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Abstrak :
Latar Belakang : Kejadian AKI di unit perawatan intensif berhubungan dengan peningkatan mortalitas, morbiditas pasca AKI dan biaya perawatan tinggi. Penelitian mengenai faktor-faktor yang berhubungan dengan mortalitas pasien AKI di unit perawatan intensif di Indonesia khususnya RSUPN dr. Cipto Mangungkusumo belum pernah dilakukan.Tujuan: Mengetahui prevalensi AKI, angka mortalitas pasien AKI, dan faktor- faktor yang berhubungan dengan peningkatan mortalitas pasien AKI di unit perawatan intensif di ICU RSUPN dr. Cipto Mangunkusumo.Metode : Penelitian kohort retrospektif terhadap seluruh AKI di unit perawatan intensif di RSUPN Cipto Mangunkusumo periode Januari 2015 ndash; Desember 2016. Dilakukan analisis hubungan bivariat saampai dengan multvariat dengan STATA Statistics 15.0 antara faktor usia >60 tahun, sepsis, ventilator, durasi ventilator, dialisis, oligoanuria, dan skor APACHE II saat admisi dengan mortalitas. Hasil : Prevalensi pasien AKI di unit perawatan intensif didapatkan 12,25 675 dari 5511 subjek dan sebanyak 220 subjek 32,59 dari 675 subjek yang dianalisis meninggal di unit perawatan intensif. Faktor-faktor yang berhubungan dengan peningkatan mortalitas pada analisis multivariat adalah sepsis OR 6,174; IK95 3,116-12,233 , oligoanuria OR 4,173; IK95 2,104-8,274 , ventilator OR 3,085; IK95 1,348-7,057 , skor APACHE II saat admisi 1/2 [OR 1,597; IK95 1,154-2,209], dan durasi ventilator OR 1,062; IK95 1,012-1,114 . Simpulan : Prevalensi pasien AKI dan angka mortalitasnya di unit perawatan intensif RSUPN dr. Cipto Mangunkusumo didapatkan sebesar 12,25 dan 32,59 . Sepsis, oligoanuria, ventilator, skor APACHE II saat admisi 1/2, dan durasi ventilator merupakan faktor-faktor yang berhubungan bermakna dengan peningkatan mortalitas pasien AKI di unit perawatan intensif. Kata Kunci : Acute Kidney Injury, Faktor Risiko, Mortalitas, Unit Perawatan Intensif ......Background Acute kidney Injury AKI in ICU associated with increased mortality rate, morbidity post AKI, and high health care cost. There is no previous study about factors associated with mortality of AKI patients in ICU in Indonesia, especially at dr. Cipto Mangunkusumo National Central General Hospital.Aim To identify prevalence, mortality rate, and factors associated with mortality of AKI patients in ICU.Method This is a retrospective cohort study. Data were obtained from all of medical records of AKI patients period January 2015 until December 2016 in ICU at Cipto Mangunkusumo hospital. Association of risk factors age 60 years old, sepsis, ventilator, duration of ventilator, oligoanuria, and APACHE II score at admission and mortality will be analyzed using STATA Statistics 15.0. Results AKI prevalence in ICU was 12,25 675 subjects from total 5511 subjects . A total of 220 subjects out of 675 subjects AKI died at ICU. Sepsis OR 6,174 95 CI 3,116 12,233 , oligoanuria OR 4,173 95 CI 2,104 8,274 , ventilator OR 3,085 95 CI 1,348 7,057 , APACHE II score at admission 1 2 OR 1,597 95 CI 1,154 2,209 , and duration of ventilator OR 1,062 95 CI 1,012 1,114 . were significant factors associated with mortality of AKI patients in ICU. Conclusion AKI prevalence and mortality rate in ICU at dr. Cipto Mangunkusumo National Central General Hospital were 12,25 and 32,59 . Sepsis, oligoanuria, ventilator, APACHE II score at admission 1 2, and duration of ventilator were significant factors associated with mortality of AKI patients in ICU. Keywords Acute Kidney Injury, Intensive Care Unit, Mortality, Risk Factor

Abstrak :
