H UB UNGAN ANTAR A KE YA KI NA N DIRI (S E LF E F FI C A CY )ME NGE RJA KAN S K RIPS I DE N GAN ST RE S YANG DIAL A MI PA DAMAH AS I S WA PRO G RAM S T U DI B K UN Y

H UB UNGAN ANTAR A KE YA KI NA N DIRI (S E LF E F FI C A CY )ME NGE RJA KAN S K RIPS I DE N GAN ST RE S YANG DIAL A MI PA DAMAH AS I S WA PRO G RAM S T U DI B K UN Y Ol eh : Bekti Pratiwi 07104241091 AB S T RAK P enel i t i an i ni bert uj uan untuk m enget ahui hu bungan ant ar a s el f ef f i cacy m engerj akan s k ri psi den gan s t r es yan g di al am i m ahas i s wa pro gr am s t udi bi m bi ngan dan konsel i ng Univers i t a s Ne geri Yo g ya kart a . P endekat an d al am penel i t i an i ni m enggunak an pe ndekat an ku ant i t at i f den gan j eni s korel as i onal . P op ul as i dal am penel i t i an i ni adal ah m ahas i s w a BK ya n g berj um l ah 214 m ahas i s wa. S am pel dal am penel i t i an i ni s eban yak 42 m ahas i s wa, p engam bi l an s am pel m enggun akan t eknik s t r a t i f i ed r andom s ampli ng . Bes a rn ya s am pel penel i t i an ya n g t erdi ri dari m ahas i s w a an gkat an t ahun 2005 ,2006,2007 m en ggun akan p erhi t ungan 20 % yan g di am bi l s ecar a a cak d ari t i ap an gkat an . Dat a dal am penel i t i an i ni di perol eh den gan m en gguna kan s kal a s el f ef f i cacy m engerj ak an s kri psi kel om pok dan s kal a s t res m engerj ak an s kri psi . Untuk m enguj i val i di t as s kal a di gunak an rum us product moment dari P ears on dan uj i rel i abi l i t as s kal a di gunakan rum us Al pha C r onbach . Dat a ya n g di perol eh kem udian di anal i s i s dengan m enggun akan an al i s i s des kri pt i f dan anal i s i s korel as i .Has i l penel i t i an m enunjukkan ada hubun gan ne ga t i f dan s i gni fi kan ant ar a s el f ef f i cacy m en ge rj akan s k ri psi dengan s t res yan g di al am i m ahas i s wa pro gr am s t udi bi m bi ngan d an konsel i n g Univers i t as N e ge ri Y og yak art a . Ha r ga ko efi s i en korel as i s ebes ar -0,730 m enunju kkan har ga n e gat i f pad a korel as i , dan has i l anal i s i s korel as i dengan s i gni fi kan s i 5%, N=42 , di perol eh th i tu n g(-6 ,759 )> tt a b el(-1,684 ) m enunjukkan t erdapat hubun gan yan g s i gni fi kan ant ara s el f ef f i cacy m en ge rj akan s k ri psi dengan s t res ya n g di al am i m ahas i s wa . Has i l anal i s i s korel as i m endukung perol eha n koefi s i en det e rm i nas i (R S qua re) s eb es ar 0,53 3 ya n g m enunjukkan b ahwa 53,3 % s t res m en gerj akan s k ri psi dapat di aki bat kan kar e na s el f ef f i cac y m en gerj a kan s kri psi . Berd as ark an h as i l t ers e but, dapat di s i m pulkan bahwa s em aki n b ai k s el f ef f i cacy m engerj akan s kri psi , m a ka s em aki n rendah t i ngkat s t res m enge rj akan s kri psi pada m ahas i s wa BK UN Y , be gi t upun s ebal i kn ya s em a ki n buruk s el f ef f i cacy mengerj ak an s kri psi , m aka s em aki n t i nggi t i ngk at s t res m en ge rj akan s kri psi pad a m ah as i s wa B K UNY. Kat a kunci : s el f e f f i c ac y mahasi s w a BK , st r es men ger j akan s kr i ps

Clinical review: Biomarkers of acute kidney injury: where are we now?

