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All Journal e-CliniC Jurnal e-Biomedik Indonesian Journal of Kidney and Hypertension Medical Scope Journal (MSJ)
Stella Palar
Universitas Sam Ratulangi
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Gagal Ginjal Kronik Hemodialisis dengan Kadar Eritropoietin dan Hemoglobin Normal: Laporan Kasus Amudi, Tulus; Palar, Stella
Medical Scope Journal Vol 2, No 2 (2021): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.2.2.2021.32547

Abstract

Abstract: Generally, chronic kidney disease (CKD) is associated with anemia due to decrease of erythropoietin that plays an important role in erythropoiesis. We reported a patient, 61-year-old male, suffered from chronic hemodialysis kidney disease with coinfection of viral hepatitis C, albeit, had normal hemoglobin and erythropoietin levels. The patient was diagnosed as CKD in March 2014 with laboratory results, as follows: hemoglobin (Hb) 9.9 g/dl; ureum 223 mg/dl; creatinine 7.5 mg/dl, and was confirmed with ultrasonography. The patient underwent hemodialysis and was treated with erythropoiesis stimulating agent (ESA) for the first time in April 2014. The last ESA was given in June 2015 and the laboratory results were serum iron 61 µg/dl, total iron binding capacity (TIBC) 173 µg/dl, ferritin 1431 ng/ml, and the qualitative anti HCV test was reactive. Afterwards, the patient was not treated with ESA anymore since his Hb level was normal without ESA or blood transfusion. Moreover, the erythropoietin (EPO) level was tested in December 2018 resulted within normal level. Until now, the patient is still undergoing hemodialysis without ESA or transfusion. This is a rare condition, and there is still no certain pathophysiology to explain. It is assumed that the mechanism is related to hepatitis C infection that stimulates the hepatocyte regeneration, therefore, the cells produce endogen erythropoietin resulting in increased Hb level.Keywords: chronic kidney disease (CKD), erythropoietin and hemoglobin level Abstrak: Umumnya penyakit ginjal kronik (PGK) disertai dengan anemia akibat penurunan eritropoietin yang berperan penting dalam proses eritropoiesis. Kami melaporkan kasus seorang laki-laki 61 tahun dengan PGK hemodialisis disertai ko-infeksi hepatitis C namun dengan kadar hemoglobin dan eritropoietin normal. Pasien dinyatakan PGK sejak Maret 2014 dengan kadar hemoglobin (Hb) 9,9 g/dL; ureum 223 mg/dl; kreatinin 7,5 mg/dl, dan didukung oleh hasil ultrasonografi. Pasien diberikan hemodialisis dan terapi ESA pertama kali pada bulan April 2014. Terapi ESA terakhir diberikan pada bulan Juni 2015 dengan hasil serum iron 61 µg/dl, total iron binding capacity (TIBC) 173 µg/dl, feritin 1431 ng/ml, dan anti HCV kualitatif reaktif, Setelah itu pasien tidak mendapat terapi ESA lagi karena pada pemeriksaan laboratorium ditemukan kadar hemoglobin normal tanpa terapi ESA atau transfusi darah. Pemeriksaan kadar eritropoietin (EPO) pada bulan Desember 2018 mendapatkan hasil 16 mIU/ml (nilai normal 2,6-18,5 mIU/ml). Hingga saat ini pasien masih rutin menjalani hemodialisis dan tidak pernah mendapat terapi ESA atau transfusi darah. Keadaan tersebut jarang ditemukan, dan tidak ada patofisologi yang pasti untuk menjelaskan penyebab keadaan tersebut. Mekanisme keadaan ini dikaitkan dengan infeksi hepatitis C yang merangsang regenerasi hepatosit, sehingga sel-sel tersebut menghasilkan hormon ertiropoietin endogen, dengan hasil akhir ialah peningkatan hemoglobin.Kata kunci: penyakit ginjal kronik (PGK), kadar eritropoietin dan hemoglobin
Gangguan Ginjal Akut et Kausa Sepsis: Laporan Kasus Kairupan, Jaquelene D.; Palar, Stella
Medical Scope Journal Vol 2, No 1 (2020): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.2.1.2020.31670

