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The Effect of Oral N-Acetyl Cysteine Administration on Acute Kidney Injury Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia Akbar, Hersusiad; Novadian; Mgs Irsan Saleh
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 7 No. 11 (2023): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v7i11.882

Background: Acute kidney injury (AKI) is a clinical condition characterized by a rapid decline in kidney function that includes structural damage (injury) or malfunction (impairment). AKI is a common complication that occurs in 5-10% of patients due to various underlying etiologies. One of the underlying pathophysiology of AKI is the role of discharge reactive oxygen species (ROS), which causes injury to kidney cells. From various studies, it has been reported that N-acetylcysteine (NAC) has anti-inflammatory and antioxidant effects and has an effect on reducing serum creatinine values. Methods: This research is an open randomized clinical trial without control involving 30 patients at Dr. Mohammad Hoesin General Hospital, Palembang, who were all given intervention in the form of NAC 1200 mg/day, starting in September – October 2023. This study aimed to determine the role of NAC in reducing serum creatinine values in patients with acute kidney injury at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Data analysis was carried out using SPSS 21 univariate and bivariate. Results: From the research results, it was found that the average age of patients was 53.9 years, involving 21 males (70%, N=30) and 9 females (30%, N=30). The most common causes were prerenal and then renal (53.3% and 46.7%). The initial serum creatinine level was found to be 2.12± 0.79 mg/dL (n = 30 samples), and after administration of the intervention, the mean serum creatinine level was 1.28± 0.63 mg/dL (n = 30 samples). By using a paired t-test, there was a decrease in serum creatinine levels significant (p=0,012). Conclusion: NAC administration to patients with acute kidney injury of pre-renal or post-renal causes has a statistical effect on reducing serum creatinine values in patients with acute kidney injury at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.

The Role of Podocyte Cells in Diabetic Nephropathy: A Narrative Literature Review Azhari, Fauzan; Novadian; Ian Effendi; Zulkhair Ali; Suprapti; Ratna Maila Dewi Anggraini; Yulianto Kusnadi; Alwi Shahab
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 7 No. 12 (2023): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v7i12.893

The main cells affected in diabetic nephropathy are podocytes and proximal tubular cells. One of the main functional proteins in the podocyte slit diaphragm is podocin which podocytes need to express together with several specific proteins in the correct way for their differentiation, as well as to maintain their complex anatomy. Podocytes are highly specialized epithelial cells. They line the urinary surface of the glomerular capillary bundles. Podocytes are part of the filtration barrier along with capillary endothelial cells and GBM. Podocytes ensure selective permeability of the glomerular capillary walls. Podocin is a membrane protein with a molecular weight of 42kD which is located in the foot processes, and also forms part of the SD with the nephrin protein. Urinary podocin levels more specifically indicate ongoing glomerular damage because they were significantly increased in the normoalbuminuria group compared with the control group.

Is It a Tumor or Not? A Case of Focal Segmental Glomerulosclerosis Secondary to Type 2 Diabetes with a Concomitant Renal Pseudotumor Rery TF Yuniarti; Ian Effendi; Zulkhair Ali; Novadian; Suprapti; Elfiani; Novandra AP; Dila Siti Hamidah; Fadil Pramudhya Husein; Ika Kartika Edi P
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 12 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i12.1154

Background: Focal segmental glomerulosclerosis (FSGS) is a histologic pattern of glomerular injury that can be primary or secondary to various conditions, including obesity, diabetes, and hypertension. Renal masses, often detected incidentally, can be benign or malignant, with renal cell carcinoma (RCC) being the most common. This case report presents a patient with FSGS secondary to type 2 diabetes and a concomitant renal pseudotumor, initially suspected to be RCC. Case presentation: A 60-year-old woman presented with weakness, fever, and weight loss. Imaging revealed a renal mass, initially suspected to be RCC. A kidney biopsy revealed FSGS, and further evaluation confirmed type 2 diabetes. After controlling her diabetes and hypertension, the renal mass regressed, suggesting a pseudotumor. Conclusion: This case highlights the importance of considering pseudotumors in the differential diagnosis of renal masses, especially in patients with comorbidities such as diabetes. A kidney biopsy can help avoid unnecessary invasive procedures like nephrectomy.

