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All Journal Medicina journal of internal medicine Majalah Kedokteran Bandung The Indonesian Biomedical Journal Universa Medicina Indonesian Journal of Rheumatology Jurnal Penyakit Dalam Udayana ISM (Intisari Sains Medis) : Jurnal Kedokteran Neurologico Spinale Medico Chirurgico Bali Anatomy Journal Al-Iqra Medical Journal : Jurnal Berkala Ilmiah Kedokteran The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Seminar Ilmiah Nasional Teknologi, Sains, dan Sosial Humaniora (SINTESA)
Yenny Kandarini
Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran, Universitas Udayana, Denpasar, Bali
Agriculture, Biological Sciences & Forestry Biochemistry, Genetics & Molecular Biology Computer Science & IT Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Social Sciences

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Journal : journal of internal medicine

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PREVALENSI DAN HUBUNGAN SINDROM METABOLIK DENGAN PENYAKIT GINJAL KRONIK PADA POPULASI DESA LEGIAN, KUTA BALI Ayu, Paramita; Kandarini, Yenny; Widiana, G Raka; Sudhana, W; Loekman, Jodhi S; Suwitra, K
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Abstract

Metabolic syndrome may relate to pathogenesis of chronic kidney disease (CKD). There is scarce data with regard to thatphenomenon in Indonesian general population. We conduct a study to determine the prevalence of metabolic syndrome and itsrelationship with CKD individuals in general population of Legian Village, Bali. An analytical cross sectional study was carriedout in the community of Legian Village, a tourist destination in Bali. Samples were selected through simple random sampling.Two hundred and eighty four samples (117 males and 107 females, aged 46.1 ± 10.02 years) were included. Prevalenceof hypertension, hypertrigliseridemia, hypoHDL-cholesterol, central obesity, impaired fasting glucose (IFG), obese and CKDwas 14.1%, 38.4%, 25%, 18%, 11.6%, 51.8% and 11.6% respectively. Using bivariate analysis, there were strong and significantrelationship between hypertension (OR 2.6, 95%CI 1.12 to 6.19, p = 0.02) and IFG (OR 5.21; 95%CI 2.23 to 12.13, p = 0.00) withCKD. Using multivariate logistic regression entering those components of metabolic syndrome into the model, it was consistentlyfound that hypertension and DM is the associated factors for CKD in the population. There was increasing odds of CKD about1,0-fold every augment of metabolic syndrome components (OR 1.098; 95%CI 0.83 to 1.44). As our conclusion, hypertensionand IFG are associated factor for CKD in general population. Multiple components increased risk factor for CKD.
HUBUNGAN ANTARA KADAR LEPTIN DAN ADIPONEKTIN PLASMA PADA PASIEN DENGAN DIALISIS RUTIN Raka Widiana, I Gde; Kandarini, Yenny; Suwitra, Ketut
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

