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Ayu, Nyoman Paramita
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Aerospace Engineering Computer Science & IT Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Social Sciences

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Contrast media induced nephropathy: case series and review of the literature focusing on management Marciyasa, Putu Agus; Kandarini, Yenny; Mahadita, Gede Wira; Ayu, Nyoman Paramita
Universa Medicina Vol. 43 No. 2 (2024)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2024.v43.252-261

Abstract

BackgroundContrast media administration during diagnostic and invasive procedures in high risk patients for nephrotoxicity is a common problem in clinical practice. Radiological procedures using intravascular iodinated contrast injection media have been widely used for therapeutic purposes. Contrast-induced nephropathy (CIN) is a serious complication of angiographic procedures and results from administration of contrast media (CM), which increases morbidity and mortality rates. Case Description                                                                                                                                                                                                               We present these 10 cases with high risk of CIN and diverse characteristics. A new generation iso-osmolar CM (iodixanol) was administered in these cases. Three of the cases experienced CIN events, where one patient experienced an improvement in his condition, but two other patients experienced complications and eventually died due to the underlying disease. The other 6 cases did not experience CIN after receiving CM, which was due to better preparation beforehand. One patient with a history of regular hemodialysis, underwent immediate post-operative dialysis with CM, and no evaluation of the incidence of CIN was required. Conclusion Of the 10 cases observed, 3 of them experienced CIN which was caused by the severity of the patient’s condition and lack of preparation time before the CM procedure. Management of CIN is complex, starting from the pre-treatment evaluation until 72 hours or more after the CM procedure. This case series suggests that even new generation CM (including iodixanol) may be severely nephrotoxic, when administered to high risk patients. The amount of CM given must be below the maximum limit and adjusted to the patient’s condition. Additionally, we review the complex mechanisms involved in management of CM nephrotoxicity.
Association Between Fluid Administration and Hemoglobin Changes During Perioperative Kidney Transplantation Sanyoto, Arundina; Widiana, I Gde Raka; Mahadita, Gede Wira; Kandarini, Yenny; Ayu, Nyoman Paramita; Erawan, I Gusti Ngurah Agung Tresna
Indonesian Journal of Kidney and Hypertension Vol 1 No 3 (2024): Volume 1 No. 3, December 2024
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v1i3.157

Abstract

Background: Chronic Kidney Disease (CKD) is a leading cause of mortality worldwide, particularly in Indonesia, so it requires effective treatment options like kidney transplantation. Optimal fluid therapy during the perioperative period is important for stable hemodynamics and graft function. However, guidelines for fluid administration remain lacking. Objective: This study investigates the association between fluid therapy and changes in hemoglobin levels in patients undergoing renal transplantation. Methods: A retrospective observational cross-sectional study was conducted at RSUP Prof. DR. I.G.N.G. Ngoerah Denpasar from January 2016 to August 2024. Data were collected from medical records of patients who underwent kidney transplantation, excluding those with incomplete data. Key variables included daily fluid intake and hemoglobin levels. The coefficient of variance was calculated and continued with correlation analyses utilizing Pearson correlation and linear regression to assess relationships between fluid administration and hemoglobin changes. Results: Of 28 patients, 10 met inclusion criteria, consisting of 4 males and 6 females. Analysis showed a strong correlation between the variance of fluid intake and the variance of hemoglobin levels (R = 0.86; R² = 0.74; P < 0.001). Conclusion: This study demonstrates a significant relationship between post-operative variance of fluid administration and variance of hemoglobin levels following kidney transplantation. It may have an impact on the management of post-operative reduction in hemoglobin levels.
Nephrotoxicity Due to Snake Bites Srikandi, Ni Made Putri Rahayu; Ayu, Nyoman Paramita
Eduvest - Journal of Universal Studies Vol. 5 No. 4 (2025): Eduvest - Journal of Universal Studies
Publisher : Green Publisher Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59188/eduvest.v5i4.51087

Abstract

Snakebites remain a critical public health issue in tropical countries, particularly due to their severe systemic effects, including nephrotoxicity and acute kidney injury (AKI). One major complication that frequently arises from envenomation, especially from Viperidae and Elapidae species, is AKI, which can progress to life-threatening conditions if not promptly managed. This study aims to explore the clinical management of snakebite-induced AKI and its systemic complications, using a case study of a 51-year-old male patient. The research employs a qualitative clinical case approach, involving observational analysis, serial laboratory tests, imaging, and documented treatment progression. The patient, who presented with swelling and bleeding in the bitten limb, was diagnosed with stage 3 AKI, Disseminated Intravascular Coagulation (DIC), and thrombocytopenia. Management included administration of antivenom, hemodialysis, and blood product transfusions. Significant improvements in kidney function and coagulation parameters were observed within two weeks. The findings highlight the urgency of early intervention, particularly in cases where the snake species is unidentified. This study contributes to a deeper understanding of AKI pathophysiology in envenomation and underscores the importance of WHO and KDIGO guideline implementation. It also emphasizes the need for enhanced clinical training and protocols in resource-limited settings to improve outcomes in snakebite victims.
Salt Wasting Syndrome: Serial Cases Anggelia, Vivi; Nugroho, Agung Adi; Ayu, Nyoman Paramita; Adnyana, I Wayan Losen
Eduvest - Journal of Universal Studies Vol. 4 No. 1 (2024): Journal Eduvest - Journal of Universal Studies
Publisher : Green Publisher Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59188/eduvest.v4i1.977

Abstract

Hyponatremia is one of the electrolyte disturbances that can be found in patients with central nervous system disorders, the most cases of hyponatremia are the Syndrome of Inappropriate Antidiuretic Hormone/SIADH compared to hyponatremia in Cerebral Salt Wasting Syndrome/CSWS and it is not uncommon to also occur in patients undergoing chemotherapy treatment without accompanying head abnormalities are referred to as Renal Salt Wasting Syndrome (RSWS). There is difficulty differentiating these two conditions due to almost the same clinical symptoms. Evaluation of volume status and monitoring of urate excretion fraction can help differentiate SIADH from RSWS and CSWS. Management requiring prompt diagnosis is essential to prevent severe hyponatremia from substantially causing cerebral edema and thereby reducing the risk of seizures. Fluid resuscitation therapy and sodium restoration are important. This case series report injured 2 CSWS patients after head trauma with different treatments and hyponatremia due to cisplatin induced RSWS.
Co-Authors Agung Adi Nugroho, Agung Adi Anggelia, Vivi Erawan, I Gusti Ngurah Agung Tresna I Gde Raka Widiana I Wayan Losen Adnyana Mahadita, Gede Wira Marciyasa, Putu Agus Sanyoto, Arundina Srikandi, Ni Made Putri Rahayu Yenny Kandarini