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Indikasi dan Persiapan Hemodialis Pada Penyakit Ginjal Kronis Radias Zasra; Harnavi Harun; Syaiful Azmi
Jurnal Kesehatan Andalas Vol 7 (2018): Supplement 2
Publisher : Fakultas Kedokteran, Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/jka.v7i0.847

Penyakit Ginjal Kronik (PGK) adalah kelainan struktural atau fungsi yang terjadi lebih dari 3 bulan dan mempunyai implikasi terhadap kesehatan serta diklasifikasikan berdasarkan penyebab, laju flitrasi glomerulus (LFG) dan albuminuria. Komplikasi serius yang ditimbulkan PGK dapat berupa malnutrisi, kelebihan cairan, perdarahan, serositis, depresi, gangguan kognitif, neuropati perifer, infertilitas dan Infeksi. Untuk mencegah komplikasi tersebut, diperlukan indikasi dan waktu yang tepat untuk memulai terapi dialisis pada pasien PGK.

Biomarker Acute Kidney Injury (AKI) pada Sepsis Dional Setiawan; Harnavi Harun; Syaiful Azmi; Drajad Priyono
Jurnal Kesehatan Andalas Vol 7 (2018): Supplement 2
Publisher : Fakultas Kedokteran, Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/jka.v7i0.838

Sepsis didefinisikan sebagai infeksi bersama dengan manifestasi sistemik dari infeksi. Sepsis berat adalah penyebab 50% kasus acute kidney injury (AKI) pada pasien kritis. Patofisiologi cedera ginjal akut (AKI) pada sepsis disebabkan oleh respon inflamasi, toksin dan perubahan hemodinamik glomerulus. Tingkat keparahan disfungsi ginjal tergantung pada tingkat keparahan sepsis. Perubahan laju filtrasi glomerulus (GFR) adalah fenomena AKI yang terlambat. Diagnosis AKI dengan mengukur kreatinin serum. Sayangnya, kreatinin adalah indikator yang kurang dapat diandalkan selama perubahan akut pada fungsi ginjal. Munculnya penanda biologis baru dalam lingkup AKI sangat membantu bagi dokter untuk dapat mendiagnosa awal AKI. Penanda biologis AKI bisa menjadi komponen serum atau urin. Penanda biologis urin menjanjikan untuk mendeteksi awal AKI, sehingga dapat berguna untuk diagnosis dini.

Hipertensi Renovaskular Afdhol Falah; Harnavi Harun
Jurnal Kesehatan Andalas Vol 7 (2018): Supplement 3
Publisher : Fakultas Kedokteran, Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/jka.v7i0.852

Hipertensi renovaskular adalah peningkatan tekanan darah sistolik dan atau diastolik yang umumnya mendadak dan resisten akibat hipoperfusi ginjal yang biasanya disebabkan stenosis arteri renalis dan aktivasi sistem renin-angiotensin. Penyakit ini merupakan salah satu penyebab dari hipertensi sekunder yang dapat terjadi karena gangguan pada vaskular berupa stenosis arteri renalis, berkaitan dengan penyakit parenkim ginjal atau dapat juga merupakan kombinasi dari keduanya. Angka kejadiannya yaitu 1-4 % dari seluruh penderita hipertensi. Hipertensi renovaskular lebih sering ditemukan pada usia remaja dibandingkan pada kelompok usia dewasa. Tujuan penatalaksanaan hipertensi renovaskular adalah memperbaiki oklusi arteri renalis sehingga hipoperfusi ginjal membaik dan tekanan darah menurun. Dalam kasus ini kami melaporkan seorang perempuan berusia 22 tahun datang dengan keluhan sakit kepala sejak 1 hari sebelum masuk rumah sakit. Hasil angiografi arteri renalis: stenosis 80-90% pada arteri renalis dextra. Selanjutnya pasien dilakukan Percutaneous Transluminal Renal Angioplasty. Setelah dilakukan pemasangan balon arteri renalis keluhan sakit kepala berkurang dan tekanan darah menjadi normal dan obat antihipertensi dihentikan.

Coronavirus Disease 2019 in Chronic Kidney Disease: A Case Report Dela Hangri Jalmas; Fauzar Fauzar; Roza Kurniati; Deka Viotra; Harnavi Harun; Vesri Yoga; Alexander Kam
Jurnal Kesehatan Andalas Vol 10, No 2 (2021): Online July 2021
Publisher : Fakultas Kedokteran, Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/jka.v10i2.1718

The COVID-19 pandemic has caused substantial morbidity and mortality worldwide. Older patients, male gender and those with preexisting comorbidities such as chronic kidney disease are reported to be more likely infected with SARS CoV-2 and are at higher risk of severe illness or death. It has been reported a 24 years old male was admitted to the hospital with shortness of breath, coughing, fever and paleness. The history of contact with confirmed COVID-19 cases was unclear. The patient works as a security officer. A history of hypertension is present. Laboratory results showed hemoglobin 7 g/dl, ureum 261 mg/dl, and creatinine 22,9 mg/dl. On the second day of admission, the patient experience increased shortness of breath, decreased consciousness and epistaxis. From the result of the nasopharyngeal swab, the patient tested positive for COVID-19 and was given Oseltamivir 75mg. The patient is prepared for hemodialysis, which was performed in the isolation room. After hemodialysis, the patient's condition improved with decreased shortness of breath and increased of consciousness. The patient comes out from the isolation room and discharges home in good condition. Antiviral therapy in CKD patients with Covid-19 infection requires dose adjustment. Immediate hemodialysis is required in patients with CKD and coexisting COVID-19 infection to improve the patient's condition. Prompt management for patients with CKD and COVID-19 will reduce the risk of mortality.Keywords: COVID-19, chronic kidney disease, hemodialysis

