Penyakit Ginjal Polikistik disertai Anemia Hemolitik Autoimun

The hereditary forms of polycystic kidney disease of autosomal dominant PKD (ADPKD) and autosomal recessive PKD (ARPKD) are the main forms. ADPKD is a multifactorial disorder characterized by bilateral renal cysts and commonly affects adult patients. The most common extrarenal manifestations of ADPKD are liver cysts and is often incidental findings and clinically insignificant. A case report has been reported with polycystic disease in the kidneys and liver with autoimmune hemolytic anemia. ADPKD is a progressive disease and symptoms tend to get worse over time. ADPKD involves managing the symptoms and slowing disease progression. The most serious complication of ADPKD is end stage kidney failure. This aim of this study were to determine the symptoms and laboratory tests that confirm the diagnosis of polycystic kidney disease accompanied by autoimmune hemolytic anemia

Lipid Peroxidation: Aging Kidney

Kidney is one of the tissues affected by age that involves cellular and structural changes inside the kidney and notably implicates with comorbidity, related to cardiovascular disease aging. Aging kidney causes the elderly susceptible to clinical deterioration from ordinary stimulation that younger individual can compensate, including acute renal injury, volume depletion or overload, sodium and potassium level disorders, and toxic reaction against kidney excreted drugs. As one of the organs with the fastest aging rate, kidney shows several age-related decline in both structural and functional with 30% of the glomerulus are damaged and represent diffuse glomerular sclerosis by age 75 and explain why the prevalence of chronic kidney disease (CKD) and end-stage renal disease are very common in the elderly. The cross-sectional population-based study by The National Health and Nutrition Examination Survey supports the theory of age-related decline in kidney function, although some other subjects did not have an absolute decline in kidney function. The underlying molecular mechanisms could be the target of future therapeutic strategies. Aging is a natural biological process characterized by a gradual decline in cellular function as well as progressive structural change of organ systems. In aging kidney, there are interactions of genetic factors, environmental changes, and cellular dysfunction that lead to the typical structural and functional changes. One of the most popular theory of aging is the theory of free radicals or oxidative stress based on the fact that cells are under chronic oxidative stress due to an imbalance between pro oxidants and antioxidants. Reactive oxygen species are oxygen-derived oxidizing compounds that are highly reactive, consisting of free radicals and non-radicals. Reactive oxygen species (ROS) and reactive nitrogen species (RNS) refer to both reactive radicals and non-radical derivatives of oxygen and nitrogen. Reactive oxygen and nitrogen species (RONS) are produced by all aerobic cells and play an important role in aging as well as age-related diseases. Lipid peroxidation is a process of oxidative degradation of lipids that process by which free radicals bind to lipid electrons in the cell membrane resulting in direct cell damage. Lipid peroxidation can cause cellular damage in several ways such as impairing the integrity of the plasma membrane and subcellular organelles by peroxidation, “chain reaction” of ROS production, and activation of phospholipase A2 (PLA2) caused by lipid peroxidation. Fatty acids and other PLA2 metabolites (such as lysophospholipids) are known to damage cell membranes. In the development of kidney damage, the process of lipid peroxidation plays an important role. This is presumably due to the large number of long-chain polyunsaturated fatty acids (PUFAs) in the lipid composition of the kidneys and there are substantial evidence to suggest that ROS is involved in the ischemic, toxic, and immunologically mediated pathogenesis of renal injury, but the cellular mechanisms that result in cell injury and death are still being studied

Hipertensi Renovaskular

Hipertensi renovaskular adalah peningkatan tekanan darah sistolik dan atau diastolik yang umumnya mendadak dan resisten akibat hipoperfusi ginjal yang biasanya disebabkan stenosis arteri renalis dan aktivasi sistem renin-angiotensin. Penyakit ini merupakan salah satu penyebab dari hipertensi sekunder yang dapat terjadi karena gangguan pada vaskular berupa stenosis arteri renalis, berkaitan dengan penyakit parenkim ginjal atau dapat juga merupakan kombinasi dari keduanya. Angka kejadiannya yaitu 1-4 % dari seluruh penderita hipertensi. Hipertensi renovaskular lebih sering ditemukan pada usia remaja dibandingkan pada kelompok usia dewasa. Tujuan penatalaksanaan hipertensi renovaskular adalah memperbaiki oklusi arteri renalis sehingga hipoperfusi ginjal membaik dan tekanan darah menurun. Dalam kasus ini kami melaporkan seorang perempuan berusia 22 tahun datang dengan keluhan sakit kepala sejak 1 hari sebelum masuk rumah sakit. Hasil angiografi arteri renalis: stenosis 80-90% pada arteri renalis dextra. Selanjutnya pasien dilakukan Percutaneous Transluminal Renal Angioplasty. Setelah dilakukan pemasangan balon arteri renalis keluhan sakit kepala berkurang dan tekanan darah menjadi normal dan obat antihipertensi dihentikan