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Leptin and adiponectin (ADPN) are adipokines with respective pro-atherogenic and anti atherogenic properties. In nonrenalpatients, both hyperleptinemia and hypoadiponectinemia are associated with cardiovascular complication. Relationshipsbetween serum leptin and ADPN in patients with dialysis is not consistently reported.Objective of this study is evaluate relationships between serum ADPN and leptin in patients with dialysis. A cross sectionalstudy was performed in and 54 HD and 22 CAPD patients.Seventy six patients were enrolled this study, M/F 41/76, aged 48.4±11.4 year, BMI 21.4±2.7 kg/m2, haemoglobin (Hb)7.9±1.5 mg/dL, blood sugar 94.8±33.5 mg/dL, albumin 4.1±0.4 g/dL, total-cholesterol 177.9±46.3 mg/dL, triglyserida 164.4±104.8mg/dL, SC 14.3±3.8 mg/dL, TNF 14.40±7.43 pg/mL, ADPN 17.6±7.6 µg/mL, leptin 13068±23589 µg/mL (log leptin 3.7±0.59µg/ml). Using Spearmans rho analysis there were negative correlation between log-leptin and ADPN (r= -0.39, p= 0.00), andpositive correlation between log leptin and Hb (r= 0.25, p= 0.04), insulin(r= 0.44, p = 0.00), total-cholesterol (r= 0.34, p = 0.003),triglyserida (r= 0.41, p= 0.00), and BMI (r= 0.41, p= 0.00), but there was no correlation between log-leptin and albumin, bloodsugar, SC and TNF alfa. Using multiple regression to analyze relationship between ADPN and leptin, insulin, Hb, and dialysismodality, we found log leptin independently correlated with ADPN (B= -0.402, p= 0.01, 95%CI B: -1.24 to -0.32). Using multipleregression to analized relationship between ADPN with log-leptin, BMI, total cholesterol, and triglyserida, we found log leptin(beta= -0.3, p= 0.01, 95%CI B: -0.98 to -0.13) and triglyserida independently correlated with ADPN (beta= -0.5, p= 0.00, 95%CIB: -0.008 to -0.003).Serum leptin and triglyseride relate with ADPN. Some metabolic parameters such as insulin resistance, anemia, dialysismodality, nutritional status (BMI and total cholesterol) have indirect relationship with ADPN may be through leptin secretion.
KEJADIAN PERITONITIS PADA PASIEN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS: IDENTIFIKASI MIKROORGANISME DAN SENSITIFITAS ANTIBIOTIK Haryanti, Elizabeth; Kandarini, Yenny; Widiana, I Gde Raka; Sudhana, Wayan; Loekman, Jod; Suwitra, Ketut
journal of internal medicine Vol. 11, No. 2 Mei 2010
Publisher : journal of internal medicine

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Abstract

Patients treated with Continuous Ambulatory Peritoneal Dialysis (CAPD) are constantly exposed to microbial invasionof the peritoneal cavity and rapid microbiological diagnosis of peritonitis is essential due to Hospitalization and imposes asignicant burden of morbidity. The aims of this study were to enumerate the association between microorganisms, sensitity,and resistence of antibiotic on CAPD patients with clinical peritonitis.We collected data through medical records by the number of CAPD patients with clinical peritonitis from June 2004 untilJune 2009. The study was analysis with one-way ANOVA. We found 23 patients clinical peritonitis out of 77 CAPD patients,with insidence was 14% per-year, aged 14 ? 65 y (15M; 8F). The chronic pyelonephritic was a leading (16/23) cause of endstages renal disease. Each patients underwent HD prior (5 ? 60 months) to CAPD, with survival time was 2 ? 51 months. Out of23 patients, 4 were returned to hemodialisis, 15 were died, due to cardiogenic shock 46.7%. Aseptic peritonitis was 31.3%, andthe common microorganism was staphylococcus 18.8%. Peritoneal !uid test showed mean score of sensitivity were tetracycline22.93, cipro!oxacin 19.36, piperacillin-tazobactam 17.36, thrimetropin/sulfamethoxazole 16.5, fosfomycin 15.78, consecutivelyand the rest were resistent. Staphylococus was strongly related to insidence peritonitis, and tetracycline was the most highlysensitive antibiotic in CAPD patients.
HUBUNGAN ANTARA PERUBAHAN VOLUME DARAH RELATIF DENGAN EPISODE HIPOTENSI INTRADIALITIK SELAMA HEMODIALISIS PADA GAGAL GINJAL KRONIK Agustriadi, Ommy; Suwitra, Ketut; Raka Widiana, Gde; Sudhana, Wayan; Sidharta Loekman, Jodi; Kandarini, Yenny
journal of internal medicine Vol. 10, No. 2 Mei 2009
Publisher : journal of internal medicine

