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The Uncoupling Phenomenon: Dissociation Between Albuminuria and Glomerular Filtration Rate in an Advanced Diabetic Kidney Disease Phenotype Naufal Fathi Ashari; Harnavi Harun; Russilawati; Dinda Aprilia; SM Rezvi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1521

Background: The classical paradigm of diabetic kidney disease (DKD) assumes a synchronous, linear trajectory where increasing albuminuria predicts the decline of glomerular filtration rate (GFR). However, emerging epidemiology suggests these markers may dissociate in advanced disease stages, particularly under modern renoprotective pharmacotherapy. We aimed to investigate this uncoupling phenomenon by evaluating the correlation between urine albumin creatinine ratio (UACR) and estimated GFR (eGFR) in a specific cohort of advanced DKD patients in Indonesia. Methods: We conducted a cross-sectional analytic study from January to November 2025 at Dr. M. Djamil General Hospital Padang, a tertiary referral center. The study population comprised 30 patients with established DKD, predominantly in CKD Stages 3b and 4. The primary outcome was the Spearman rank correlation (r) between UACR and eGFR, reported with 95% Confidence Intervals (CI). An exploratory sub-analysis compared trends in patients receiving SGLT2 inhibitors (n=12) versus standard care (n=18). Results: The cohort was elderly (mean age 61.93 years) with critical renal reserve depletion (median eGFR 32.50 mL/min/1.73 m²). Median UACR was 403.90 mg/g, yet exhibited massive heterogeneity (IQR: 170.82–1779.27). Spearman analysis revealed a complete lack of linear correlation between albuminuria and filtration function (r = 0.041; 95% CI: -0.322 to 0.395; p = 0.830). While SGLT2 inhibitor users (n=12) demonstrated numerically lower median UACR than non-users (n=18), the dissociation from eGFR persisted in both subgroups. Conclusion: We demonstrate a distinct dissociation between albuminuria severity and filtration function in advanced DKD. This uncoupling suggests that in late-stage nephropathy, structural glomerulosclerosis and tubulointerstitial fibrosis progress independently of permeability changes. Consequently, albuminuria cannot serve as a sole surrogate for disease progression in this phenotype, supporting a dual-biomarker strategy where UACR and eGFR are monitored as independent risk factors.

Diabetic Ketoacidosis in Type 1 Diabetes Mellitus Lukman Nurhakim; Rudy Afriant; Dinda Aprilia
Sumatera Medical Journal Vol. 7 No. 1 (2024): Sumatera Medical Journal (SUMEJ)
Publisher : Talenta Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/sumej.v7i1.11837

Background: Diabetic ketoacidosis (DKA) is a state of metabolic decompensation/disorder characterized by the triad of hyperglycemia, acidosis and ketosis, caused by absolute or relative insulin deficiency and increased counter-regulatory hormones. Objective: To report a case of diabetic ketoacidosis (DKA) in a young adult patient with type 1 diabetes mellitus and scalp abscess, emphasizing the importance of early diagnosis and prompt management to achieve clinical improvement. Methods: This case report describes the clinical presentation, diagnostic approach, and therapeutic management of a 19-year-old male with DKA. Results: A 19-year-old male treated in the internal medicine ward of Dr. M djamil Padang with diabetic ketoacidosis, type 1 DM, and Abscess capitis. The patient was treated with rehydration and intravenous insulin infusion can show clinical improvement. Conclusion: The diagnosis in patients is based on anamnesis, physical examination and supporting examinations. Immediate therapy is needed in the management of DKA in patients. After DKA is resolved, look for the causes of the risk of DKA. On the third day of treatment the patient's condition improved clinically and the laboratory.