Renal tubular asidosis tipe I dengan anemia hemolitik stomatositosis

Renal tubular acidosis (RTA) tipe I adalah sindrom klinik akibat kegagalan pengasaman urine oleh tubuli distal yang ditandai oleh asidosis metabolik, hipokalemia, hiperkloremia, sedangkan anion gap serum dan fungsi glomerulus normal. Anemia stomatositosis adalah tipe anemia hemolitik non-autoimun yang diakibatkan kelainan pada membran eritrosit yang ditandai dengan ditemukannya stomatosit pada gambaran darah tepi. Tujuan: melaporkan kasus RTA tipe I dengan anemia stomatositosis herediter. Kasus: Dilaporkan sebuah kasus, wanita 30 tahun dengan keluhan utama lemah pada keempat anggota gerak sejak 1 hari sebelum masuk rumah sakit. Pasien juga merasakan sesak nafas, poliuri, polidipsi, pucat, lemah dan letih. Keluhan telah dirasakan berulang sejak 5 tahun yang lalu. Pemeriksaan fisik: pasien sadar, kusmaul, anemis, tetraparesis. Pemeriksaan penunjang: laboratorium Hb 8,8 gr/dL; normositik normokrom dengan sel target (+) sel stomatosit (+); Kalium 1,7 mmol/L; Khlorida 122 mmol/L.  Analisis gas darah: pH 7,05; HCO3- 6,9 mmol/L. Urinalisis: pH urine 6,5; elektrolit urine; kalium 18,2 mmol; TTKG 13; anion gap serum 11,4; anion gap urine 16,2. Diberikan substitusi kalium dan bikarbonat intravena. Pasien mengalami perbaikan gejala setelah di terapi. Simpulan: Perlu diberikan terapi substitusi kalium dan alkali seumur hidup pasien untuk mencegah kekambuhan

The Relationship between Nutritional Status and the Incidence of Hypertension in the Elderly at the Working Area of the Lubuk Pinang Health Center, North Bengkulu

Hypertension may occur primarily or is idiopathic. Where the causative factor cannot be identified or can occur secondarily as a result of a particular disease. This study aims to determine the relationship between nutritional status and the incidence of hypertension in the Elderly Work Area of the Lubuk Pinang Health Center, Muko-Muko Regency, North Bengkulu. The type of research used is analytical observational research with a cross-sectional approach. The affordable population in this study was the elderly who were registered for treatment at the Lubuk Pinang Health Center, Muko-Muko Regency, North Bengkulu, with 36 samples using the total sampling technique. Univariate data analysis is presented in frequency and percentage distribution and bivariate analysis using the spearman correlation test and data processing using the computerized IBM SPSS program version 24.0. The results of this study show that the highest age was 60-70 years, namely 28 people (77.8%), and the most gender was female, namely 31 people (86.1%). The most nutritional status was overweight, 15 people each (41.7%), the most hypertension was stage II, namely 25 people (69.4%), and there was a relationship between nutritional status and the incidence of hypertension in the Elderly Work Area of the Lubuk Pinang Health Center, Muko-Muko Regency, North Bengkulu (p=0.031). This research concludes that the highest age is 60-70 years. The most gender is female, the most nutritional status is overweight, the most hypertension is stage II, and there is a relationship between nutritional status and the incidence of hypertension in the Elderly Work Area of the Lubuk Pinang Health Center, Muko-Muko Regency, North Bengkul

The Effect of Giving Dadih on Malondialdehyde Levels and Renal Interstitial Fibrosis at Aging Kidney

