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"[ABSTRAKPenyakit ginjal kronik (PGK) adalah salah satu komplikasi yang biasanya terjadi pada pasien diabetes melitus tipe 2. Pendeteksian PGK dilakukan dengan menghitung nilai estimasi laju filtrasi glomerulus (eLFG) maupun urine albumin creatinine ratio (UACR). Salah satu biomarker yang sedang diteliti adalah senyawa 8-iso-Prostaglandin F2α. Tujuan dari penelitian ini adalah menganalisis kadar 8-iso-Prostaglandin F2α dan hubungannya dengan eLFG. Sampel yang dianalisis adalah pasien diabetes melitus tipe 2 wanita di Puskesmas Pasar Minggu yang dikumpulkan oleh peneliti sebelumnya tahum lalu secara total sampling. Nilai eLFG diperoleh berdasarkan nilai kreatinin serum yang dihitung dengan rumus Cockroft-Gault, MDRD study, serta CKD-EPI, sedangkan kadar 8-iso-Prostaglandin F2α diukur dengan menggunakan metode ELISA (Enzyme Linked Immunosorbent Assay). Kadar 8-iso-Prostaglandin F2α diperoleh 7069,38 ± 7611,13 pg/mg kreatinin dan nilai eLFG diperoleh 93,15 ± 37,65 (Cockroft-Gault); 89,47 ± 34,30 (MDRD study); dan 87,05 ± 24,69 (CKD-EPI). Hubungan antara kadar 8-iso-Prostaglandin F2α dengan nilai eLFG (92 pasien) berdasarkan persamaan Cockroft-Gault (r = 0,396; p = < 0,001), MDRD (r = 0,375; p = < 0,001) dan CKD-EPI (r = 0,342; p = 0,001). Sehingga diketahui terdapat hubungan yang bermakna antara kadar 8-iso-Prostaglandin F2α dengan nilai eLFG dengan α = 0,05.

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ABSTRACTChronic Kidney Desease (CKD) is one of complication that most common in type 2 diabetes mellitus patients. The detection of CKD is be done by calculating estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (UACR). One of the biomarkes being studied is 8-iso-Prostaglandin F2α. The aim of this study was to analyze concentration of 8-iso-Prostaglandin F2α and its correlation with estimated glomerular filtration rate (eGFR). Samples analyzed were type 2 diabetes mellitus woman patients at Pasar Minggu Local Government Clinic that collected by previous researcher last year in total sampling. eGFR was obtained based on the measurement of serum creatinine, 8-iso-Prostaglandin F2α was measured by ELISA (Enzyme Linked Immunosorbent Assay) method. Concentration of 8-iso-Prostaglandin F2α was 7069,38 ± 7611,13 pg/mg creatinine and the eGFR values 93,15 ± 37,65 (Cockroft-Gault); 89,47 ± 34,30 (MDRD study); and 87,05 ± 24,69 (CKD-EPI). The correlation between 8-iso-Prostaglandin F2α concentration and eGFR (92 samples) is based on Cockroft-Gault (r = 0,396; p = < 0,001), MDRD (r = 0,375; p = < 0,001) and CKD-EPI (r = 0,342; p = 0,001). So there was a significant correlation between 8-iso-Prostaglandin F2α concentration and eGFR.;Chronic Kidney Desease (CKD) is one of complication that most common in type 2 diabetes mellitus patients. The detection of CKD is be done by calculating estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (UACR). One of the biomarkes being studied is 8-iso-Prostaglandin F2α. The aim of this study was to analyze concentration of 8-iso-Prostaglandin F2α and its correlation with estimated glomerular filtration rate (eGFR). Samples analyzed were type 2 diabetes mellitus woman patients at Pasar Minggu Local Government Clinic that collected by previous researcher last year in total sampling . eGFR was obtained based on the measurement of serum creatinine, 8-iso-Prostaglandin F2α was measured by ELISA (Enzyme Linked Immunosorbent Assay) method. Concentration of 8-iso-Prostaglandin F2α was 7069,38 ± 7611,13 pg/mg creatinine and the eGFR values 93,15 ± 37,65 (Cockroft-Gault); 89,47 ± 34,30 (MDRD study); and 87,05 ± 24,69 (CKD-EPI). The correlation between 8-iso-Prostaglandin F2α concentration and eGFR (92 samples) is based on Cockroft-Gault (r = 0,396; p = < 0,001), MDRD (r = 0,375; p = < 0,001) and CKD-EPI (r = 0,342; p = 0,001). So there was a significant correlation between 8-iso-Prostaglandin F2α concentration and eGFR., Chronic Kidney Desease (CKD) is one of complication that most common in type 2 diabetes mellitus patients. The detection of CKD is be done by calculating estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (UACR). One of the biomarkes being studied is 8-iso-Prostaglandin F2α. The aim of this study was to analyze concentration of 8-iso-Prostaglandin F2α and its correlation with estimated glomerular filtration rate (eGFR). Samples analyzed were type 2 diabetes mellitus woman patients at Pasar Minggu Local Government Clinic that collected by previous researcher last year in total sampling . eGFR was obtained based on the measurement of serum creatinine, 8-iso-Prostaglandin F2α was measured by ELISA (Enzyme Linked Immunosorbent Assay) method. Concentration of 8-iso-Prostaglandin F2α was 7069,38 ± 7611,13 pg/mg creatinine and the eGFR values 93,15 ± 37,65 (Cockroft-Gault); 89,47 ± 34,30 (MDRD study); and 87,05 ± 24,69 (CKD-EPI). The correlation between 8-iso-Prostaglandin F2α concentration and eGFR (92 samples) is based on Cockroft-Gault (r = 0,396; p = < 0,001), MDRD (r = 0,375; p = < 0,001) and CKD-EPI (r = 0,342; p = 0,001). So there was a significant correlation between 8-iso-Prostaglandin F2α concentration and eGFR.]"