The Uncoupling Phenomenon: Dissociation Between Albuminuria and Glomerular Filtration Rate in an Advanced Diabetic Kidney Disease Phenotype Naufal Fathi Ashari; Harnavi Harun; Russilawati; Dinda Aprilia; SM Rezvi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1521

Background: The classical paradigm of diabetic kidney disease (DKD) assumes a synchronous, linear trajectory where increasing albuminuria predicts the decline of glomerular filtration rate (GFR). However, emerging epidemiology suggests these markers may dissociate in advanced disease stages, particularly under modern renoprotective pharmacotherapy. We aimed to investigate this uncoupling phenomenon by evaluating the correlation between urine albumin creatinine ratio (UACR) and estimated GFR (eGFR) in a specific cohort of advanced DKD patients in Indonesia. Methods: We conducted a cross-sectional analytic study from January to November 2025 at Dr. M. Djamil General Hospital Padang, a tertiary referral center. The study population comprised 30 patients with established DKD, predominantly in CKD Stages 3b and 4. The primary outcome was the Spearman rank correlation (r) between UACR and eGFR, reported with 95% Confidence Intervals (CI). An exploratory sub-analysis compared trends in patients receiving SGLT2 inhibitors (n=12) versus standard care (n=18). Results: The cohort was elderly (mean age 61.93 years) with critical renal reserve depletion (median eGFR 32.50 mL/min/1.73 m²). Median UACR was 403.90 mg/g, yet exhibited massive heterogeneity (IQR: 170.82–1779.27). Spearman analysis revealed a complete lack of linear correlation between albuminuria and filtration function (r = 0.041; 95% CI: -0.322 to 0.395; p = 0.830). While SGLT2 inhibitor users (n=12) demonstrated numerically lower median UACR than non-users (n=18), the dissociation from eGFR persisted in both subgroups. Conclusion: We demonstrate a distinct dissociation between albuminuria severity and filtration function in advanced DKD. This uncoupling suggests that in late-stage nephropathy, structural glomerulosclerosis and tubulointerstitial fibrosis progress independently of permeability changes. Consequently, albuminuria cannot serve as a sole surrogate for disease progression in this phenotype, supporting a dual-biomarker strategy where UACR and eGFR are monitored as independent risk factors.

Profil Risiko Diabetes dan Sindrom Metabolik Berdasarkan Indeks Massa Tubuh dan Glukosa Darah Sewaktu di Bukik Batabuah Dinda Aprilia; Eva Decroli; Alexander Kam; Yanne Pradwi Efendi; Athari Fadhila Namanda Putri
Abdika Sciena Vol 3 No 2 (2025): JURABDIKES Volume 3 No 2, Desember 2025
Publisher : CV. AKBAR PUTRA MANDIRI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56260/jurabdikes.v3i2.328

Latar Belakang: Diabetes melitus (DM) dan sindrom metabolik merupakan masalah kesehatan global dengan peningkatan prevalensi setiap tahun. Indeks massa tubuh (IMT) dan kadar glukosa darah merupakan indikator penting dalam menilai risiko DM dan sindrom metabolik pada populasi komunitas. Tujuan: Mengetahui karakteristik indikator risiko DM dan sindrom metabolik berdasarkan IMT, GDS dan demografis masyarakat Bukik Batabuah tahun 2024. Metode: Penelitian deskriptif observasional terhadap 69 responden. Data yang dikumpulkan meliputi usia, jenis kelamin, IMT, kategori IMT, dan GDS. Analisis dilakukan secara deskriptif. Hasil: Rerata usia responden 50,93 tahun, dengan mayoritas perempuan (76,81%). Rerata IMT 23,23 kg/m² dengan 24,64% responden tergolong overweight–obesitas. Rerata GDS 130,59 mg/dL dengan nilai maksimum 337 mg/dL menunjukkan adanya risiko gangguan glukosa. Kesimpulan: Populasi Bukik Batabuah menunjukkan risiko metabolik yang ditandai dengan IMT di atas normal. Skrining komunitas dan intervensi promotif-preventif diperlukan