BACKGROUND: The increase in the elderly poses problems in the areas of health, since it can cause aging of the physiological function of organs. It also has an impact on kidney function, which will enhance the chronic kidney disease. One of the theory that causes aging process is the free radical theory, which that accumulation of free radicals is caused by depletion of antioxidants. Therefore, exogenous antioxidants are needed and in this study author use dadih. Dadih is fermented buffalo milk, indigenous from West Sumatera-Indonesia. Peptides found in fermented milk contained antioxidant that can stimulate the formation of endogenous antioxidants and diversification of dadiah increases its effect as antioxidant. AIM: This study aims to prove the effect of dadih antioxidants on malondialdehyde (MDA) levels of kidney tissue and renal interstitial fibrosis. MATERIALS AND METHODS: An experimental study with post-test only control group design conducted to observe effect of dadih to kidney aging of Rattus norvegicus in the Laboratory of Andalas University. It used 30 R. norvegicus which were divided into three groups. Group K was a positive control (did not get dadih), Group P1 was given dadih 4.5 g once a day, and Group P2 was given dadih 4.5 g twice a day for 42 days. After that, MDA levels of kidney tissue are examined using the thiobarbituric acid reactive substances examination technique and examination of renal interstitial fibrosis which is done by histopathology with Sirius-red staining. Data were analyzed using the normality test with Shapiro–Wilk. RESULTS: The results showed that dadih can reduce levels of MDA in kidney tissue, where its decrease very significant in Group P1 (given dadih once a day) and Group P2 (given dadih twice a day) compared to the Group K (control group) 0.97 ± 0.06 pg/ml to 0.75 ± 0.03 pg/ml (p < 0.05). Group P1 and Group P2 can also reduce the renal interstitial fibrosis rank. Obtained a decrease in the average fibrosis rank from Group K to Group P1 and subsequently to Group P2 (p < 0.05). CONCLUSION: This study concluded that dadih can reduce MDA levels in kidney tissue and reduce renal interstitial fibrosis rank on aging kidney

Correlation Between Oxidative Stress, SIRT1 Serum Level, and eGFR on Elderly

The aging network kidney causes Oxidative Stress (OS) and damages the kidney. Studies of aging kidneys keep going growing by developing sirtuin as an antiaging. Sirtuin 1 (SIRT1) is a protein implicated in several disorders including diabetes functions as an anti-aging protein. Decreased eGFR in the elderly caused by his height prevalence factor risk disease kidney at an older age. The study aims to study the correlation between oxidative stress, SIRT1 serum levels, and eGFR in the elderly.  The method used in this research is observational with the cross-sectional method. The sample in this study was the whole elderly who met the inclusion and exclusion criteria, totaling 30 people. Exclusion criteria are patients with glomerulonephritis, nephropathy obstruction, nephropathy sour veins, and obesity. All patients complied requirements asked to fill informed consent form. The inspection was carried out by urinalysis ultrasound kidney and assessing serum MDA levels which were found to be higher in this study. This study showed SIRT1 and eGFR levels decreased in the elderly. There was a negative correlation with moderate correlation strength between serum MDA levels and serum SIRT1 levels and a strong correlation between serum MDA levels and eGFR in the elderly. There was a positive correlation with a moderate correlation between serum SIRT1 levels and eGFR in the elderly. SIRT1 is suggested to be examined in elderly patients with decreased eGFR, even without comorbidity

The Effect of Giving Dadih on Manganese Superoxide Dismutase Gene Expression and Malondialdehyde Levels at Aging Kidney

BACKGROUND: The aging process is a complex physiological mechanism that cannot be disclosed in exact detail. Various theories about the aging process have been put forward by many experts. AIM: This study aims to prove the effect of dadih on manganese superoxide dismutase (MnSOD) gene expression and malondialdehyde levels at aging kidney. MATERIALS AND METHODS: This study used 30 Rattus norvegicus which were divided into three groups: Group 1 was a positive control (did not get dadih), Group 2 received dadih 1 × 4.5 g/day, and Group 3 received dadih 2 × 4.5 g/day for 42 days. After that, MDA levels of kidney tissue are examined using the thiobarbituric acid reactive substances examination technique and examination of kidney and examination of MnSOD was done by immunohistochemical staining of kidney tissue. Data were analyzed using the normality test with Shapiro-Wilk. RESULTS: The results showed that dadih were be able to decreased MDA levels in Group 2 and Group 3 compared to Group 1 (control) 0.97 ± 0.06 pg/mL to 0.75 ± 0.03 (p < 0.05). Dadih also increased MnSOD expression sequentially from Group 1 33.66 ± 9.29 to Group 2 53.58 ± 8.51 and Group 3 73.70 ± 4.29 (p < 0.05) CONCLUSION: This study concluded that dadih can reduce MDA levels in old kidney tissue and dadih can increase the expression of MnSOD

Indikasi dan Persiapan Hemodialis Pada Penyakit Ginjal Kronis

Penyakit Ginjal Kronik (PGK) adalah kelainan struktural atau fungsi yang terjadi lebih dari 3 bulan dan mempunyai implikasi terhadap kesehatan serta diklasifikasikan berdasarkan penyebab, laju flitrasi glomerulus (LFG) dan albuminuria. Komplikasi serius yang ditimbulkan PGK dapat berupa malnutrisi, kelebihan cairan, perdarahan, serositis, depresi, gangguan kognitif, neuropati perifer, infertilitas dan Infeksi. Untuk mencegah komplikasi tersebut, diperlukan indikasi dan waktu yang tepat untuk memulai terapi dialisis pada pasien PGK