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Comparative Prognostic Value of Podocyturia Versus Microalbuminuria in Predicting Diabetic Nephropathy Progression: A Meta-Analysis Bayu Arief Hartanto; Deka Viotra; Harnavi Harun; Drajad Priyono
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 5 (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.v10i5.1578

Background: Diabetic nephropathy represents the primary etiology of end-stage renal disease globally. Historically, clinical practice relied upon microalbuminuria as the definitive non-invasive biomarker for early detection. However, advanced histopathological evidence establishes that severe structural degradation of the glomerular filtration barrier, specifically the visceral epithelial cells known as podocytes, occurs significantly earlier than the clinical manifestation of microalbuminuria. Podocyturia, defined as the urinary excretion of intact podocytes and podocyte-specific proteins or messenger RNA, emerged as a direct indicator of active glomerular injury. This meta-analysis investigated the comparative prognostic value of podocyturia versus microalbuminuria in predicting the longitudinal progression of diabetic nephropathy. Methods: A systematic literature search was executed to identify comparative clinical studies evaluating both podocyturia and microalbuminuria in diabetic cohorts. Seven essential manuscripts met rigorous inclusion criteria. Following peer-review recommendations, statistical pooling was strictly stratified by study design. Data extraction focused on prognostic effect sizes in longitudinal cohorts and diagnostic effect sizes in cross-sectional cohorts. Statistical synthesis utilized DerSimonian-Laird random-effects models to calculate pooled Standardized Mean Differences and 95% confidence intervals. Results: Synthesized data demonstrated podocyturia possessed a significantly superior prognostic value compared to microalbuminuria. In longitudinal cohorts, the pooled Standardized Mean Difference for podocyturia predicting progression was 1.95 (95% CI: 1.50 to 2.40, p < 0.001), whereas microalbuminuria was 0.58 (95% CI: 0.25 to 0.91, p = 0.04). Cross-sectional data similarly demonstrated massive podocyte biomarker elevation in strictly normoalbuminuric patients. Conclusion: Podocyturia represents a substantially more accurate, sensitive, and temporally earlier prognostic biomarker for diabetic nephropathy progression than microalbuminuria. Incorporating podocyte-specific urinary quantification into routine clinical practice could fundamentally alter early therapeutic intervention strategies, shifting the focus toward arresting primary podocyte detachment.

Pola Kuman dan Sensitivitas Antimikroba Infeksi CDL pada Pasien Hemodialisis di RSUP Dr. M. Djamil Jen Hendriman; Vendry Rivaldy; Harnavi Harun; Drajad Priyono; Deka Viotra
Scientific Journal Vol. 5 No. 3 (2026): SCIENA Volume V No 3, May 2026
Publisher : CV. AKBAR PUTRA MANDIRI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56260/sciena.v5i3.356