Neutrophil-Lymphocyte Ratio as a Novel Biomarker for Diabetic Nephropathy in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study Pradesta, Rahnowi; Novadian; Yulianto Kusnadi; Nova Kurniati; Syarif Husin
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 3 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i3.1235

Background: Early detection of diabetic nephropathy (DN) is crucial to prevent progression to end-stage renal disease. The gold standard for diagnosing DN involves urine microalbumin testing and renal biopsy. However, the availability of these diagnostic tools is limited in many healthcare facilities across Indonesia. Consequently, there is a pressing need for an alternative examination that is readily accessible and can effectively monitor the progression of DN. Methods: This cross-sectional study was conducted at Dr. Mohammad Hoesin General Hospital, Palembang, from February 2024 to May 2024. The study aimed to investigate the correlation between neutrophil-lymphocyte ratio (NLR) and urinary albumin levels in type 2 diabetes mellitus (DM) patients. NLR, calculated from complete blood counts, has emerged as a potential inflammatory marker for various conditions. A total of 65 participants diagnosed with type 2 DM were enrolled in the study. Data analysis involved Spearman's correlation test to assess the relationship between NLR and urinary albumin levels. Results: The majority of the 65 subjects were female (58.5%). The study found that 44 subjects had normoalbuminuria, 18 had microalbuminuria, and 3 had macroalbuminuria. A significant positive correlation was observed between NLR and albuminuria levels in type 2 DM patients (r = 0.795; p < 0.01). Conclusion: The study's findings suggest that NLR is a potential cost-effective biomarker for the early detection of DN in type 2 DM patients, especially in resource-limited settings. Further large-scale studies are recommended to validate these findings and establish specific NLR thresholds for predicting DN progression.

Bridging the Therapeutic Gap: A Systematic Review and Meta-Analysis on the Efficacy, Safety, and Pathophysiological Impact of Sodium Zirconium Cyclosilicate in Enabling Guideline-Directed Medical Therapy Edy Nur Rachman; Ian Effendi; Zulkhair Ali; Novadian; Suprapti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1489

Background: Hyperkalemia is a life-threatening complication of chronic kidney disease (CKD) and heart failure (HF), primarily impeding the use of life-saving renin-angiotensin-aldosterone system inhibitors (RAASi). This systematic review and meta-analysis evaluate the evidence for sodium zirconium cyclosilicate (SZC) in managing hyperkalemia and enabling RAASi therapy. Methods: This systematic review searched Medline, Embase, and Cochrane CENTRAL to September 2025. Dual reviewers independently screened, extracted data, and assessed bias (Cochrane RoB 2, Newcastle-Ottawa Scale). We included RCTs and observational studies of SZC in adults with hyperkalemia. A random-effects meta-analysis was performed on RCTs reporting maintenance-phase efficacy and safety. Results: The search yielded 1,254 citations, with 6 pivotal studies included. The meta-analysis of 3 RCTs found that SZC (5-10g daily) was significantly more effective than placebo at maintaining normokalemia over 12-28 days. The pooled mean difference in serum K+ was -0.58 mEq/L (95% CI: -0.65 to -0.51; I2 = 0%). SZC did increase the risk of edema (pooled Risk Ratio: 2.95; 95% CI: 1.51 to 5.76; I2 = 0%). The narrative synthesis of observational data confirmed that SZC use was associated with a >2.5-fold increase in the likelihood of continuing RAASi therapy. Conclusion: Sodium zirconium cyclosilicate is a highly effective and rapidly acting agent for both acute correction and chronic management of hyperkalemia. Our meta-analysis provides a precise estimate of its high maintenance-phase efficacy. Its primary clinical benefit lies in providing a renal-independent pathway for potassium excretion, thereby "uncoupling" potassium levels from RAASi use and bridging a critical treatment gap.