"Nefropati diabetik disebabkan oleh peningkatan aktivitas NADPH oksidase NOX yang diinduksi angiotensin II dan hipergikemia. Terapi ACE-inhibitor dan ARB memiliki potensi dalam menghambat aktivitas NOX. Namun perbandingan efektivitas keduanya belum diketahui. Peningkatan Aktivitas NOX ditandai oleh penurunan NADPH serum dan laju filtrasi glomerulus LFG. Namun hubungan antara NADPH serum dengan LFG juga belum diketahui. Tujuan dari penelitian ini adalah membandingkan kadar NADPH serum dan eLFG pada pasien diabetes melitus DM tipe 2 yang mendapat terapi ACE-inhibitor dan ARB serta menilai hubungan NADPH serum dengan eLFG. Penelitian ini menggunakan metode cross sectional. Pengambilan sampel dilakukan pada periode April hingga Mei 2018 di RSCM dan Puskesmas Kecamatan Pasar Minggu. Subjek dibagi menjadi 2 kelompok, yaitu kelompok yang mendapat terapi ACE-inhibitor n=11 dan kelompok yang mendapat terapi ARB n=25. Kadar NADPH dan kreatinin serum diukur menggunakan metode kolorimetri. Kelompok ARB memiliki rata-rata konsentrasi NADPH yang lebih tinggi 9,61 1,33 dibandingkan dengan kelompok ACE-Inhibitor 6,56 1,5 namun tidak memiliki perbedaan yang bermakna p>0,05. Selain itu kelompok ARB juga memiliki rata-rata eLFG 66,24 3,95 yang lebih tinggi dibandingkan dengan kelompok ACE-Inhibitor 61,11 7,41 namun tidak memiliki perbedaan yang signifikan p>0,05. Namun demikian terdapat hubungan yang bermakna dan positif antara kadar NADPH serum dengan eLFG r= 0,383.

