. Studies to find additional instruments to increase the performance of G8 is needed."

"Kidney cancer : principles and practice is a comprehensive and interdisciplinary textbook that encompasses all clinically relevant aspects of the disease. This new edition has been extensively updated and includes brand new material covering the most recent developments in kidney cancer diagnosis and therapy. The user-friendly and clinically oriented content of the book guarantees that it will be of great interest to a wide range of medical professionals, and every effort has been made to ensure that contributions are both easy to understand and directly related to patient care. Content presentation departs from the usual dense chapter format featuring a lengthy series of paragraphs. Instead, each chapter contains several boxed sections, including one that summarizes essential "take home points" for the busy clinician and another that presents a patient-oriented case highlighting the clinical application of elements discussed in that chapter. In addition, accessible original images, illustrations, and diagrams (some in full color) are used to simplify particularly complex material. "

"Variasi ukuran, bentuk, dan lokasi dapat mempersulit dalam penentuan tindakan pembedahan kanker ginjal. Skor R.E.N.A.L. telah lama digunakan untuk menentukan teknik mana yang digunakan. Penelitian ini dilakukan untuk mengevaluasi profil skor R.E.N.A.L. pasien dengan tumor ginjal. Data dikumpulkan dari pasien yang menjalani prosedur Nefrektomi Radikal (RN) dan Nefrektomi Parsial (PN) secara terbuka atau laparoskopi dari tahun 2014-2017. Skor R.E.N.A.L. dihitung berdasarkan (R)adius of renal, (E)xophytic/ Endophytic properties, (N)earness to the collecting system, (A)nterior or Posterior position of the tumor, dan (L)ocation of the tumor. Diklasifikasikan menjadi tiga kompleksitas: rendah (4-6 poin), sedang (7-9 poin), dan tinggi (10-12 poin). Subjek kemudian dibagi berdasarkan jenis prosedur yang dilakukan. Gambaran skor R.E.N.A.L. di perlihatkan berdasarkan tiap prosedur.Pada penelitian ini, 63 pasien di inklusi: 52 pasien menjalani RN dan 11 menjalani PN. Pada tumor dengan kompleksitas rendah, semua pasien dilakukan PN. Pada kompleksitas sedang, 22 (78,5%) pasien dilakukan RN dan 6 (21.5%) pasien dilakukan PN. Semua tumor dengan kompleksitas tinggi dilakukan RN. Rerata skor R.E.N.A.L. adalah 9.03 (+1.72) untuk semua pasien, 9.59 (+1.11) untuk kelompok RN, dan 6.36 (+1.6) untuk kelompok PN. Semakin tinggi skor (R), (N), dan (L), semakin tinggi juga kemungkinan untuk dilakukan RN. Tumor dengan kompleksitas tinggi lebih besar peluang untuk dilakukan RN. Selanjutnya, skor (R), (N), dan (L) dapat digunakan untuk menentukan RN atau PN sebagai pilihan terapi. Penelitian ini dapat dijadikan dasar dalam penelitian lain mengenai skor R.E.N.A.L. di Indonesia.

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The variation of sizes, shapes, and location of kidney cancers complicate the choices of surgical treatment. To determine which technique to use, R.E.N.A.L. nephrometry scoring systems were established. This study was conducted to evaluate R.E.N.A.L.-NS profile in kidney cancer patients at CMH. Data were collected from patients that underwent both open and laparoscopic Radical (RN) and Partial Nephrectomy (PN) procedures from 2014-2017. R.E.N.A.L.-NS was calculated based on (R)adius of renal, (E)xophytic/ Endophytic properties, (N)earness to the collecting system, (A)nterior or Posterior position of the tumor, and (L)ocation of the tumor. It was categorized into three complexity: low (4-6 points), medium (7-9 points), and high (10-12 points). Subjects then grouped based on the procedure given. Profile of R.E.N.A.L.-NS was shown based on each procedure.

In this study, 63 patients were included: 52 underwent RN and 11 underwent PN. In low complexity tumors, all patients received PN. In medium complexity tumors, 22 (78.5%) patients received RN and 6 (21.5%) received PN. All high complexity tumors received RN. Mean renal score was 9.03 (+1.72) in all patients, 9.59 (+1.11) in RN group, and 6.36 (+1.6) in PN group. Higher (R), (N), and (L) scores mean higher prevalence of RN. Tumors with higher complexity were more likely to be treated with RN. Furthermore, (R), (N), and (L) score can be useful to determine treatment of choice in kidney cancers. This study could be used as a reference to another study regarding R.E.N.A.L.-NS in Indonesia."