Abstract

Abstract: Acute kidney injury (AKI) is a sudden episode of decreased renal function that occurs within a few hours until a few weeks, followed by renal failure in excretion of nitrogen-waste products with or without imbalance of fluid and electrolytes. Sepsis is the main cause of critical illnesses as well as the main cause of AKI, albeit, the pathophysiology of AKI due to sepsis is not jet fully understood. We reported a female patient aged 35 years with AKI due to sepsis caused by abscess of suprafundal uterine that occured due to nosocomial infection post laparoscopy of utero myoma. Diagnosis was based on anamnesis, physical examination, and laboratory examination as well as radiology examination. The patient had been given an adequate antibiotic treatment with infection source control, renal supportive therapy using intermittent hemodialysis, exploration surgery, and abscess drainage. The prognosis of this patient was good since the condition of sepsis was resolved and the renal supportive therapy of hemodialysis improved her renal function.Keywords: acute kidney injury, sepsis Abstrak: Gangguan ginjal akut (GgGA) adalah penurunan fungsi ginjal yang terjadi mendadak dalam beberapa jam sampai beberapa minggu, diikuti oleh kegagalan ginjal untuk mengekskresi sisa metabolisme nitrogen dengan atau tanpa disertai terjadinya gangguan keseimbangan cairan dan elektrolit. Sepsis merupakan penyebab utama dari penyakit kritis dan juga merupakan faktor penyebab paling umum untuk terjadinya GgGA namun patofisiologi terjadinya GgGA akibat sepsis belum dipahami dengan jelas. Kami melaporkan seorang pasien wanita usia 35 tahun dengan GgGA akibat sepsis yang disebabkan oleh abses suprafundus uteri dengan kausa infeksi nosokomial pasca laparoskopi mioma uteri. Diagnosis ditegakkan berdasarkan anamnesis, pemeriksaan fisik, pemeriksaan laboratorium dan radiologi. Pasien telah diberikan pengobatan antibiotik adekuat dengan kontrol sumber infeksi, terapi suportif ginjal menggunakan intermittent hemodialysis, operasi eksplorasi, dan drainase abses. Prognosis pada pasien ini ialah baik bila kondisi sepsis teratasi dan terapi suportif ginjal hemodialisis memberi hasil perbaikan fungsi ginjal.Kata kunci: gangguan ginjal akut (GgGA), sepsis 
Estimated Glomerular Filtration Rate and Sleep Quality in Stage 3-5 Non-Dialysis Chronic Kidney Disease Patients: Is There a Correlation? Umboh, Octavianus; Palar, Stella; Moeis, Emma Syarifih
Indonesian Journal of Kidney and Hypertension Vol 1 No 2 (2024): Volume 1 No. 2, August 2024
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v1i2.136

Abstract

Background: Chronic kidney disease (CKD) is a growing health issue that significantly affects patients' quality of life. CKD patients are prone to sleep disturbances, which can lead to chronic fatigue and a decrease in their quality of life. The Pittsburgh Sleep Quality Index (PSQI) is a parameter that can be used to assess the sleep quality of CKD patients. Objective: This study aims to determine the relationship between estimated glomerular filtration rate (eGFR) and sleep quality in non-dialysis CKD patients. Methods: The research design is an observational analytic study with a cross-sectional approach. The research subjects were stage 3-5 non-dialysis CKD patients aged 18 to 60 years at Prof. Dr. R. D. Kandou Hospital Manado from March to May 2022. The sleep quality of CKD patients was assessed using the PSQI score. Data analysis was performed with a significance level of p < 0.05. Results: A total of 30 patients with stage 3-5 non-dialysis CKD were found. They consisted of 20 males and 10 females, aged 38-59 years, with an average of 59.80 ± 9.86 years. In the normality test using Shapiro-Wilk, the patient samples were not normally distributed (p = .000). For statistical analysis using the Spearman test, a negative correlation was found between eGFR and PSQI scores (r = -0.554), which was statistically significant (p = 0.002). Conclusion: This study found a significant relationship between eGFR and PSQI scores, which shows that a decrease in eGFR worsens the sleep quality of non-dialysis CKD patients.
Co-Authors . Susilawati Amudi, Tulus Ayu R. Pribadini Nelwan B. J. Waleleng Bradley J. Waleleng Cindy R. Senduk, Cindy R. Dicky Conreng Frans Wantania Janry Pangemanan Julia C. M. Lombo Kairupan, Jaquelene D. Karel Pandelaki Kurniawan K. Patambo Linda Rotty Linda W. A. Rotty Moeis, Emma Syarifih Nathania P. Rengkung Ratnawulan Afriyanti Stephen Masengi Tjhie, Otto S. Umboh, Octavianus