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Diabetic nephropathy is caused by increased activity of NADPH oxidase NOX induced angiotensin II and hyperglycaemia. ACE inhibitor and ARB therapy have the potential to inhibit NOX activity. But the comparison of the effectiveness of both is unknown. Increased NOX activity is characterized by decreased serum NADPH and glomerular filtration rate GFR. However, the association between serum NADPH and GFR is also unknown. The purpose of this study was to compare serum NADPH and eGFR levels in type 2 diabetes mellitus DM patients who receiving ACE inhibitor and ARB therapy and also to evaluate serum NADPH association with eGFR. This research use cross sectional method. Sampling was conducted from April to May 2018 at RSCM and Puskesmas Kecamatan Pasar Minggu. Subjects were divided into 2 groups, the group receiving ACE inhibitor therapy n 11 and the group receiving ARB therapy n 25. NADPH and serum creatinine levels were measured using colorimetric method. The ARB group had a higher mean serum NADPH concentration 9.61 1.33 than the ACE Inhibitor group 6.56 1.5 but did not have a significant difference p 0.05 . In addition the ARB group also had an average eGFR 66.24 3.95 higher than the ACE Inhibitor group 61.11 7.41 but did not have a significant difference p 0.05. However, there was a significant and positive relationship between serum NADPH levels and eGFR r 0.383."

"Penyakit Ginjal Diabetes (PGD) merupakan salah satu komplikasi yang paling umum terjadi dari diabetes. Deteksi dini gangguan fungsi ginjal pada pasien diabetes melitus tipe-2 (DMT2) dapat mencegah progresivitas PGD. Tujuan penelitian ini adalah menilai perbedaan profil metabolit urin pasien DMT2 yang mengonsumsi metformin-glimepirid pada kelompok risiko rendah dan sedang PGD serta menganalisis pemetaan jalur biokimia yang terjadi. Penelitian dilakukan dengan desain potong lintang dengan metode consecutive sampling di Puskesmas Kecamatan Pasar Minggu dan RSUD Jati Padang. Sampel urin dan darah dikumpulkan untuk pengukuran HbA1c, eLFG (estimasi laju filtrasi glomerulus), UACR (rasio albumin-kreatinin urin), dan analisis metabolomik berbasis LC/MS-QTOF. Total 32 subjek penelitian dibagi menjadi kelompok risiko rendah PGD (n=16) dan kelompok risiko sedang PGD (n=16) berdasarkan kategori prognosis KDIGO. Analisis data karakteristik dasar dan klinis dilakukan menggunakan software IBM SPSS Statistics Premium versi 24. Analisis hasil kromatogram dan spektra dari alat LC/MS-QTOF dianalisis menggunakan software Metaboanalyst 5.0. Hasil yang diperoleh menunjukkan tidak ada perbedaan bermakna secara statistik pada karakteristik dasar dan klinis kedua kelompok, kecuali jenis kelamin (p=0,013) dan HbA1c (p=0,001). Terdapat metabolit urin yang berbeda signifikan (Variable Importance for the Projection (VIP)-score>1; fold change>1,2, dan p<0,05) antara kelompok risiko rendah dan sedang PGD, yaitu sphinganine, lysophospatidic acid, gamma-glutamylalanine, dan N-acetyl-Laspartic acid. Perubahan jalur biokimia yang berkaitan dengan metabolit penanda kerusakan ginjal pada kedua kelompok adalah metabolisme (1) sphingolipid, (2) gliserolipid, (3) gliserofosfolipid, (4) glutation, dan (5) alanin, aspartat, dan glutamat. Dengan demikian, disregulasi metabolisme lipid dan asam amino dapat menjadi biomarker (AUC>0,65) dalam perkembangan PGD pada tahap awal.