Modulation of TGF-β/Smad and Nrf2 Signaling Pathways by Thymoquinone in the Attenuation of Renal Fibrosis: A Systematic Review and Meta-Analysis of Pre-clinical Models Chairil Makky; Ian Effendi; Zulkhair Ali; Novadian; Suprapti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1491

Background: Renal fibrosis is the irreversible, final common pathway for all progressive forms of chronic kidney disease (CKD), leading to end-stage renal disease. Its pathogenesis is characterized by the over-activation of pro-fibrotic signaling, chiefly the Transforming Growth Factor-beta (TGF-β)/Smad pathway, and the failure of endogenous cytoprotective mechanisms like the nuclear factor erythroid 2-related factor 2 (Nrf2) antioxidant response. Thymoquinone (TQ), the primary bioactive constituent of Nigella sativa, is a pleiotropic compound with known anti-inflammatory and antioxidant properties. This study was designed to systematically quantify its mechanistic efficacy in modulating the core Nrf2 and TGF-β pathways in established pre-clinical models of renal fibrosis and injury. Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. We performed a comprehensive search of major databases (including PubMed and Scopus) for pre-clinical in vivo studies published between 2014 and 2025 that investigated TQ monotherapy or TQ-dominant combination therapy in rodent models of renal injury. The eight studies that met the inclusion criteria utilized diverse models: Unilateral Ureteral Obstruction (UUO), cisplatin-induced nephrotoxicity, gentamicin-induced nephrotoxicity, 5-fluorouracil (5-FU)-induced acute kidney injury (AKI), lipopolysaccharide (LPS)-induced inflammation, carfilzomib (CFZ)-induced renal impairment, and ischemia-reperfusion (IRI). Primary outcomes were the expression of renal Nrf2 and TGF-β1. Secondary outcomes included markers of fibrosis (collagen deposition, histology scores), renal function (BUN, creatinine), oxidative stress (MDA, SOD, GSH, CAT), and inflammation (TNF-α, NF-κB, IL-6, IL-1β). Data were pooled using a random-effects model, and primary analyses were stratified by injury model subgroup. Results: Thymoquinone treatment resulted in a profound and significant upregulation of the protective Nrf2 pathway (SMD: 2.38; 95% CI [1.05, 3.71]; p < 0.001; 3 studies) and its downstream target Heme Oxygenase-1 (HO-1). Concurrently, TQ treatment markedly suppressed the primary pro-fibrotic driver, TGF-β1 (SMD: -2.09; 95% CI [-2.99, -1.19]; p < 0.001; 2 studies). This pivotal dual modulation translated into significant functional and structural improvements. TQ robustly attenuated renal fibrosis scores (SMD: -1.89; 95% CI [-2.55, -1.23]; p < 0.001; 2 studies). Stratified subgroup analysis showed TQ significantly improved renal function in both chemotoxic AKI models (BUN SMD: -2.31; 95% CI [-3.22, -1.40]) and chronic obstructive/fibrosis models (BUN SMD: -1.17; 95% CI [-1.75, -0.59]). This functional protection was underpinned by potent, broad-spectrum reversal of oxidative stress and inflammation across all subgroups. Conclusion: Thymoquinone consistently ameliorates renal injury and fibrosis across a wide spectrum of pre-clinical models. Its mechanism of action is multifaceted, critically involving the dual modulation of opposing pro-fibrotic and protective pathways: it suppresses the TGF-β1 cascade while simultaneously activating and restoring the Nrf2 antioxidant response. This body of evidence strongly supports Thymoquinone as a high-potential candidate for translational research and development as a novel, network-targeting therapy for human renal fibrosis.

Beyond Phosphate Binding: A Systematic Review and Meta-Analysis on the Efficacy and Safety of the Novel Paracellular Phosphate Inhibitor, Tenapanor, for Hyperphosphatemia in Dialysis Patients Eva Julita; Ian Effendi; Zulkhair Ali; Novadian; Suprapti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1492