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Abstract

Intradialytic hypotension (IDH) is a common complication in chronic hemodialysis (HD) patients, in turn would increase morbidity and mortality. Relative blood volume changes during HD play a role in IDH episode. Those changes can be assessed by total plasma protein measurement before and after HD. To determine relationship between relative blood volume changes (assessed by percentage of total plasma protein changes during HD) and IDH episode during HD in chronic renal failure, an analytical cross-sectional study was perferomed in 51 patients (28 males and 23 females, age 47.8 ±11.6 years) underwent chronic HD at Hemodialysis Unit of Sanglah Hospital Denpasar. Data were collected during single HD session. Blood pressure was measured every 30 minutes and relative blood volume changes assessed by measuring percentage of total plasma protein changes during HD. Among them, IDH episode experienced in 10 (19.6%) patients. Logistic regression analysis revealed a strong and significant relationship between relative blood volume changes and IDH episode during HD in chronic renal failure (Beta = 0.29; OR = 1.35; CI 95%: 1.1 - 1.6; p < 0.01) and it was found that every 1% changes in relative blood volume, would increase risk of hypotension episode by 35%. This relationship was still strong and significant (Beta = 0.46; OR = 1.58; CI 95%: 1.11 -2.25; p = 0.01) after adjusted by hemoglobin levels, intradialytic body weight changes, use of antihypertensive medi¬cations and diabetes melitus. Using ROC curve, found that optimal cut of point of intradialytic total plasma protein changes to predict an IDH episode during HD was 5.56% with 90.0% sensitivity and 80.5% specificity (95% CI: 0.83-0.99; p < 0.01). Our data revealed a strong and significant relationship between intradialytic relative blood volume changes assessed by intradialytic total plasma protein changes and IDH episode during HD in chronic renal failure.
PENGARUH SPIRONOLAKTON SEBAGAI TERAPI TAMBAHAN ACE INHIBITOR DAN/ATAU ANGIOTENSIN RECEPTOR BLOCKERS TERHADAP ALBUMINURIA PADA PENYAKIT GINJAL KRONIK PRADIALITIK STUDI KLINIS ACAK TERKONTROL BUTA GANDA -, Yuriawantini; Suwitra, Ketu; Raka Widiana, I Gde; Sidharta Loekman, Jodi; Sudhan, Wayan; Kandarini, Yenny
journal of internal medicine Vol. 9, No. 3 September 2008
Publisher : journal of internal medicine

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Abstract

Recently studies suggest that aldosterone contributes to progressive kidney disease. This has raised the possibility ofusing aldosterone antagonist in CKD. To evaluate effects of spironolactone 25 mg/day on albuminuria in CKD patients, thirtyCKD patients were enrolled in randomized double blind placebo controlled study. Permutted block randomization was done toreceive spironolactone 25 mg/day or placebo as control in addition to ACE inhibitors and/or ARBs. Albuminuria and bloodpressure were examined at baseline and 12 weeks. Albuminuria was measured as urinary albumin:creatinine ration and comparedas primary out come. During this study 15 patient were received conventional therapy and spironolactone 25 mg/day and 15patient were received placebo. One of patient dropped-out after 4 weeks due to hiperkalemia in spironolactone group and one ofpatient in the control group lost to follow-up. After 12 weeks of therapy, in spironolactone group albuminuria was decreased from510 (180.0 ? 798.0) to 254.0 (40.3 ? 491.8) mg/g, MD, 187.0 (29.0 ? 332.3) mg/g, p= 0.035 and in control group from 804.0 (52.0? 1126.0) to 637.0 (99.0 ? 1098.8) mg/g MD -10.5 (-186.5-86.0) mg/g, p= 0.490. There was significant difference of decreamentof albuminuria in both groups (Z=-0.69, p=0.046). There were no statistically different of serum potassium levels and bloodpressure in both groups after treatment. Baseline aldosterone levels were not significantly correlated with albuminuria (r = -0.128,p = 0.499). As Conclusion in this study is spironolactone reduces albuminuria in pradialytic CKD patients
HUBUNGAN PENYAKIT GINJAL KRONIS PREDIALISIS DENGAN BEBERAPA PARAMETER PENYAKIT ATEROSKLEROSIS ARTERI KAROTIS Sutarka, Nyoma; Suwitra, Ketut; Loekman, Jodi S; Sudhana, Wayan; Kandarini, Yenny; Martadiani, Elysanti Dwi; Margian, Nyoman
journal of internal medicine Vol. 11, No. 3 September 2010
Publisher : journal of internal medicine