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Diabetic Kidney Disease (DKD) is one of the most common complications of diabetes. Early detection of impaired kidney function in type-2 diabetes mellitus (T2DM) patients can prevent the progression of DKD. The study aimed to compare the urine metabolites profile of T2DM patients who consumed metformin-glimepiride with low and moderaterisk groups of DKD and to analyze the mapping of the biochemical pathways that occur. The study was conducted using a cross-sectional design with a consecutive sampling method at Pasar Minggu District Health Center and Jati Padang Hospital. Urine and blood samples were collected for measurements of HbA1c, eGFR (estimated glomerular filtration rate), UACR (urine albumin-creatinine ratio), and LC/MS-QTOF-based metabolomics analysis. A total of 32 subjects were divided into low-risk (n=16) and moderate-risk groups of DKD (n=16) based on KDIGO prognosis category. The baseline and clinical characteristics of the subjects were analyzed using IBM SPSS Statistics Premium software version 24. The chromatogram and spectra results from the LC/MSQTOF were analyzed using Metaboanalyst 5.0 software. The results showed that there were no statistically significant differences in the baseline and clinical characteristics of the two groups, except for sex (p=0.013) and HbA1c (p=0.001). There are significant differences in urine metabolites (VIP-score>1; fold change>1.2, and p<0.05) between low and moderate-risk groups of DKD i.e. sphinganine, lysophosphatidic acid, gammaglutamylalanine, and N-acetyl-L-aspartic acid. Changes in biochemical pathways associated with markers of kidney damage in both groups are the metabolism of (1)sphingolipids, (2)glycerolipids, (3)glycerophospholipids, (4)glutathione, and (5) alanine, aspartate, and glutamate. Therefore, dysregulation of lipid and amino acid metabolism could be biomarkers (AUC > 0,65) for the progression of DKD in the early stage."

"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."

"NADP terbentuk sejalan dengan pembentukan radikal bebas anion superoksida O2 - yang dapat menyebabkan stres oksidatif dan berujung pada komplikasi ginjal yang disebut dengan nefropati diabetik pada pasien diabetes melitus tipe 2. Salah satu faktor yang dapat meningkatkan radikal bebas O2 - adalah peningkatan angiotensin II pada ginjal dan dapat dihambat oleh penghambat sistem renin-angiotensin, yaitu inhibitor ACE dan ARB. Penelitian ini bertujuan untuk mengetahui perbandingan terapi inhibitor ACE dan ARB dalam mengatasi stres oksidatif yang diukur melalui kadar NADP serum dan dikorelasikan dengan nilai estimasi laju filtrasi glomerulus eLFG sebagai parameter yang sudah sering digunakan untuk menandakan perubahan fungsi ginjal. Kadar NADP serum diukur menggunakan uji NADP /NADPH dengan metode kolorimetri dan nilai eLFG dihitung menggunakan persamaan CKD-EPI. Penelitian ini dilakukan di RSUPN Dr. Cipto Mangunkusumo dan Puskesmas Kecamatan Pasar Minggu. Subjek penelitian dibagi menjadi dua kelompok pasien diabetes melitus tipe 2, yaitu kelompok yang mendapat inhibitor ACE n = 11 dan kelompok yang mendapat ARB n = 25 . Rata-rata kadar NADP serum pada kelompok inhibitor ACE adalah 3,4576 pmol/ml dan pada kelompok ARB adalah 5,6240 pmol/ml p = 0,091, sedangkan nilai eLFG pada kelompok inhibitor ACE adalah 61,109 ml/menit/1,73 m2 dan pada kelompok ARB adalah 66,240 ml/menit/1,73 m2 p = 0,510. Korelasi antara kadar NADP serum dengan nilai eLFG r = -0,032; p = 0,851. Data hasil penelitian menunjukkan bahwa inhibitor ACE dan ARB tidak berbeda signifikan dalam menurunkan kadar NADP serum dan mempertahankan fungsi ginjal, selain itu tidak terdapat korelasi signifikan antara kadar NADP serum dengan nilai eLFG pada kedua kelompok sampel.