Background: Hyperphosphatemia is a critical driver of cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD) undergoing dialysis. Current management, reliant on phosphate binders, is hampered by high pill burden and poor adherence. Tenapanor, a first-in-class, minimally-absorbed sodium/hydrogen exchanger 3 (NHE3) inhibitor, reduces paracellular phosphate absorption. We performed a systematic review and meta-analysis of all available Phase 3 trials to quantify its efficacy and safety. Methods: We searched PubMed, Embase, and Cochrane CENTRAL through October 2025 for Phase 3 clinical trials evaluating tenapanor for hyperphosphatemia in dialysis patients. Data were extracted from 6 eligible studies (N=1573). We conducted separate random-effects meta-analyses for different study designs: 1) parallel-group monotherapy vs. placebo, 2) withdrawal-design monotherapy vs. placebo, 3) parallel-group add-on therapy vs. placebo, and 4) safety (diarrhea incidence) vs. placebo. Efficacy was measured by Mean Difference (MD) in serum phosphate change; safety by Risk Ratio (RR). Results: Tenapanor demonstrated significant efficacy across all study designs. In parallel-group monotherapy (1 study, N=167), tenapanor was superior to placebo (MD: -1.89 mg/dL; 95% CI: -2.36 to -1.42). In withdrawal-design studies (2 RCTs, N=373), tenapanor maintained serum phosphate levels significantly better than placebo (Pooled MD: -0.75 mg/dL; 95% CI: -1.05 to -0.45; I2=0%). As an add-on therapy (1 RCT, N=235), tenapanor provided additional phosphate reduction versus binders alone (MD: -0.65 mg/dL; 95% CI: -0.96 to -0.35). Tenapanor significantly increased the risk of diarrhea versus placebo (3 RCTs, N=521; Pooled RR: 4.10; 95% CI: 2.50 to 6.72; I2=30%), which was the primary adverse event leading to discontinuation. Conclusion: Tenapanor represents a new mechanistic paradigm for hyperphosphatemia management. It is a highly effective phosphate-lowering agent, both as monotherapy and add-on therapy, but is associated with a significant, mechanism-based risk of gastrointestinal side effects.

Gut Microbiota in Chronic Kidney Disease: A Narrative Literature Review Abdillah, Novandra; Zulklhair Ali; Novadian; Ian Effendi; Suprapti; Elfiani; Rery TF Yuniarti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 4 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i4.976

Chronic kidney disease (CKD) is a growing public health problem related to loss of kidney function and cardiovascular disease as the main causes of morbidity and mortality in CKD. It is known that CKD is associated with intestinal dysbiosis. There is an influence of the gut microbiota on the gut-kidney axis and it works reciprocally: on the one hand, CKD significantly changes the composition and function of the gut microbiota. On the other hand, gut microbiota is able to manipulate the processes that cause the emergence and progression of CKD through inflammatory, endocrine and neurological pathways. Understanding the complex interactions between gut and kidney microbiota may provide novel nephroprotective interventions to prevent the progression of CKD by therapeutically targeting balance of gut microbiota composition.

Gut Microbiota in Chronic Kidney Disease: A Narrative Literature Review Abdillah, Novandra; Zulklhair Ali; Novadian; Ian Effendi; Suprapti; Elfiani; Rery TF Yuniarti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 4 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i4.976

Chronic kidney disease (CKD) is a growing public health problem related to loss of kidney function and cardiovascular disease as the main causes of morbidity and mortality in CKD. It is known that CKD is associated with intestinal dysbiosis. There is an influence of the gut microbiota on the gut-kidney axis and it works reciprocally: on the one hand, CKD significantly changes the composition and function of the gut microbiota. On the other hand, gut microbiota is able to manipulate the processes that cause the emergence and progression of CKD through inflammatory, endocrine and neurological pathways. Understanding the complex interactions between gut and kidney microbiota may provide novel nephroprotective interventions to prevent the progression of CKD by therapeutically targeting balance of gut microbiota composition.

Is It a Tumor or Not? A Case of Focal Segmental Glomerulosclerosis Secondary to Type 2 Diabetes with a Concomitant Renal Pseudotumor Rery TF Yuniarti; Ian Effendi; Zulkhair Ali; Novadian; Suprapti; Elfiani; Novandra AP; Dila Siti Hamidah; Fadil Pramudhya Husein; Ika Kartika Edi P
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 12 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i12.1154

Background: Focal segmental glomerulosclerosis (FSGS) is a histologic pattern of glomerular injury that can be primary or secondary to various conditions, including obesity, diabetes, and hypertension. Renal masses, often detected incidentally, can be benign or malignant, with renal cell carcinoma (RCC) being the most common. This case report presents a patient with FSGS secondary to type 2 diabetes and a concomitant renal pseudotumor, initially suspected to be RCC. Case presentation: A 60-year-old woman presented with weakness, fever, and weight loss. Imaging revealed a renal mass, initially suspected to be RCC. A kidney biopsy revealed FSGS, and further evaluation confirmed type 2 diabetes. After controlling her diabetes and hypertension, the renal mass regressed, suggesting a pseudotumor. Conclusion: This case highlights the importance of considering pseudotumors in the differential diagnosis of renal masses, especially in patients with comorbidities such as diabetes. A kidney biopsy can help avoid unnecessary invasive procedures like nephrectomy.

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