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Abstract

Carotid artery intima media thickness (cIMT) is valid marker of subclinical atherosclerosis because it gives sign of earlyatherosclerosis process. We conduct this study to know the relationship between predialysis chronic kidney disease (CKD) withseveral parameters of carotid arterial atherosclerosis.A cross sectional study was done in patients with predialysis CKD who came to outpatient Clinic of Nephrology inSanglah General Hospital from May 2009. CKD criteria is based on KDQQI 2003. Estimated Glomerular Filtration Rate (eGFR)was calculated with Cockroft-Gault formula. Measurement of cIMT is done by USG B-Mode with USG Logig-5.There were 30 patients (20 with eGFR < 60 ml/mnt and 10 with eGFR 60 ml/mnt). Mean of cIMT in eGFR < 60ml/mnt: right/left cIMT1 0.24445 ± 0.3096/0.3210 ± 0.4006 mm; IMT2 0.2405 ± 0.3138/0.2825 ± 0.3971 mm; IMT3 0.2315 ±0.3026/0.2820 ± 0.3672 mm; bifurkatio IMT 0.3115 ± 0.4069/0.3515 ± 0.4991 mm; total IMT 0.6350 ± 0.1738/0.6938 ± 0.1912mm. For eGFR > 60 ml/mnt: right/left IMT1 0.1120 ± 0.1722/0.1030 ± 0.1398 mm; IMT2 0.0880 ± 0.1103/0.1130 ± 0.1718mm; IMT3 0.1010 ± 0.1408/0.1170 ± 0.1700 mm; bifurcatio IMT 0.1920 ± 0.3545/0.1980 ± 0.3527 mm, total IMT 0.6250 ±0.1269/0.6750 ± 0.1124 mm. There was signiÞ cant difference in eGFR < 60 ml/mnt the left IMT1 (MD: 0.21 CI95% 0.01 ! 0.42;p = 0.038). Five out of 20 patients with eGFR < 60 ml/mnt and 6 among 10 patients of eGFR 60 ml/mnt were found plaques.There are no signiÞ cant difference of plaque location, plaque width, and lumen diameter between carotid arterial with andwithout plaque. As a conclusion we found there is no signiÞ cant difference between predialysis CKD with several parameters ofcarotid arterial atherosclerosis but cIMT tends to be thicker on predialysis CKD patients with eGFR < 60 ml/mnt.
Co-Authors Anak Agung Gde Oka Anak Agung Wiradewi Lestari Ayu, Nyoman Paramita Bagus Juniada Cokorda Agung Wahyu Purnamasidhi Djodi Sidartha Dwijo Anargha Sindhughosa Elim Jusri Elizabeth Haryanti Elysanti Dwi Martadiani Gede Andi Aditya Gede Kambayana Gede Wira Mahadita Gede Wira Mahadita Gede Wirya Kusuma Duarsa Hanik Nuryanti Hendra Koncoro I Dewa Nyoman Wibawa I Gde Raka Widiana I Gede Ketut Sajinadiyasa I Gusti Agung Ayu Indira Nirmala Dewi I Ketut Mariadi I KETUT SUARDANA, I KETUT I Made Ady Wirawan I Made Arya Winangun I Made Bakta I Made Jawi I Wayan Putu Sutirta Yasa I Wayan Yudiana IBN Mahendra Ida Bagus Putra Pramana Jod Loekman Jodhi S Loekman Jodi S Loekman Jodi Sidharta Loekman K Suwitra Kadek Budi Santosa Kadek Wisnu Segara Karya Ketu Suwitra Ketut Suega Ketut Suwitra Lesmana, Cokorda Agung Bagus Jaya Made Dyah Vismita Indramila Duarsa Made Dyah Vismita Indramila Duarsa Duarsa Mahadita, Gede Wira Marciyasa, Putu Agus Marleen Ni Luh Parameswari Praptika Ni Nyoman Shinta Prasista Sari Ni Putu Rani Apsari Dewi Ni Wayan Winarti Nicholas Wijayanto Nyoma Sutarka Nyoman Margian Nyoman Paramita Ayu Nyoman Yudia Trianadewi Nurbudhi Oka Udrayana Ommy Agustriadi Pande Ketut Kurniari Pande Made Wisnu Tirtayasa Purnamawati, Susy Putu Aryani Putu Astri Novianti Santosa, I Gusti Ngurah Putra Eka Sianny Herawati Sudjana, Karismayusa Triharnoto Triharnoto W Sudhana Wayan Sudana Wayan Sudhan Wayan Sudhana Wira Gotera Yuriawantini -