Dose-dependent effects of Stevia rebaudiana leaf extract on malondialdehyde and catalase activity in alloxan-induced hyperglycemic rats Zhira Shada Athaya; Eti Yerizel; Dinda Aprilia; Rozi Abdullah; Fadrian; Westi Permata Wati; Husna Yetti
Acta Biochimica Indonesiana Vol. 9 No. 1 (2026): Acta Biochimica Indonesiana
Publisher : Indonesian Society for Biochemistry and Molecular Biology

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32889/actabioina.232

Background: Diabetes mellitus-induced hyperglycemia triggers oxidative stress, characterized by elevated malondialdehyde (MDA) and impaired catalase (CAT) activity. Stevia rebaudiana, rich in steviol glycosides and polyphenols, demonstrates promising antioxidant properties, yet systematic dose-response data on oxidative stress biomarkers remain limited. Objectives: To evaluate the dose-dependent effects of stevia leaf extract on serum MDA levels and CAT activity in alloxan-induced hyperglycemic rats. Methods: Twenty-five male Wistar rats were allocated into normal control, diabetic control (alloxan 120 mg/kg), and three treatment groups receiving alloxan plus stevia extract at 100, 200, or 400 mg/kg body weight orally for 14 days (n=5/group). Serum MDA and CAT were measured spectrophotometrically. Results: Diabetic control showed significantly elevated MDA (2.68±0.62 mg/dL) versus normal control (1.78±0.30 mg/dL). Stevia extract dose-dependently reduced MDA: 1.70±0.19, 1.54±0.20, and 1.38±0.09 mg/dL at 100, 200, and 400 mg/kg, respectively, representing 36.6%, 42.5%, and 48.5% reduction. The 400 mg/kg dose achieved MDA levels comparable to normal control. CAT activity showed dose-dependent restoration trend (7.92±0.76 to 8.58±0.52 mg/dL). Conclusion: Stevia leaf extract (400 mg/kg BW) effectively reduces oxidative stress in hyperglycemic rats through significant dose-dependent MDA reduction, with potential catalase benefits requiring further investigation.

Perbandingan skor SOFA pada pasien sepsis dengan dan tanpa diabetes melitus tipe 2 Munsyi Nares Wari; Fadrian; Eti Yerizel; Mohamad Reza; Dinda Aprilia; Eka Nofita
Jurnal Kesehatan Andalas Vol. 15 No. 1 (2026): March 2026
Publisher : Faculty of Medicine, Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/jka.v15i1.2672

Comparison of SOFA scores in septic patients with and without type 2 diabetes mellitus Sepsis is a life-threatening organ dysfunction. A dysregulated host response to infection causes it. Organ dysfunction can be represented by an increase in the SOFA score of > 2 points. Every increase in the score reflects worsening of organ dysfunction. Type-2 Diabetes Mellitus (T2DM) is one of the most common comorbidities in sepsis patients. T2DM patients have chronic hyperglycemia. This condition can impair immune function and damage the endothelium. Objective: To find out the comparison of SOFA scores in sepsis patients with and without T2DM. Methods: This research was an analytical, cross-sectional study using medical record data from RSUP Dr. M. Djamil Padang. The 132 samples comprised 66 sepsis patients with T2DM and 66 without T2DM. Sampling was carried out by using a stratified random sampling technique. Bivariate data analysis used an independent-samples t-tes. The mean of SOFA scores in sepsis patients with T2DM was 8.05 +_ 2.36 and the mean of SOFA scores in sepsis patients 6.38 +_ 2.96. The p-value (<0,05) in both groups was 0.001. Conclusion: There is a significant difference in SOFA scores between sepsis patients with and without T2DM. Keywords: sepsis, SOFA score, T2DM

Pituitary macroadenoma with optic chiasm compression and hypopituitarism: a case report Alexander Kam; Dinda Aprilia; Eva Decroli
Universa Medicina Vol. 45 No. 1 (2026)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2026.v45.81-87

