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All Journal Medical Journal of Indonesia eJournal Kedokteran Indonesia Jurnal Penyakit Dalam Indonesia Ebers Papyrus
Maruhum B.H. Marbun
Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia- RS Dr. Cipto Mangunkusumo, Jakarta
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Milestones of kidney transplantation in Indonesia Susalit, Endang; Rasyid, Nur; Mochtar, Chaidir A.; Alfarissi, Fekhaza; Soeroto, Adhitama A.; Hamid, Agus Rizal A.H.; Wahyudi, Irfan; Marbun, Maruhum B.H.; Rodjani, Arry
Medical Journal of Indonesia Vol 26, No 3 (2017): September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (489.945 KB) | DOI: 10.13181/mji.v26i3.1770

Abstract

Although kidney transplantation in Indonesia has started since 1977, it has only covered less than 3% ESRD treatment methods. This indicates that the development of kidney transplantation program in Indonesia is still stagnant. Based on observation, the growth of kidney transplantation in Indonesia can be divided into several eras, which are: the birth of new treatment for ESRD era, the expected growth era, the first downfall, the stable period, the unstable period, the rebirth of kidney transplant era, and the explosive growth era. Many factors contribute to this issue including the government policy, the funding problems, the limited donor pool, the dissenting cultural views, the number of human resources, the need for multi-disciplinary approach, and the life-after-graft care. However, many improvements have been made to increase kidney transplantation i.e. the government support for opening new kidney transplant centers, the use of minimally invasive techniques, the development of pediatric kidney transplant, and National Insurance coverage for transplantation. These conditions are expected to improve the number of kidney transplantation in Indonesia.
Non-psychogenic polydipsia in 45-year-old man with primary hyperparathyroidism and recurrent bilateral nephrolithiasis Cahyanur, Rahmat; Sarwono, Johannes; Armelia, Linda; Marbun, Maruhum B.H.; Soewondo, Pradana
Medical Journal of Indonesia Vol 21, No 4 (2012): November
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (446.727 KB) | DOI: 10.13181/mji.v21i4.506

Abstract

Non-psychogenic polydipsia with hyponatremia is a rare clinical presentation. Primary hyperparathyroidism is a disorder of calcium, phosphate, and bone metabolism caused by increased level of parathyroid hormone (PTH). It is estimated the incidence of primary hyperparathyroidism are 21.6 per 100,000 person a year. This case report describe a 45-year-old man presented with non-psychogenic polydipsia. This patient drank a lot of water out of the fear of recurrent kidney stones. He had history of recurrent nephrolithiasis with hypercalcemia. We investigate further the cause of hypercalcemia and we diagnosed primary hyperparathryoidism as the cause. (Med J Indones. 2012;21:230-4)Keywords: Hyponatremia, non-psychogenic polydipsia, primary hyperparathyroidism
Pengaruh Fungsi Ginjal Sebelum Intervensi Koroner Perkutan Primer Terhadap Perbedaan Kesintasan 30 Hari Pasien Infark Miokard Elevasi Segmen ST Fahmi Razi Darkuthni; Sally Aman Nasution; Aida Lydia; Murdani Abdullah; Dono Antono; Cleopas Martin Rumende; Maruhum Bonar Hasiholan Marbun; Hamzah Shatri; Arif Mansjoer; Ika Prasetya Wijaya; Lusiani Lusiani
eJournal Kedokteran Indonesia Vol 10, No. 3 - Desember 2022
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.23886/ejki.10.195.204-11