Latar Belakang: Penggunaan catheter double lumen (CDL) sebagai akses vaskular pada pasien hemodialisis masih sering diperlukan, terutama pada kondisi yang membutuhkan akses segera. Namun, penggunaan CDL berhubungan dengan peningkatan risiko infeksi terkait kateter yang dapat menyebabkan bakteremia, sepsis, peningkatan biaya perawatan, serta mortalitas pasien. Pola kuman dan sensitivitas antimikroba antar layanan kesehatan menyebabkan data lokal sangat diperlukan untuk menentukan terapi empiris yang tepat. Hingga saat ini, data pola kuman dan sensitivitas antimikroba pada infeksi terkait CDL di RSUP Dr. M. Djamil Padang masih terbatas. Tujuan: Mengetahui pola kuman dan sensitivitas antimikroba pada kasus infeksi terkait CDL pada pasien yang menjalani hemodialisis di RSUP Dr. M. Djamil Padang. Metode: Penelitian deskriptif dengan desain retrospektif dilakukan menggunakan data rekam medis dan hasil pemeriksaan mikrobiologi pasien penyakit ginjal kronik yang menjalani hemodialisis dengan CDL selama periode Januari–Juni 2023. Sampel dipilih menggunakan metode total sampling dan diperoleh 70 pasien yang memenuhi kriteria penelitian. Data kultur darah perifer, kultur ujung kateter, dan kultur sekret purulen dianalisis untuk mengidentifikasi pola kuman serta sensitivitas antimikroba. Analisis data dilakukan secara univariat dan disajikan dalam bentuk distribusi frekuensi dan persentase. Hasil: Sebagian besar pasien berjenis kelamin laki-laki (62,9%). Kuman yang paling sering ditemukan adalah Staphylococcus aureus (18,6%), diikuti Pseudomonas aeruginosa (17,1%), Staphylococcus epidermidis (15,7%), Methicillin-Resistant Staphylococcus aureus (MRSA) (14,3%), dan Enterobacter cloacae complex (12,9%). Secara keseluruhan, bakteri Gram positif mendominasi pola kuman. Staphylococcus aureus menunjukkan sensitivitas terhadap gentamisin, siprofloksasin, levofloksasin, moksifloksasin, eritromisin, klindamisin, vankomisin, tetrasiklin, dan trimetoprim/sulfametoksazol. Kesimpulan: Staphylococcus aureus merupakan kuman tersering pada infeksi terkait CDL pada pasien hemodialisis di RSUP Dr. M. Djamil Padang. Dominasi bakteri Gram positif serta pola sensitivitas yang masih baik terhadap beberapa antibiotik utama dapat menjadi dasar dalam pemilihan terapi empiris dan penyusunan strategi pengendalian infeksi di unit hemodialisis.

Corticosteroid Therapy and the Risk of Kidney Failure in IgA Nephropathy: A Dose- and Ethnicity-Stratified Meta-Analysis of Randomised Controlled Trials Festi Eliza; Harnavi Harun; Drajad Priyono; Deka Viotra
Sriwijaya Journal of Internal Medicine Vol. 4 No. 1 (2026): Sriwijaya Journal of Internal Medicine
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjim.v4i1.276

Background: Corticosteroids are widely used in IgA nephropathy, but their net benefit is contested because the largest trials show both protection against kidney-function decline and excess serious infection; the optimal dose and consistency across ethnic groups are uncertain. Objective: To quantify the effect of systemic corticosteroids on the risk of kidney failure in IgA nephropathy and to explore modification by dose and ethnicity. Methods: Four databases were searched from inception for randomised controlled trials. Risk ratios (RR) were pooled with a DerSimonian–Laird random-effects model and proteinuria as Hedges' g; heterogeneity was assessed with I² and a prediction interval, bias with RoB 2 and the Egger test, and certainty with GRADE. Results: Ten non-overlapping trials (1,153 participants; 104 vs 165 events) were included. Corticosteroids reduced the risk of kidney failure (RR 0.61, 95% CI 0.42–0.90; I² = 21%; p = 0.012), remaining significant under the Hartung–Knapp correction (0.39–0.97); a dose subgroup difference was significant (p = 0.010, larger effect with high-dose regimens). Proteinuria fell moderately (Hedges' g −0.68, −1.00 to −0.35). Serious infection was more frequent with corticosteroids. Conclusion: Corticosteroids reduce kidney failure and proteinuria but increase serious infection; a reduced-dose strategy preserves benefit while improving safety, supporting individualised, risk-stratified use.

Efficacy, Safety, and Metabolic Effects of Low-Molecular-Weight Heparin versus Unfractionated Heparin in Chronic Hemodialysis: A Systematic Review and Meta-Analysis of Clinical Studies Evelin Veronike; Harnavi Harun; Drajad Priyono; Deka Viotra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (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.v10i1.1494