Latar Belakang : Asfiksia neonatorum menyebabkan gangguan multiorgan, salah satunya adalah gangguan ginjal. Belum adanya kesepakatan dalam menentukan gangguan ginjal akut (acute kidney injury, AKI) pada neonatus menyebabkan kesulitan dalam mendiagnosis dan selanjutnya menghambat tata laksana AKI. Acute Kidney Injury Network (AKIN) merekomendasikan kriteria AKI berdasarkan peningkatan kadar kreatinin serum dan penurunan luaran urin. Tujuan : Mengetahui prevalens AKI dengan menggunakan kriteria AKIN pada asfiksia neonatorum, dan mengetahui perbedaan stadium AKI antara asfiksia sedang dan berat. Metode : Studi ini merupakan potong lintang analitik yang berlangsung selama Juli 2012 hingga Januari 2013. Subjek penelitian adalah semua bayi baru lahir usia gestasi >35 minggu dengan asfiksia yang lahir dan dirawat di Divisi Neonatologi RS Cipto Mangunkusumo dan RSUD Koja. Analisis menggunakan uji hipotesis Chi-square dengan SPSS versi 20. Hasil : Penelitian dilakukan pada 94 subjek yang terdiri atas 70 neonatus asfiksia sedang dan 24 neonatus asfiksia berat. Prevalens AKI berdasarkan kriteria AKIN pada asfiksia neonatorum adalah 63%. Prevalens bayi dengan asfiksia berat dan sedang yang mengalami AKI berturut-turut adalah 21 dari 24 subjek (88%) dan 38 subjek (54%). Prevalens bayi dengan asfiksia berat mengalami AKI stadium 3 yang terbanyak yaitu 14 dari 21 subjek (67%). Stadium AKI yang lebih berat lebih banyak dijumpai pada bayi dengan asfiksia berat dibandingkan asfiksia sedang (P<0,001). Simpulan : Prevalens AKI pada asfiksia neonatorum cukup tinggi. Makin berat derajat asfiksia neonatorum, makin berat stadium AKI. ......Background: Asphyxia neonatorum may result in multiorgan disfunction including renal disfunction. There is no consensus on the determination of acute kidney injury (AKI) in neonates making establishment of the diagnosis and its management difficult. The Acute Kidney Injury Network (AKIN) recommends AKI criteria based on increased serum creatinine level and reduced urine output. Objective: To identify the prevalence of AKI in asphyxiated neonates using the AKIN criteria and to recognize the difference of AKI stadium between moderate and severe asphyxia. Methods: The study was a cross-sectional analytical study, which was conducted between July 2012 and January 2013. The study subjects were all asphyxiated neonates with gestational age of >35 weeks who were delivered and hospitalized in Cipto Mangunkusumo Hospital and Koja District Hospital. Analysis was performed by hypothesis Chi-square test using SPSS version 20. Results: Of 94 subjects participated in the study, there were 70 and 24 neonates with moderate and severe asphyxia, respectively. The prevalence of AKI was 63%. The prevalence of neonates with severe and moderate asphyxia who experienced AKI was 21 out of 24 subjects (88%) and 38 subjects (54%), respectively. The prevalence of AKI in neonates with severe asphyxia who had stage 3 AKI was 14 out of 21 subjects (67%). More severe AKI stage was found more common in neonates with severe asphyxia (P<0.001) Conclusions: The prevalence of AKI in neonatal asphyxia is high. The more severe stage of neonatal asphyxia, the more severe the AKI stage

Abstrak :
Latar Belakang: Penyakit arteri koroner dapat di tata laksana dengan bedah pintas arteri koroner (BPAK) menggunakan mesin pintas jantung paru (PJP) dan fraksi ejeksi (FE) yang rendah berhubungan dengan peningkatan mortalitas jangka pendek dan jangka panjang. Kejadian AKI pascaoperasi BPAK dengan mesin PJP merupakan kejadian yang cukup sering dengan prevalensi bervariasi antara 7,6-48,5%. Patogenesis acute kidney injury(AKI) pascaoperasi jantung bersifat kompleks dan multifaktorial, dengan beberapa mekanismenya melibatkan proses inflamasi, iskemia-cedera reperfusi, dan stres oksidatif. Hingga saat ini belum ada pedoman strategi proteksi ginjal pada operasi BPAK. Glutamin, sebuah asam amino esensial-kondisional memiliki efek anti inflamasi dan anti oksidena melalui induksi heat shock