INTRODUCTIONPituitary macroadenomas are benign pituitary tumors measuring more than 1 cm in diameter that constitute a substantial proportion of intracranial neoplasms. Despite their benign histology, these tumors may lead to significant morbidity due to local mass effects and endocrine dysfunction. Compression of the optic chiasm can result in progressive visual impairment and irreversible blindness if not promptly treated. Additionally, pituitary hormonal deficiencies may cause life-threatening metabolic and systemic complications. Early recognition and multidisciplinary management are therefore essential to prevent permanent sequelae and optimize functional recovery. Case DescriptionA 40-year-old woman presented with a one-year history of recurrent headaches accompanied by progressive blurring of vision, diplopia, and visual field defects. She also reported irregular menstruation and unintended weight loss. Brain magnetic resonance imaging demonstrated a 2.13 × 2.28 × 3.05 cm pituitary macroadenoma with a characteristic “snowman appearance” compressing the optic chiasm. Hormonal evaluation revealed secondary adrenal insufficiency, hypogonadotropic hypogonadism, suppressed thyroid-stimulating hormone (TSH) with elevated free thyroxine (T4), and hyperprolactinemia attributed to the stalk effect, consistent with hypopituitarism and thyroid dysfunction. Initial stabilization with hydrocortisone and methimazole was performed prior to definitive management. The patient subsequently underwent transsphenoidal tumor resection with appropriate perioperative glucocorticoid coverage. Postoperatively, she remained clinically stable with improvement in headache and visual symptoms, and continued hormonal therapy under close endocrinological supervision. ConclusionsThis case underscores the importance of comprehensive hormonal assessment, timely neurosurgical intervention, and coordinated multidisciplinary care in managing pituitary macroadenomas complicated by optic chiasm compression and hypopituitarism to achieve favorable clinical outcomes.

Glucocorticoid-induced adrenal insufficiency after receiving intravenous methylprednisolone for Graves' ophthalmopathy: a case report Yanne Pradwi Efendi; Dinda Aprilia; Eva Decroli
Universa Medicina Vol. 45 No. 1 (2026)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2026.v45.76-80

BACKGROUNDGraves’ ophthalmopathy (GO) is the most common extrathyroidal manifestation of Graves’ disease and can significantly impair visual function and quality of life. High-dose intravenous methylprednisolone (IVMP) is recommended as first-line therapy for moderate-to-severe active GO due to its superior efficacy and tolerability compared with oral glucocorticoids. However, IVMP therapy may be associated with rare but potentially serious adverse effects, including suppression of the hypothalamic–pituitary–adrenal (HPA) axis leading to GI adrenal insufficiency (GI-AI). Case descriptionWe report the case of a 38-year-old man with Graves’ disease who developed AI following IVMP therapy for moderate-to-severe GO. The patient received five weekly doses of IVMP 500 mg (cumulative dose 2.5 g) for progressive ocular symptoms. He subsequently presented with fatigue, weight gain, moon face, and buffalo hump. Laboratory evaluation revealed a markedly low morning serum cortisol level of 1 mcg/dL, confirming adrenal insufficiency. Patient was diagnosed with GI-AI accompanied by features of iatrogenic Cushing’s syndrome. Management consisted of hydrocortisone replacement therapy at a dose of 20 mg/day along with ongoing antithyroid treatment using methimazole. Serial monitoring of cortisol levels demonstrated gradual recovery of HPA axis function, accompanied by clinical improvement. ConclusionThis case highlights that glucocorticoid-induced adrenal insufficiency can occur on IVMP used for GO. Clinicians should maintain a high index of suspicion and perform appropriate adrenal function monitoring during and after IVMP therapy to ensure early detection and safe management of this potentially life-threatening complication.