Background: The optimal anticoagulation for chronic hemodialysis (HD) remains debated. Unfractionated heparin (UFH) is the historical standard but carries risks of metabolic complications and requires intensive monitoring. Low-Molecular-Weight Heparin (LMWH) offers pharmacological advantages, but concerns over bleeding risk in end-stage renal disease (ESRD) have limited its use. This study aimed to provide a holistic comparison by synthesizing recent evidence on the efficacy, safety, and, uniquely, the key metabolic consequences of LMWH versus UFH. Methods: This systematic review followed PRISMA 2020 guidelines. We searched PubMed, EMBASE, and CENTRAL from January 2014 to March 2025 for clinical studies comparing LMWH and UFH in chronic HD patients. We included 6 studies (3 prospective trials, 3 retrospective cohorts) totaling 7,890 patients. The primary efficacy outcome was circuit thrombosis; the primary safety outcome was major bleeding. Secondary outcomes focused on key metabolic markers (pre-dialysis potassium, lipid profile). Data from prospective trials and observational studies were analyzed separately using subgroup analysis and tested for interaction. Metabolic data were pooled using a random-effects model. Results: The analysis of key metabolic outcomes, derived from homogenous prospective trials (I2=0%), was the most robust finding. LMWH use was associated with a clinically significant reduction in pre-dialysis serum potassium (Mean Difference [MD]: -0.30 mEq/L; 95% CI: -0.50 to -0.10) and a superior atherogenic profile, including lower triglycerides (MD: -20.10 mg/dL) and higher HDL (MD: +4.50 mg/dL). For safety, no difference in major bleeding was found, a finding that was consistent across prospective trials (OR: 0.78; 95% CI: 0.33-1.85) and large retrospective cohorts (OR: 0.87; 95% CI: 0.69-1.09), with no subgroup interaction (p=0.75). Efficacy for preventing circuit thrombosis was also similar. Conclusion: This meta-analysis provides strong, high-quality evidence that LMWH confers significant and clinically relevant metabolic advantages over UFH, particularly in mitigating hyperkalemia and atherogenic dyslipidemia. Furthermore, our stratified analysis provides high confidence from real-world data that LMWH, when dosed appropriately, is as safe and effective as UFH.

Beyond Serum Creatinine: Urinary KIM-1 as a Predictive Biomarker for Subclinical Acute Kidney Injury and Chronic Kidney Disease Progression: A Systematic Review and Meta-Analysis Puti Anggun Sari; Drajad Priyono
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (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.v10i4.1563

Background: The global burden of chronic kidney disease (CKD) is escalating, requiring earlier and more precise diagnostic modalities. Traditional reliance on serum creatinine and glomerular filtration rate (GFR) creates a significant blind spot regarding structural tubular integrity. A dangerous diagnostic window known as subclinical acute kidney injury (AKI) exists when tubular damage progresses despite preserved filtration function. This study aims to systematically analyze the diagnostic accuracy of urinary kidney injury molecule-1 (uKIM-1) in detecting subclinical injury and quantify its predictive value for CKD progression in populations where serum creatinine fails to provide an early warning. Methods: A systematic review and meta-analysis of five pivotal studies were conducted, encompassing experimental models of ischemia-reperfusion and human cohorts involving Autosomal Dominant Polycystic Kidney Disease (ADPKD), Diabetic Nephropathy, and Contrast-Induced AKI. Data were synthesized using random-effects models to calculate Standardized Mean Differences (SMD) and pooled Hazard Ratios (HR) to assess the prognostic value of uKIM-1 for long-term renal decline. Results: The analysis demonstrated that uKIM-1 levels remained significantly elevated during apparent functional recovery where serum creatinine had returned to baseline. In experimental models, persistent uKIM-1 elevation correlated strongly with histological evidence of interstitial fibrosis (r > 0.70). Clinical cohorts revealed that elevated KIM-1 is a robust independent predictor of progression to ESRD, with hazard ratios ranging from 1.34 to 3.30. Pooled analysis showed a Risk Ratio of 2.45 (95% CI: 1.55 – 3.88; p < 0.0001). Conclusion: Urinary KIM-1 serves as a sensitive and specific biomarker for subclinical tubular injury, identifying the at-risk"phenotype missed by creatinine. Its persistent elevation signifies maladaptive repair and predicts the transition from AKI to CKD, supporting its clinical integration for early risk stratification.

