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"ABSTRACTBACKGROUND:kidney transplantation has been developing rapidly in Indonesia in recent years, yet data on transplants' characteristics and survival is still unavailable. In Indonesia, only living donors are permitted. Living donor are advantageous, but challenging to recruit. This study aimed to establish the graft and patient survival rates and to describe the characteristics of recipient and donor as well as the process of donor recruitment and evaluation of kidney transplantation in Indonesia.METHODS:the study was a retrospective cohort on all donors and kidney transplant recipients at Cipto Mangunkusumo General Hospital (CMGH) from January 2011 to May 2017. Only recipients from January 2011 to May 2014 were included to establish the 1-year and 3-year graft and patient survival; which were described using Kaplan-Meier method. RESULTS:data from 492 kidney transplant procedures were obtained (donor median age, 30 (17 - 66) years; 25.1% were family-related. Recipients mean age, 47 (SD 13.18 years). Data from total of 138 kidney transplant recipients were further analyzed. The 1-year death- censored graft survival, all-cause graft survival and patient survival were 92 %, 82.6 % and 87%. The 3-year death-censored graft survival, all-cause graft survival and patient survival were 90.6%, 76.1% and 79.7%. Kaplan-Meier's curve showed the highest mortality rates occured in the early months.CONCLUSION:the 1-year graft and patient survival rate were 92% and 87%. The 3-year graft and patient survival rate were 90.6% and 79.7%. Only small percentage of donor were family-related. Living donor recruitment and evaluation are still a big challenge in Indonesia"

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

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

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

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

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

"Tujuan Kekerapan hiponatremia pada usia lanjut cukup tinggi disebabkan adanya peningkatan kadar ADH, dan ANP yang merupakan bagian dari 8 perubahan fisiologi. Komplikasi yang ditimbulkan cukup spesifik yaitu meningkatnya risiko patah tulang, penurunan kesadaran hingga kejang-kejang. Penyebab tersering hiponatremia pada usia lanjut adalah asupan air yang tinggi. Mendapatkan asupan air optimal yaitu volume asupan air tertinggi yang tidak menimbulkan hiponatremia dan hipovolemia. Metode Dilakukan penelitian pada 31 orang usia lanjut sehat setelah melalui pemilihan dari 107 usia lanjut secara simple random sampling dan kriteria eksklusi. Kemudian dibagi secara Randomisasi Blok dalam 5 kelompok asupan air (1000-2500 mL). Hasil Dapat dibuktikan bahwa 1000 mL merupakan asupan air optimal pada usia lanjut sehat. Diperlihatkan juga bahwa kadar ADH plasma memiliki gambaran hubungan dengan volume asupan air yang tidak menimbulkan hiponatremia dan kadar NT-proBNP tidak berkorelasi dengan kadar natrium urin sewaktu. (Med J Indones 2009; 18: 18-25) Kesimpulan Asupan air optimal pada usia lanjut adalah 1000 mL/24 jam.

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Aim The prevalence of hyponatremia in the elderly is quite high due to the rising of ADH and ANP concentrations which are part of eight physiologic changes. The complications are quite specific, among others, increased risk of bone fracture, declining of conciousness, and convulsion. The frequent cause of hyponatremia is high water intake. To achieve the optimal water intake designated as the highest water intake that did not cause hyponatremia and hypovolemia. Methods A study was conducted on 31 healthy elderly subjects, selected from 107 persons using simple random sampling and exclusion criteria. By block randomisation were classified into five water-intake groups (1000-2500 mL). Results In this study, it could be proved that 1000 mL was the optimal. It was also unraveled that the ADH levels had a role in determining the water intake volume that did not cause hyponatremia and NT-proBNP concentrations did not correlate with spot urine sodium. Conclusion The optimal water intake for the elderly is 1000 mL per day. Keywords: Hyponatremia, healthy elderly, water intake."