Abstract

Penyakit jantung koroner merupakan penyebab kematian penyakit kardiovaskular utama di Indonesia. Revaskularisasi fase akut secara mekanis maupun farmakologis merupakan tatalaksana utama pada STEMI. Mortalitas paska revaskularisasi masih tinggi. Salah satu faktor penting yang memengaruhi kesintasan pasien STEMI adalah fungsi ginjal. Gangguan fungsi ginjal yang dicerminkan dengan estimated glomerulus filtration rate (eGFR) < 60 diketahui berhubungan dengan perfusi miokard yang buruk paska IKP primer. Penelitian ini bertujuan untuk memberikan gambaran karakteristik pasien STEMI yang menjalani IKP primer berdasarkan fungsi ginjal sebelum IKP dan menganalisa perbedaaan kesintasan dalam 30 hari pasien STEMI-IKP primer berdasarkan fungsi ginjal sebelum IKP. Metode studi observasional kohort retrospektif dan pengukuran fungsi ginjal dikelompokkan berdasarkan eGFR dengan rumus CKD-EPI menjadi dua yaitu eGFR < 60 dan eGFR ≥ 60. IKP primer dilakukan pada 211 pasien STEMI. Insiden mortalitas eGFR < 60 sebesar 14,7%, sedangkan dengan eGFR ≥ 60 sebesar 4,4%. Perbedaan kesintasan pasien STEMI-IKP antar-kelompok eGFR (p < 0,05) dengan crude HR (IK95%) 3,433 (1,269-9,284). Tidak terdapat perbedaan kesintasan pasien STEMI-IKP antar-kelompok eGFR setelah di-adjusted. Mortalitas dalam 30 hari pada kelompok eGFR < 60 lebih tinggi dibandingkan dengan kelompok eGFR ≥ 60. Kata kunci: infark miokard akut, intervensi koroner perkutan, fungsi ginjal, mortalitas.
Survival Kidney Transplantation from Related and Emotionally Related Living Donors in Cipto Mangunkusumo Hospital 2010-2015 Susilowati, Utami; Sutrisna, Bambang; Marbun, Maruhum Bonar H; Susalit, Endang
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 2
Publisher : UI Scholars Hub

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Diagnosis and Treatment of Conn Syndrome: A Case Study Abdaly, Muhammad Syah; Juliyanti, Juliyanti; Marbun, Maruhum Bonar
Jurnal Penyakit Dalam Indonesia Vol. 4, No. 3
Publisher : UI Scholars Hub

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Abstract

Acute neuromuscular disorder is a commonly found medical condition, which may prove to be fatal in certain conditions. Hypokalemia is one possible cause of neuromuscular disorder. In patient with hypokalemia accompanied with hypertension, primary hyperaldosteronism might be the primary cause. Primary hyperaldosteronism (Conn syndrome) is clinically known as a triad, which is consists of hypertension, hypokalemia, and metabolic alkalosis. In this article, the case of a patient with neuromuscular disorder is presented, and after evaluation, it was found that the patient was suffered from the Conn syndrome
Factors Affecting Rapid Decline in Glomerular Filtration Rate in HIV/AIDS Patients Using Tenofovir Disoproxil Fumarate Yuriandro, Prima; Yunihastuti, Evy; Marbun, Maruhum Bonar H; Nugroho, Pringgodidgo
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 3
Publisher : UI Scholars Hub