Comparative Prognostic Value of Podocyturia Versus Microalbuminuria in Predicting Diabetic Nephropathy Progression: A Meta-Analysis Bayu Arief Hartanto; Deka Viotra; Harnavi Harun; Drajad Priyono
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 5 (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.v10i5.1578

Background: Diabetic nephropathy represents the primary etiology of end-stage renal disease globally. Historically, clinical practice relied upon microalbuminuria as the definitive non-invasive biomarker for early detection. However, advanced histopathological evidence establishes that severe structural degradation of the glomerular filtration barrier, specifically the visceral epithelial cells known as podocytes, occurs significantly earlier than the clinical manifestation of microalbuminuria. Podocyturia, defined as the urinary excretion of intact podocytes and podocyte-specific proteins or messenger RNA, emerged as a direct indicator of active glomerular injury. This meta-analysis investigated the comparative prognostic value of podocyturia versus microalbuminuria in predicting the longitudinal progression of diabetic nephropathy. Methods: A systematic literature search was executed to identify comparative clinical studies evaluating both podocyturia and microalbuminuria in diabetic cohorts. Seven essential manuscripts met rigorous inclusion criteria. Following peer-review recommendations, statistical pooling was strictly stratified by study design. Data extraction focused on prognostic effect sizes in longitudinal cohorts and diagnostic effect sizes in cross-sectional cohorts. Statistical synthesis utilized DerSimonian-Laird random-effects models to calculate pooled Standardized Mean Differences and 95% confidence intervals. Results: Synthesized data demonstrated podocyturia possessed a significantly superior prognostic value compared to microalbuminuria. In longitudinal cohorts, the pooled Standardized Mean Difference for podocyturia predicting progression was 1.95 (95% CI: 1.50 to 2.40, p < 0.001), whereas microalbuminuria was 0.58 (95% CI: 0.25 to 0.91, p = 0.04). Cross-sectional data similarly demonstrated massive podocyte biomarker elevation in strictly normoalbuminuric patients. Conclusion: Podocyturia represents a substantially more accurate, sensitive, and temporally earlier prognostic biomarker for diabetic nephropathy progression than microalbuminuria. Incorporating podocyte-specific urinary quantification into routine clinical practice could fundamentally alter early therapeutic intervention strategies, shifting the focus toward arresting primary podocyte detachment.

Diagnostic Value of Urinary Kidney Injury Molecule-1 in Diagnosis of Sepsis Associated Acute Kidney Injury Puti Anggun Sari; Drajad Priyono; Harnavi Harun; Deka Viotra; Najirman Najirman; Fauzar Fauzar; Dwitya Elvira; Arina Widya Murni
Indonesian Journal of Kidney and Hypertension Vol 3 No 2 (2026): Volume 3 No. 2 August 2026
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v3i2.263

Abstract Background: Sepsis asscociated acute kidney injury (SA-AKI) is common condition that found in sepsis. Due to the lack of creatinine serum, this condition possibly makes therapy delayed. Kidney Injury Molecule-1 (KIM-1) is a a type 1 transmembrane protein with immunoglobulin and mucin domains, which is expressed increased in the proximal tubules of the kidney. Elevated urinary KIM-1 levels are an indicator of AKI. However, previous studies have shown varies results. Objectives: This study aims to determine early diagnosis biomarkers for the presence of AKI in sepsis. Methods: This diagnostic test was conducted at Dr. M. Djamil General Hospital Padang in sepsis patients. The diagnosis of AKI was established based on the 2012 KDIGO criteria. Results: The study involved 94 sepsis patients, only 22,34% (n=21) of them experienced AKI. Serum creatinine levels at admission and within 48 hours of hospitalization were 0,7 (IQR 0,2-1,6) mg/dl and 0,8 (IQR 0,3-2,2m) mg/dl. An urinary KIM-1 level at admission ≥11,74 ng/mL had sensitivity of 44,68%, specificity of 59,57%, positive predictive value of 52,5%, negative predictive value of 51,85%, and accuracy of 52,12% in early diagnosis of AKI in sepsis. Conclusion: Urinary Kidney injury molecule-1 level has poor diagnostic value in diagnosis of AKI in sepsis. Keywords: Sepsis, Kidney injury molecule-1, AKI.

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