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NADP is formed in line with the formation of superoxide anion O2 free radical which can cause oxidative stress and lead to renal complications called diabetic nephropathy in type 2 diabetes mellitus. One of the factors that can increase O2 free radical is increased angiotensin II in the kidneys and can be inhibited by the inhibitor of the renin angiotensin system, ie ACE inhibitors and ARBs. This study aims to determine the comparison of ACE inhibitor and ARB therapy in overcoming oxidative stress measured through serum NADP levels and correlate them with estimated glomerular filtration rate eGFR as a parameter that has been frequently used to indicate changes in renal function. Serum NADP levels were measured using an NADP NADPH assay by colorimetric method and eGFR values were calculated using the CKD EPI equation. This research was conducted at Dr. Cipto Mangunkusumo National Central General Hospital and District Health Clinics Pasar Minggu. The subjects were divided into two groups of patients with type 2 diabetes mellitus, the group receiving ACE inhibitors n 11 and the group receiving ARBs n 25. The mean serum NADP level in the ACE inhibitor group was 3,4576 pmol ml and in the ARB group was 5,6240 pmol ml p 0,091, whereas the eGFR value in the ACE inhibitor group was 61,109 ml minute 1,73 m2 and in the ARB group was 66,240 ml minute 1,73 m2 p 0,510. The correlation between serum NADP levels and eGFR values r 0,032 p 0,851. The results showed that ACE inhibitors and ARBs did not differ significantly in reducing serum NADP levels and maintaining renal function, and there was no significant correlation between serum NADP levels and eGFR values in both groups."

"Glikosaminoglikan merupakan komponen penyusun glikokaliks yang berperan penting dalam per selektivitas muatan anionik kapiler glomerulus. Gangguan hemodinamik dan metabolik akibat hiperglikemia kronis menyebabkan peluruhan komponen glikokaliks endotel. Beberapa pedoman telah menyetujui keamanan tiap OAD berdasarkan fungsi ginjal. Tujuan penelitian adalah menilai keamanan penggunaan metformin (metformin dan metformin-glimepirid) berdasarkan fungsi ginjalnya serta menilai perbandingan kadar GAG urin pasien DMT 2 kelompok risiko rendah terhadap risiko sedang-tinggi PGK. Desain penelitian potong lintang dan metode consecutive di Puskesmas Depok Jaya dan Kecamatan Pasar Minggu. Sampel urin dan darah dikumpulkan untuk pengukuran eLFG, HbA1c, ACR, dan kadar GAG urin. Sebanyak 137 partisipan dinilai keamanan penggunaan metformin berdasarkan fungsi ginjalnya. Terdapat ketidaksesuaian pada 1 partisipan dalam penggunaan metformin (n=55) dan semua partisipan (n=82) sesuai dengan pedoman dalam penggunaan metformin-glimepirid. Hanya 121 partisipan yang dianalisis kadar GAG urin menggunakan 1,9-DMMB dan terdiri dari 4 yaitu kelompok risiko rendah PGK: G1-A1(eLFG ≥90ml/min/1,73m² - <30mg/g) (n=25) dan G2-A1(eLFG 60-89ml/min/1,73m² - <30mg/g) (n=45) serta risiko sedang-tinggi PGK: GI-A2(eLFG ≥ 90ml/menit/1,73m² - >30mg/g) (n=23) dan G2-A2(eLFG 60-89ml/menit/1,73m² - >30mg/g) (n=28). Tidak ada perbedaan bermakna (p<0,05) pada karakteristik dasar dan klinis keempat kelompok kecuali usia (p=0,006) dan HbA1c (p<0,001). Tidak terdapat perbedaan kadar GAG urin yang bermakna antara kelompok G1 dengan G2 (p=0,290) serta pada keempat kelompok (p=0,221). Terdapat perbedaan kadar GAG urin yang bermakna (p=0,034) pada kelompok normoalbuminuria dan albuminuria. Faktor lain seperti durasi DMT 2 >5 tahun dan komorbiditas dapat meningkatkan kadar GAG urin. Oleh karena itu, diperlukan studi lanjut mengenai potensi GAG urin pada awal perkembangan penyakit ginjal diabetes.