The recognition that acute kidney injury (AKI) is a significant independent risk factor for morbidity and mortality has resulted in a substantial number of publications over the past 5 years or more. In no small part these have, to a degree, highlighted the inadequacy of conventional markers of renal insufficiency in the acute setting. Much effort has been invested in the identification of early, specific AKI markers in order to aid early diagnosis of AKI and hopefully improve outcome. The search for a 'biomarker' of AKI has seen early promise replaced by a degree of pessimism due to the lack of a clear candidate molecule and variability of results. We outline the major studies described to date as well as discuss potential reasons for the discrepancies observed and suggest that evolution of the field may result in success with ultimately an improvement in patient outcomes

Diagnosis, evaluation, and management of acute kidney injury : a KDIGO summary (part 1)

Acute kidney injury (AKI) is a common and serious problem affecting millions and causing death and disability for many. In 2012, Kidney Disease: Improving Global Outcomes completed the first ever, international, multidisciplinary, clinical practice guideline for AKI. The guideline is based on evidence review and appraisal, and covers AKI definition, risk assessment, evaluation, prevention, and treatment. In this review we summarize key aspects of the guideline including definition and staging of AKI, as well as evaluation and nondialytic management. Contrast-induced AKI and management of renal replacement therapy will be addressed in a separate review. Treatment recommendations are based on systematic reviews of relevant trials. Appraisal of the quality of the evidence and the strength of recommendations followed the Grading of Recommendations Assessment, Development and Evaluation approach. Limitations of the evidence are discussed and a detailed rationale for each recommendation is provided

Long Term Prognosis after Acute Kidney Injury (AKI) - What is the Role of Baseline Kidney Function and Recovery? A Systematic Review

Peer reviewedPublisher PD

Involvement of heparanase in the pathogenesis of acute kidney injury: Nephroprotective effect of PG545

Despite the high prevalence of acute kidney injury (AKI) and its association with increased morbidity and mortality, therapeutic approaches for AKI are disappointing. This is largely attributed to poor understanding of the pathogenesis of AKI. Heparanase, an endoglycosidase that cleaves heparan sulfate, is involved in extracellular matrix turnover, inflammation, kidney dysfunction, diabetes, fibrosis, angiogenesis and cancer progression. The current study examined the involvement of heparanase in the pathogenesis of ischemic reperfusion (I/R) AKI in a mouse model and the protective effect of PG545, a potent heparanase inhibitor. I/R induced tubular damage and elevation in serum creatinine and blood urea nitrogen to a higher extent in heparanase over-expressing transgenic mice vs. wild type mice. Moreover, TGF-\u3b2, vimentin, fibronectin and \u3b1-smooth muscle actin, biomarkers of fibrosis, and TNF\u3b1, IL6 and endothelin-1, biomarkers of inflammation, were upregulated in I/R induced AKI, primarily in heparanase transgenic mice, suggesting an adverse role of heparanase in the pathogenesis of AKI. Remarkably, pretreatment of mice with PG545 abolished kidney dysfunction and the up-regulation of heparanase, pro-inflammatory (i.e., IL-6) and pro-fibrotic (i.e., TGF-\u3b2) genes induced by I/R. The present study provides new insights into the involvement of heparanase in the pathogenesis of ischemic AKI.Our results demonstrate that heparanase plays a deleterious role in the development of renal injury and kidney dysfunction,attesting heparanase inhibition as a promising therapeutic approach for AKI

Development of a MALDI MS-based platform for early detection of acute kidney injury

Purpose: Septic acute kidney injury (AKI) is associated with poor outcome. This can partly be attributed to delayed diagnosis and incomplete understanding of the underlying pathophysiology. Our aim was to develop an early predictive test for AKI based on the analysis of urinary peptide biomarkers by MALDI-MS. Experimental design: Urine samples from 95 patients with sepsis were analyzed by MALDI-MS. Marker search and multimarker model establishment were performed using the peptide profiles from 17 patients with existing or within the next 5 days developing AKI and 17 with no change in renal function. Replicates of urine sample pools from the AKI and non-AKI patient groups and normal controls were also included to select the analytically most robust AKI markers. Results: Thirty-nine urinary peptides were selected by cross-validated variable selection to generate a support vector machine multidimensional AKI classifier. Prognostic performance of the AKI classifier on an independent validation set including the remaining 61 patients of the study population (17 controls and 44 cases) was good with an area under the receiver operating characteristics curve of 0.82 and a sensitivity and specificity of 86% and 76%, respectively. Conclusion and clinical relevance: A urinary peptide marker model detects onset of AKI with acceptable accuracy in septic patients. Such a platform can eventually be transferred to the clinic as fast MALDI-MS test format

Xenobiotic metabolism: the effect of acute kidney injury on non-renal drug clearance and hepatic drug metabolism.