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Abstract

Introduction. Tenofovir disoproxil fumarate (TDF) treatment in HIV/AIDS patient has particular effect to the kidney, which is rapid decline in glomerular filtration rate (GFR) (> 5 cc/min/1.72 m2 one year after using the drug). The incidence rate for rapid decline in GFR and factors affecting it are still contradictive and not assessed completely. This study was done to identify cumulative incidence and factors affecting TDF related nephrotoxicity. Methods. A retrospective cohort study was conducted in HIV/AIDS outpatient clinic Cipto Mangunkusumo Hospital Jakarta. We included patients who start taking TDF as their medication from January 2010 until January 2015 with consecutive sampling method. Inclusion criterias were minimum one year of TDF treatment and baseline GFR > 60 cc/minute/1.72 m2. The study used secondary data from medical record, therefore subject with no GFR evaluation after one year was excluded. Logistic regression test was used to evaluate variabel that could potentially affect rapid decline in GFR. Results. 164 subjects were included for analysis and we found rapid decline in GFR after one year of TDF medication in 87 subjects (cumulative incidence 53%; 95% CI 45-60.4%). Factors affecting rapid decline in GFR were male gender (RR 4.0; 95% CI 1.1-4.8), CD4 cell count below 100 cell/mm3 (RR 3.7; 95% CI 1.7-8.1), weight increase above 20 % (RR 4.0; 95% CI 1.0-4.8), and baseline GFR above 90 cc/min/1.72 m2 (RR 9.8; 95% CI 2.3-42.1). Conclusion. The incidence rate for rapid decline in GFR after a year of TDF medication in HIV/AIDS patients in Cipto Mangunkusumo hospital was 53%. Risk factors that affecting this nephrotoxicity were male gender, CD4 cell count below 100 cell/mm3, weight increase above 20%, and baseline GFR above 90 cc/min/1.72 m2.
NILAI DIAGNOSTIK SKOR KALSIFIKASI ARKUS UNTUK DETEKSI KALSIFIKASI VASKULAR PADA PASIEN DENGAN HEMODIALISIS RUTIN Eva Sian Li; Maruhum Bonar Marbun; Vanny Wulani
Ebers Papyrus Vol. 16 No. 3 (2010): EBERS PAPYRUS
Publisher : Medical Faculty Universitas Tarumanagara

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Kalsifikasi vaskular pada pasien Penyakit Ginjal Kronik (PGK) dikaitkan dengan peningkatan morbiditas dan mortalitas kardiovaskular. Penilaian kalsifikasi vaskular dapat dilakukan dengan  pemeriksaan  pencitraan  yang canggih  sampai  yang sedehana  seperti  foto palos abdomen   lateral  dan  toto  toraks   PA.  Adanya   perbedaan demografi dan praktek klinis di setiap unit hemodialisis (HD) akan mempengaruhi  karakteristik pasien HD dengan kalsi­ fikasi vaskular. Tujuan penelitian ini untuk mengetahui nilai diagnostik skor Kalsifikasi Arkus Aorta (KAA) untuk deteksi kalsifikasi vaskular pada pasien HD  rutin dan karakteristik pasien HD dengan kalsifikasi vaskular. Penelitian ini dilakukan dengan disain studi potong lintang analitik  di unit HD RS Cipto Mangunkusumo dengan metoda  pengambilan  sampel  konse­ kutif. Kalsifikasi vaskular dinilai dengan dua pemeriksaan foto toraks PA (skor KAA) dan foto palos abdomen lateral (skor Kalsifikasi Aorta Abdominalis/KAAb).  Dari 55 subjek penelitian didapatkan kalsifikasi vaskular pada 76%   subjek penelitian (71% dengan foto toraks PA, 58% dengan foto palos abdomen lateral, dan 53%  dengan  keduanya). Rerata  usia  subjek penelitian  50,9±12,4  tahun  dan  penyebab  PGK terbanyak  nefropati  diabetik  (33%).  Re­ rata  lama  HD  subjek  penelitian  43±44  bulan. Penggunaan Obat Pengikat Fosfat (OPF) terbanyak berbasis kalsium (89%) dengan rerata asupan  kalsium  dari OPF  1,3 gram/hari. Peningkatan   kejadian  kalsifikasi  vaskular didapatkan   pada  pasien  dengan  rerata  usia yang   lebih  tinggi   (53,1±11,4  vs  44,2±13,7 tahun), gender pria (62% vs 54%), diabetes melitus (33% vs 23%), lama HD lebih panjang 47±49 vs 31±20 bulan),  subjek dalam  terapi OPF berbasis kalsium   (93% vs 77%), obat hipoglikemik (26% vs 15%), anti-dislipidemia (19% vs 15%), warfarin (5% vs 2%), dan  vitamin D  (2%  vs  0%). Median  untuk  skor KAA pada   penelitian   ini  18,75%,  skor KAAb   segmental   25%,   dan  skor KAAb   gabungan 2,0. Terdapat  korelasi  positif  antara skor KAA dengan  skor KAAb  segmental  (r = 0,582;p<0,0001) dan dengan  skor KAAb gabungan (r = 0,593; p< 0,0001). Nilai Area Under Curve (AUC) skor KAA 0,815 (p< 0,0001; IK 95% 0,697-0,923)  untuk  skor KAAb  gabungan  >0. Nilai  titik  potong  skor KAA  pada  skor KAAb gabungan >0 didapatkan 9,375% dengan sensitivitas 87,5%, spesifisitas 73,9%, nilai duga positif 82,4%, dan nilai duga negatif 80,9%. Dari penelitian ini dapat disimpulkan nilai   diagnostik  skor KAA  untuk  deteksi   kalsifikasi vaskular  pada  pasien HD rutin cukup tinggi. Peningkatan kejadian kalsitikasi vaskular dida­ patkan pada pasien dengan rerata usia yang lebih tinggi, gender pria, diabetes melitus, lama HD lebih panjang, subjek  yang  dalam  terapi  OPF  berbasis  kalsium,  obat  hipoglikemik, anti-dislipidemia, warfarin, dan vitamin D.
Profilaksis vs. Terapi Preemtif Penyakit Cytomegalovirus (CMV) pada Pasien Transplantasi Ginjal Risiko Tinggi: Suatu Laporan Kasus Berbasis Bukti Wardhani, Ariani Intan; Tunjungputri, Rahajeng N.; Tetrasiwi, Erpryta Nurdia; Marbun, Maruhum Bonar
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 3
Publisher : UI Scholars Hub