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Glycosaminoglycans are components of the glycocalyx which play an important role in the permeselectivity of the anionic charge of the glomerular capillaries. Hemodynamic and metabolic disturbances due to chronic hyperglycemia cause the breakdown of the glycocalyx component of the endothelium. Several guidelines have agreed on the safety of each OAD based on renal function. The aims of this study were to assess the safety of using metformin (metformin and metformin-glimepiride) based on kidney function and to evaluate the comparison of urinary GAG levels in patients with DMT 2 in low-risk groups to moderate-high risk of CKD. Cross-sectional research design and consecutive in Depok Jaya Public Health Center and Pasar Minggu District. Urine and blood samples were collected for measurement of eGFR, HbA1c, ACR, and urinary GAG levels. A total of 137 participants assessed the safety of using metformin based on their kidney function. There was a discrepancy in 1 participant in the use of metformin (n=55) and all participants (n=82) according to the guidelines for the use of metformin-glimepiride. Only 121 participants were analyzed for urine GAG ​​levels using 1,9-DMMB and consisted of 4 low risk groups for CKD: G1-A1(eGFR 90ml/min/1.73m² - <30mg/g) (n=25) and G2-A1(eGFR 60-89ml/min/1.73m² - <30mg/g) (n=45) and moderate-high risk of CKD: GI-A2(eGFR 90ml/min/1.73m² - >30mg/g) (n=23) and G2-A2(eLFG 60-89ml/min/1.73m² - >30mg/g) (n=28). There was no significant difference (p<0.05) in the baseline and clinical characteristics of the four groups except age (p=0.006) and HbA1c (p<0.001). There was no significant difference in urine GAG ​​levels between the groups G1 with G2 (p= 0.290) and in the four groups (p= 0.221). There was a significant difference in urine GAG ​​levels (p= 0.034) in the normoalbuminuria and albuminuria groups. Other factors such as duration of DMT 2 > 5 years and comorbidities can increase urinary GAG levels. Therefore, further studies are needed regarding the potential of urinary GAGs in the early development of diabetic kidney disease. "

"[ABSTRAKGangguan fungsi ginjal yang sering terjadi pada pasien diabetes melitus tipe 2 diperankan oleh stres oksidatif. Belum diketahui efektivitas pengobatan diabetes melitus tipe 2 terhadap gangguan fungsi ginjal. Penelitian ini membandingkan dan menganalisis hubungan hidrogen peroksida urin yang merupakan produk stress oksidatif dan estimasi Laju Filtrasi Glomerulus (eLFG) pada kelompok pengobatan sulfonilurea dan kombinasi biguanid-sulfonilurea. Penelitian ini menggunakan desain penelitian kohort retrospektif dengan jumlah sampel 50 orang yang diambil di RSK Dr. Sitanala Tangerang dengan teknik total sampling. Nilai eLFG diperoleh berdasarkan nilai kreatinin serum yang diukur menggunakan metode kinetik Jaffe, sedangkan hidrogen peroksida urin menggunakan metode FOX (Ferrous ion Oxidation Xylenol Orange) 1. Nilai hidrogen peroksida urin pada dua kelompok pengobatan tidak memiliki perbedaan yang bermakna (p = 0,69). Sedangkan nilai eLFG pada dua kelompok juga tidak memiliki memiliki perbedaan yang bermakna dengan Cockroft Gault adalah p = 0,884; MDRD p = 0,886; dan CKDEP p= 0,490. Analisis hubungan hidrogen peroksida urin dengan eLFG berdasarkan persamaan MDRD dan CKDEPI menghasilkan hubungan positif bermakna (r = 0,326; p = 0,021) dan (r = 0,282; p = 0,047).

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ABSTRACT

, Renal dysfunction which frequently occurs in type 2 diabetes mellitus patients caused by oxidative stress. The effectiveness of the type 2 diabetes mellitus treatment to renal dysfunction is unknown. This study compare and analyze the correlation between urinary hydrogen peroxide which is a product of oxidative stress and estimated glomerular filtration rate (eGFR) in the treatment groups of sulfonylurea and combination biguanide-sulfonylurea. This study used a retrospective cohort study design with 50 sampels that was taken in Dr. Sitanala Tangerang hospital with total sampling technique. Estimated GFR value obtained based on serum creatinine values were measured using a kinetic Jaffe method, while the urinary hydrogen peroxide using FOX (Ferrous ion Oxidation Xylenol Orange) 1. Value of urinary hydrogen peroxide in the two treatment groups did not have significant difference (p = 0.69) , While the value eGFR the two groups did not have significant differences with the Cockroft Gault is p = 0.884; MDRD p = 0.886; and CKDEP p = 0.490. Analysis of urinary hydrogen peroxide and eGFR based on the MDRD equation and CKDEPI generate significant positive correlation (r = 0.326; p = 0.021) and (r = 0.282; p = 0.047).