Acute kidney injury (AKI) is a common complication of critical illness, and evidence is emerging that suggests AKI disrupts the function of other organs. It is a recognized phenomenon that patients with chronic kidney disease (CKD) have reduced hepatic metabolism of drugs, via the cytochrome P450 (CYP) enzyme group, and drug dosing guidelines in AKI are often extrapolated from data obtained from patients with CKD. This approach, however, is flawed because several confounding factors exist in AKI. The data from animal studies investigating the effects of AKI on CYP activity are conflicting, although the results of the majority do suggest that AKI impairs hepatic CYP activity. More recently, human study data have also demonstrated decreased CYP activity associated with AKI, in particular the CYP3A subtypes. Furthermore, preliminary data suggest that patients expressing the functional allele variant CYP3A5*1 may be protected from the deleterious effects of AKI when compared with patients homozygous for the variant CYP3A5*3, which codes for a non-functional protein. In conclusion, there is a need to individualize drug prescribing, particularly for the more sick and vulnerable patients, but this needs to be explored in greater depth

Massive MU-MIMO Downlink TDD Systems with Linear Precoding and Downlink Pilots

We consider a massive MU-MIMO downlink time-division duplex system where a base station (BS) equipped with many antennas serves several single-antenna users in the same time-frequency resource. We assume that the BS uses linear precoding for the transmission. To reliably decode the signals transmitted from the BS, each user should have an estimate of its channel. In this work, we consider an efficient channel estimation scheme to acquire CSI at each user, called beamforming training scheme. With the beamforming training scheme, the BS precodes the pilot sequences and forwards to all users. Then, based on the received pilots, each user uses minimum mean-square error channel estimation to estimate the effective channel gains. The channel estimation overhead of this scheme does not depend on the number of BS antennas, and is only proportional to the number of users. We then derive a lower bound on the capacity for maximum-ratio transmission and zero-forcing precoding techniques which enables us to evaluate the spectral efficiency taking into account the spectral efficiency loss associated with the transmission of the downlink pilots. Comparing with previous work where each user uses only the statistical channel properties to decode the transmitted signals, we see that the proposed beamforming training scheme is preferable for moderate and low-mobility environments.Comment: Allerton Conference on Communication, Control, and Computing, Urbana-Champaign, Illinois, Oct. 201

Prevention of acute kidney injury and protection of renal function in the intensive care unit : update 2017

Background: Acute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity. Objectives: To determine and update previous recommendations for the prevention of AKI, specifically the role of fluids, diuretics, inotropes, vasopressors/vasodilators, hormonal and nutritional interventions, sedatives, statins, remote ischaemic preconditioning and care bundles. Method: A systematic search of the literature was performed for studies published between 1966 and March 2017 using these potential protective strategies in adult patients at risk of AKI. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, exposure to potentially nephrotoxic drugs and radiocontrast. Clinical endpoints included incidence or grade of AKI, the need for renal replacement therapy and mortality. Studies were graded according to the international GRADE system. Results: We formulated 12 recommendations, 13 suggestions and seven best practice statements. The few strong recommendations with high-level evidence are mostly against the intervention in question (starches, low-dose dopamine, statins in cardiac surgery). Strong recommendations with lower-level evidence include controlled fluid resuscitation with crystalloids, avoiding fluid overload, titration of norepinephrine to a target MAP of 65-70 mmHg (unless chronic hypertension) and not using diuretics or levosimendan for kidney protection solely. Conclusion: The results of recent randomised controlled trials have allowed the formulation of new recommendations and/or increase the strength of previous recommendations. On the other hand, in many domains the available evidence remains insufficient, resulting from the limited quality of the clinical trials and the poor reporting of kidney outcomes