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Kidney transplant recipients require the use of immunosuppressive agents to prevent multiple organ rejection. Administration of immunosuppressive agents triggers an increased risk of impaired immunity and microbial infections, one of which is cytomegalovirus (CMV). Prevention of cytomegalovirus infection can be given as a prophylaxis or preemptive therapy. However, the efficacy of choosing prophylaxis or preemptive therapy is still under debate, thus we conducted this study to identify current approach in preventing CMV disease in clinical practice. A literature search was carried out using the PubMed, Cochrane Library, Embase and Scopus databases with the keywords “high risk kidney transplant”, “prophylaxis”, “preemptive” and “CMV infection disease”. Inclusion criteria were only studies in adult kidney transplant patients as a population. , prophylaxis as intervention, preemptive therapy as comparison, and cytomegalovirus infection as outcome. The exclusion criteria of this study were the study articles that were not in Bahasa Indonesia or English, case reports and studies with subjects <18 years old. Critical review using Oxford Center for Evidence Based Medicine (CEBM) Critical Appraisal Tools for Prognostic Study And Systematic Review. The total number of articles identified based on the keywords used is 115 articles. Eliminating duplication with EndNote resulted in 92 articles. Furthermore, exclusion was carried out based on title and abstract so that 29 articles were filtered for which the full text was available. Of these, 23 articles did not have appropriate research questions, 3 studies did not have appropriate patient populations, and 3 articles with types that did not meet the inclusion criteria of this study. As a result, there were 4 articles that can be used in this report. Based on those four articles, it can be concluded that prophylaxis is more effective in preventing CMV disease but had more side effects, when compared to preemptive therapy. However, there was no difference in long term outcome between kidney transplant patients with CMV prophylactic or preemptive therapy.
Modifikasi Skor TIMI sebagai Model Prediksi Mortalitas 30 Hari Pasien STEMI Muda Mansur, M. Tasrif; Yamin, Muhammad; Rusdi, Lusiani; Abdullah, Murdani; Karim, Birry; Rumende, Cleopas Martin; Marbun, Maruhum Bonar H.; Shatri, Hamzah
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 4
Publisher : UI Scholars Hub