Profil Metabolik pada Masyarakat Sijunjung: Studi Cross-Sectional Dinda Aprilia; Eva Decroli; Alexander Kam; Yanne Pradwi Efendi; Athari Fadhila Namanda Putri
Abdika Sciena Vol 4 No 1 (2026): JURABDIKES Volume 4 No 1, Juni 2026
Publisher : CV. AKBAR PUTRA MANDIRI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56260/jurabdikes.v4i1.376

Latar Belakang: Penyakit tidak menular (PTM) seperti obesitas, diabetes melitus (DM), dislipidemia, dan hiperurisemia merupakan permasalahan kesehatan yang semakin meningkat prevalensinya di Indonesia, termasuk di daerah pedesaan. Desa Lansek Manih kabupaten Sijunjung sebagai salah satu daerah di Sumatera Barat memiliki akses terbatas terhadap fasilitas kesehatan sehingga deteksi dini terhadap faktor risiko metabolik menjadi sangat penting. Tujuan: Penelitian ini bertujuan untuk menggambarkan profil indeks massa tubuh (IMT), prevalensi diabetes melitus, kadar kolesterol, dan kadar asam urat pada masyarakat Desa Lansek Manih, Sijunjung. Metode: Penelitian ini merupakan studi deskriptif observasional dengan desain cross-sectional. Sebanyak 74 responden yang direkrut secara consecutive sampling dari kegiatan pengabdian masyarakat di desa Lansek Manih Sijunjung. Data yang dikumpulkan meliputi usia, jenis kelamin, indeks massa tubuh (IMT), status diabetes melitus, kadar kolesterol total, dan kadar asam urat. Hasil: Rerata usia responden adalah 49,62 tahun (18–70 tahun) dengan lebih banyak berjenis kelamin perempuan (57,97%). Rerata IMT sebesar 26,25 kg/m², dengan 62,16% responden termasuk kategori overweight dan obesitas. Sebanyak 12,16% responden terdiagnosis diabetes melitus. Rerata kadar kolesterol adalah 237 mg/dL dan rerata kadar asam urat adalah 6,12 mg/dL. Kesimpulan: Prevalensi overweight/obesitas, dislipidemia, dan diabetes melitus yang tinggi pada masyarakat desa Lansek Manih Sijunjung mengindikasikan perlunya program skrining dan intervensi dini terhadap faktor risiko metabolik di tingkat komunitas.

Two-Year Follow-Up of Parathyroid Hormone, Calcium, and Vitamin D Serum Levels in a Patient after Parathyroidectomy Alexander Kam; Dinda Aprilia; Eva Decroli; Syafril Syahbuddin
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolism and Diabetes Vol. 2 No. 1 (2025): InaJEMD Vol. 2, No. 1
Publisher : PP PERKENI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.66266/inajemd.v2i1.37

Parathyroidectomy is the definitive treatment for primary hyperparathyroidism. Because of the hungry bone syndrome and prolonged hypocalcemia risk, we must follow up on a patient's parathyroid hormone, calcium, and vitamin D serum after parathyroidectomy. In this case report, we reported on a parathyroidectomy patient whom we followed for two years and who, interestingly, had elevated parathyroid hormone levels. A 35-year-old male patient diagnosed with a left parathyroid tumor underwent parathyroidectomy and isthmolobectomy. The patient was treated with calcium, vitamin D, and levothyroxine supplementation. We diagnosed the patient with hungry bone syndrome on the fourth day of post-parathyroidectomy. Then, we documented calcium, vitamin D, and PTH levels in the next two years. The calcium levels are 7.2 (June 2022), 8.2 (July 2022), 8.5 (September 2022), 7.8 (October 2022), 8.1 (June 2023), 9.7 (June 2024). The PTH levels are 244.2 (June 2022), 328.3 (July 2022), 306.5 (September 2022), 457.2 (October 2022), 163.3 (June 2023), 34.4 (June 2024). The Vitamin D levels are 34.4 (July 2022), 13.4 (March 2023), 35.2 (September 2023), 50.4 (April 2024). We increased the dose of calcium and vitamin D supplementation. The patient is in good condition and has reached a normal level of these laboratory parameters in the second year post-parathyroidectomy. PTH, calcium, and vitamin D serum are needed for follow-up in patients after parathyroidectomy. Normalizing calcium and vitamin D serum is essential to maintaining a normal PTH level. Normal PTH, calcium, and vitamin D serum are the cure indications in this patient.

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