Jodi SL
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HUBUNGAN ANTARA PRODUK KALSIUM X FOSFAT SERUM DENGAN PENYAKIT ARTERI PERIFER PADA PASIEN HEMODIALISIS REGULER DI RSUP SANGLAH DENPASAR Wulandari, Dewi Catur; Raka Widiana, I G; SL, Jodi; Sudhana, I W; Suwitra, Ketut
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Abstract

Peripheral Arterial Occlusive Disease (PAOD) is common among patients undergoing hemodialysis (HD). In the generalpopulation, DM, male, cigarette smoking, advanced age, hypertension and dyslipidemia are the most important risk factorsfor PAOD. Recently, some studies in patients with regular HD found evidences that PAOD associated with increase of calciumand phosphate serum level and increase of Ca.P product due to secondary hyperparatiroidism. A cross-sectional study was doneon 46 regular HD patients to evaluate prevalence of PAOD among patients who are undergoing regular HD and their associationbetween Ca.P product. Morning fasting plasma were taken for lipid profile, blood sugar, blood urea nitrogen, serum creatinin,albumin level, Ca, inorganic P. Ankle-brachial index (ABI) of blood pressure as measured after dialysis session using Va-SeraVS-100. Fourty six (26 males, 20 females) regular HD patients, age 50.95 ± 9.90 years, duration of HD 27.7 ± 22 months wereincluded in this study. Using ABI < 0.9 as cut off value for the presence of PAOD, 15.2% had PAOD. Means of Ca serum levelwas 9.04 ± 0.76 mg/dl, phosphate serum level was 56.48 ± 23.90 mg/dl. Using 55 or more as cut off value for abnormal concentrationof Ca.P product, 47.7% patients had abnormal Ca.P product. Three of 21 patients with Ca.P 55 had PAOD and 4 of 23patients with Ca.P < 55 had PAOD ( OR 0.79 with 95% CI : 0.15 ? 4.04 for patients with Ca.P < 55 ). Using logistic regression tocontrol Ca and P levels, Ca.P 55 tend to associate with increased risk of PAOD (OR 6.22 ; 95% CI : 0.23 ? 167.71)More than fifteen percent of patients with regular HD had PAOD. More than fourty seven percent of patients had abnormal Ca.P.Patients with Ca.P 55 tend to associated with increased risk of PAOD (OR 6.22 ; 95% CI : 0.23 ? 167.71)
SEORANG PENDERITA CALCIPHYLAXIS PADA GAGAL GINJAL KRONIK -, Arvanita; SL, Jodi
journal of internal medicine Vol. 12, No. 1 Januari 2011
Publisher : journal of internal medicine

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Abstract

Calciphylaxis, also called calciÞ c uremic arteriolopathy, is a rare abnormality which characterized by medial calciÞ cation of the small arteries and ischemia of the subcutaneous tissue, often leading to necrosis of subcutaneous fat and skin. It affects mainly woman with ESRD.  A 48 year old woman with ESRD had a history of long standing ESRD which was being treated by hemodialysis for 13 years and peritoneal dialysis for 12 months. Two weeks prior to admission, she complained of a constant dull aching pain accompanied by multiple cutaneous ulcers on both distal extremities. The symptoms did not resolve with antibiotic and analgesic treatment. The skin of the leg had multiple violaceous lesions which were tender on palpation. There was multiple painful lesions with diameter 6 ! 8 cm, necrotic ulcerated lesions surround by erythema. Laboratory data revealed serum calcium was 10.4 mg/dl, phosphate was 8.5 mg/dl and parathyroid hormone level 2,164. Plain Photo of abdomen and both extremity revealed calciÞ cation soft tissue. Skin biopsy was consistent of CalciÞ c Uremic Arteriolopathy (CUA). Histopathology studies showed metastatic calciÞ cation sub cutis (cutaneous calciphylaxis) and arteriolosclerosis within superÞ cial dermis. The patients was treated with local wound care, fosrenol 3 x 500 mg and usual treatment for CKD were continued.  Response calciphylaxis after the treatment was getting bette