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Introduction. Cardiovascular disease is a leading cause of death worldwide. Three-quarters of these deaths occur in lowand middle-income countries among individuals in their productive years. ST-segment elevation myocardial infarction (STEMI) is a dangerous manifestation of coronary artery disease (CAD) and can lead to sudden death. Smoking and a family history of early CAD are major risk factors for STEMI cases. However, their role in any risk stratification system for patients has not been clearly established. The most widely used score in assessing the prognosis of STEMI patients is the TIMI score, but its accuracy in the young patient population is still unknown. The objectives of this study were to determine the proportion of mortality in young STEMI patients at RSCM, validate the TIMI score in young patients, and develop a risk stratification system for young STEMI patients. Methods. This research is a retrospective cohort study using medical record data from the Dr. Cipto Mangunkusumo National General Hospital (RSCM) on patients aged ≤50 years who were treated for ST-elevation myocardial infarction (STEMI) from 2018 to 2022. Univariate analysis was conducted to obtain subject characteristics and the 30-day mortality proportion of young STEMI patients. Bivariate Cox regression analysis was performed to examine the relationship between smoking and a family history of early coronary artery disease (CAD) with 30-day mortality. The TIMI score was validated in the study subjects of young patients. Multivariate analysis was conducted to obtain a new prediction model, and the model’s discriminatory performance was assessed using the area under the ROC curve (AUC), and model calibration was modified using the Hosmer-Lemeshow test. Results. A total of 164 study subjects were included. There were 107 patients (65.2%) with a smoking risk factor, while 39 patients (23.9%) had a family history of early CAD. The proportion of 30-day mortality among young patients was 7.9% (13 individuals). Statistical analysis showed that there was no correlation between 30-day mortality in young STEMI patients and a history of smoking (HR 0.0441 (95% CI 0.148-1.312)) or a family history of early CAD (HR 0.567 (95% CI 0.126- 2.559)). The TIMI score showed good predictive ability for 30-day mortality in young STEMI patients, with an AUC value of 0.836 (95% CI 0.717- 0.956). The combination of the TIMI score with the smoking history variable demonstrated good discriminatory performance in predicting 30-day mortality among young STEMI patients, with an AUC value of 0.875. However, when comparing the AUC values between the TIMI score and the TIMI score with the addition of the smoking history factor, no significant increase in accuracy was observed (p-value=0.215). Conclusions. The TIMI score demonstrates good discrimination and calibration in predicting 30-day mortality among young STEMI patients. The TIMI score, when combined with the smoking history factor, shows improved discriminatory performance and calibration in predicting 30-day mortality among young STEMI patients compared to the pure TIMI score but does not significantly enhance the accuracy.
Co-Authors Agus Rizal Ardy Hariandy Hamid, Agus Rizal Ardy Hariandy Aida Lydia Alfarissi, Fekhaza Arif Mansjoer Arry Rodjani Bambang Sutrisna Bambang Sutrisna Birry Karim Chaidir A. Mochtar Cleopas Martin Rumende Cleopas Martin Rumende Cosphiadi Irawan Daniel Happy Putra Dono Antono E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Endang Susalit Endang Susalit Endang Susalit Endang Susalit Eva Sian Li Evy Yunihastuti Fahmi Razi Darkuthni Fitri Imelda Fitri Imelda, Fitri Ika Prasetya Wijaya Irfan Wahyudi Johannes Sarwono Juliyanti Juliyanti JULIYANTI JULIYANTI, JULIYANTI Kuntjoro Harimurti Linda Armelia Linda Armelia Lusiani Lusiani Lusiani Rusdi, Lusiani Mansur, M. Tasrif Muhammad Syah Abdaly Muhammad Syah Abdaly, Muhammad Syah Muhammad Yamin Murdani Abdullah Murdani Abdullah Nugroho, Pringgodidgo Nur Rasyid Pradana Soewondo Prima Yuriandro Prima Yuriandro Pringgodigdo Nugroho Rahmat Cahyanur Sally Aman Nasution Soeroto, Adhitama A. Susilowati, Utami Tetrasiwi, Erpryta Nurdia Tri Juli Edi Tarigan Tunjungputri, Rahajeng N. Utami Susilowati Vanny Wulani Vidhia Umami, Vidhia Wardhani, Ariani Intan