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"Glikokaliks endotel pada glomerulus membantu mempertahankan homeostasis vaskular. Perubahan hemodinamik ginjal yang disebabkan oleh hiperglikemia kronis meningkatkan tekanan hidrolik glomerulus yang berkontribusi terhadap peluruhan glikokaliks. Faktor ini berkontribusi terhadap inisiasi penyakit ginjal kronis. Penelitian ini bertujuan untuk mengetahui asosiasi antara degradasi glikokaliks urin dan penyakit ginjal diabetes yang dinilai dengan estimasi laju filtrasi glomerulus (eLFG) pada pasien diabetes melitus tipe 2. Penelitian dilakukan dengan desain potong lintang dan teknik pengambilan sampel consecutive di Puskesmas Kecamatan Pasar Minggu. Sampel darah dan urin partisipan dikumpulkan untuk pengukuran eLFG, HbA1c, perbandingan albumin-kreatinin urin, dan degradasi glikokaliks. Degradasi glikokaliks urin diukur menggunakan 1,9- dimetilmetilen biru (GAG-DMMB). Total 75 partisipan dibagi menjadi dua kelompok menurut eLFG, ≥ 90 ml/min per 1,73 m2 (n = 33) (kelompok G1) dan 60-89 ml/min per 1,73 m2 (n = 42) (kelompok G2). Tidak ada perbedaan bermakna secara statistik (p<0,05) pada karakteristik dasar dan klinis kedua kelompok kecuali usia (p<0,001) dan HbA1c (p=0,039). Lebih lanjut, degradasi glikokaliks urin (mg/g kreatinin) lebih rendah pada kelompok G1 (median (min-max): 1,50 (0,00-16,59)) dibandingkan dengan kelompok G2 (2,04 (0,00-17,00)), namun tidak bermakna secara statistik. Tidak terdapat korelasi antara eLFG dengan degradasi glikokaliks urin (r=-0,11; p=0.33). Peningkatan degradasi glikokaliks urin tidak berhubungan terhadap tahap awal penyakit ginjal diabetes.

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Endothelial glycocalyx in the glomeruli helps maintain vascular homeostasis. Renal hemodynamic alterations caused by chronic hyperglycemia increase glomerular hydraulic pressure that contributes to the shedding of glycocalyx. This factor predisposes to the initiation of chronic kidney disease. This study aimed to investigate the association between endothelial glycocalyx breakdown and diabetic kidney disease assessed by the estimated glomerular filtration rate (eGFR) among type 2 diabetes mellitus patients. This cross-sectional study used consecutive sampling method and was conducted in Pasar Minggu Primary Health Center. Participants’ blood and urine samples were collected for measurement of eGFR, HbA1c, urine albumin-to-creatinine ratio (UACR), and glycocalyx degradation. Urinary glycocalyx breakdown was measured in the form of glycosaminoglycan and was assayed with 1,9-dimethylmethylene blue (GAG-DMMB). A total of 75 participants were divided into two groups according to the eGFR, ≥ 90 ml/minute per 1.73 m2 (n = 33) (G1 group) and 60-89 ml/minute per 1.73 m2 (n = 42) (G2 group). There were no statistically significant differences (p<0.05) in baseline and clinical characteristics among groups except for age (p<0.001) and HbA1c level (p=0.039). Furthermore, there was a decrease in urinary glycocalyx degradation product (mg/g creatinine) in G1 group (median (min-max): 1.50 (0.00-16.59)) compared to G2 group (2.04 (0.00-17.00)) with no statistically significant difference. There was no correlation between eGFR and urinary glycocalyx degradation product (r=-0,11; p=0.33). Increased urinary glycocalyx degradation was not associated with early phase of diabetic kidney disease."