protein (HSP) dan produksi antioksidan glutathione (GSH). Sehingga, dihipotesiskan pemberian glutamin dapat menurunkan kejadian AKI menurunkan gangguan fungsi ginjal pascaoperasi BPAK. Metodologi: Penelitian ini merupakan penelitian kohort retrospektif pada pasien yang menjalani operasi BPAK menggunakan mesin PJP dengan FE rendah. Subjek dibagi menjadi kelompok yang mendapat glutamin intravena praoperasi dan kelompok yang tidak mendapat glutamin. Kejadian AKI 24 jam pascaoperasi, kadar kreatinin serum 24 jam pascaoperasi dan estimated glomerular filtration rate(eGFR) 24 jam pascaoperasi merupakan luaran yang dinilai pada penelitian ini. Hasil: Dari hasil penelitian didapatkan kejadian AKI 24 jam pascoperasi pada kelompok glutamin sebesar 3,3% dan kelompok kontrol 10%. Namun, tidak didapatkan hubungan bermakan kejadian AKI 24 jam pascaoperasi terhadap pemberian glutamin intravena praoperasi (p=0,612). Dari hasil pemeriksaan eGFR 24 jam pascaoperasi, didapatkan rerata kelompok kontrol 57,67 ± 18,86 mL/min/1,73m2dan kelompok glutamin 64,43 ± 17,56 mL/min/1,73m2, namun tidak berbeda bermakna (p=0,156). Dari hasil pemeriksaann kreatinin serum 24 jam pascaoperasi, didapatkan median kelompok kontrol 1,3 (0,87 – 2,68) mg/dL dan kelompok glutamin 1,2 (0,78 – 2,35), namun hasil ini juga tidak berbeda bermakna (p=0,258) Kesimpulan: Pemberian glutamin intravena praoperasi pada pasien dengan fraksi ejeksi rendah yang menjalani BPAK menggunakan mesin PJP, tidak memiliki hubunga bermakna terhadap kejadian AKI dan eGFR serta kadar kreatinin serum 24 jam pascaoperasi. ......Background: Coronary artery disease can be managed by coronary artery bypass graft surgery (CABG) using a cardiopulmonary machine (CPB) and low ejection fraction (FE) is associated with increased short-term and long-term mortality. The incidence of postoperative acute kidney injury (AKI) after CABG using a CPB machine is quite common with a prevalence varying between 7.6-48.5%. The pathogenesis AKI after cardiac surgery is complex and multifactorial, with several mechanisms involving inflammation, ischemia-reperfusion injury, and oxidative stress. Until now, there are no guidelines for kidney protection strategies in CABG surgery. Glutamine, a conditionally essential amino acid has anti-inflammatory and anti-oxidant effects through the induction of heat shock protein (HSP) and the production of the antioxidant glutathione (GSH). Thus, it is hypothesized that the administration of glutamine can reduce the incidence of AKI and decrease renal function impairment after CABG surgery. Methods: This study is a retrospective cohort study in patients who underwent CPA surgery using a PJP machine with low FE. Subjects were divided into groups that received preoperative intravenous glutamine and groups that did not receive glutamine. The incidence of AKI 24 hours postoperatively, serum creatinine levels 24 hours postoperatively and the estimated glomerular filtration rate (eGFR) 24 hours postoperatively were the outcomes assessed in this study. Results:From this study, the incidence of AKI 24 hours postoperatively in the glutamine group was 3.3% and the control group was 10%. However, there was no significant relationship between the incidence of AKI 24 hours postoperatively with preoperative intravenous glutamine administration (p=0.612). From the results of the 24-hour postoperative eGFR examination, the mean of the control group was 57.67 ± 18.86 mL/min/1.73m2 and the glutamine group was 64.43 ± 17.56 mL/min/1.73m2, but not significantly different (p= 0.156). From the results of serum creatinine examination 24 hours postoperatively, the median control group was 1.3 (0.87 – 2.68) mg/dL and the glutamine group 1.2 (0.78 – 2.35) mg/dL, but these results also did not differ significantly (p=0,258)