Gitelman Syndrome in a 32-Years-Old Female Patient Andikha Putra; Harnavi Harun
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 6 No. 3 (2022): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v6i3.464

Introduction. Gitelman syndrome is an autosomal recessive disorder that is milder than Bartter syndrome and is often not diagnosed until late childhood or even adulthood. However, this syndrome is usually symptomatic and can result in serious clinical manifestations, such as muscle spasms that can be severe and involve the hands and feet. These symptoms are frequently observed in almost all patients, partly due to hypokalemia and hypomagnesemia. Case presentation. A 32-year-old female patient is being treated in the Internal Medicine ward of Dr. M. Djamil Padang General Hospital with the main complaint of cramping of the left hand, which has gotten worse since 1 day ago. The patient also complained that both legs were prone to cramping that went on and on since 1 month ago. The patient had been hospitalized with the same complaint and is currently taking slow release potassium (KSR) medication. Examination of the patient's limbs revealed a positive trousseau sign and carpopedal spasms. Laboratory examination of the patient showed potassium levels of 1.8 mmol/L, calcium levels of 5.7 mg/dl, Magnesium levels of 0.8 mg/dl, and electrolyte disturbances in the patient's urine. ECG results revealed a prolonged QT interval. Conclusion. Gitelman syndrome is an autosomal recessive disorder and often goes undiagnosed. However, this syndrome is usually symptomatic and can lead to serious clinical manifestations. Most patients require oral potassium and magnesium supplementation, as drug therapy is usually not fully effective.

Renal tubular asidosis tipe I dengan anemia hemolitik stomatositosis Rizkianto Imannual; Harnavi Harun
Majalah Kedokteran Andalas Vol 42, No 3S (2019): Published in November 2019
Publisher : Faculty of Medicine, Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/mka.v42.i3S.p66-74.2019

Renal tubular acidosis (RTA) tipe I adalah sindrom klinik akibat kegagalan pengasaman urine oleh tubuli distal yang ditandai oleh asidosis metabolik, hipokalemia, hiperkloremia, sedangkan anion gap serum dan fungsi glomerulus normal. Anemia stomatositosis adalah tipe anemia hemolitik non-autoimun yang diakibatkan kelainan pada membran eritrosit yang ditandai dengan ditemukannya stomatosit pada gambaran darah tepi. Tujuan: melaporkan kasus RTA tipe I dengan anemia stomatositosis herediter. Kasus: Dilaporkan sebuah kasus, wanita 30 tahun dengan keluhan utama lemah pada keempat anggota gerak sejak 1 hari sebelum masuk rumah sakit. Pasien juga merasakan sesak nafas, poliuri, polidipsi, pucat, lemah dan letih. Keluhan telah dirasakan berulang sejak 5 tahun yang lalu. Pemeriksaan fisik: pasien sadar, kusmaul, anemis, tetraparesis. Pemeriksaan penunjang: laboratorium Hb 8,8 gr/dL; normositik normokrom dengan sel target (+) sel stomatosit (+); Kalium 1,7 mmol/L; Khlorida 122 mmol/L. Analisis gas darah: pH 7,05; HCO3- 6,9 mmol/L. Urinalisis: pH urine 6,5; elektrolit urine; kalium 18,2 mmol; TTKG 13; anion gap serum 11,4; anion gap urine 16,2. Diberikan substitusi kalium dan bikarbonat intravena. Pasien mengalami perbaikan gejala setelah di terapi. Simpulan: Perlu diberikan terapi substitusi kalium dan alkali seumur hidup pasien untuk mencegah kekambuhan.

Gitelman Syndrome in a 32-Years-Old Female Patient Andikha Putra; Harnavi Harun
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 6 No. 3 (2022): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v6i3.464

Introduction. Gitelman syndrome is an autosomal recessive disorder that is milder than Bartter syndrome and is often not diagnosed until late childhood or even adulthood. However, this syndrome is usually symptomatic and can result in serious clinical manifestations, such as muscle spasms that can be severe and involve the hands and feet. These symptoms are frequently observed in almost all patients, partly due to hypokalemia and hypomagnesemia. Case presentation. A 32-year-old female patient is being treated in the Internal Medicine ward of Dr. M. Djamil Padang General Hospital with the main complaint of cramping of the left hand, which has gotten worse since 1 day ago. The patient also complained that both legs were prone to cramping that went on and on since 1 month ago. The patient had been hospitalized with the same complaint and is currently taking slow release potassium (KSR) medication. Examination of the patient's limbs revealed a positive trousseau sign and carpopedal spasms. Laboratory examination of the patient showed potassium levels of 1.8 mmol/L, calcium levels of 5.7 mg/dl, Magnesium levels of 0.8 mg/dl, and electrolyte disturbances in the patient's urine. ECG results revealed a prolonged QT interval. Conclusion. Gitelman syndrome is an autosomal recessive disorder and often goes undiagnosed. However, this syndrome is usually symptomatic and can lead to serious clinical manifestations. Most patients require oral potassium and magnesium supplementation, as drug therapy is usually not fully effective.

The Role of Methylglyoxal Accumulation on Cognitive Function Impairment of Chronic Hemodialysis Patients: an Observational Study Harnavi Harun; Roslaini Roslaini; Syaiful Azmi; Rose Dinda Martini
Indonesian Journal of Kidney and Hypertension Vol 2 No 1 (2019): January - April 2019
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (480.665 KB)

Background: Cognitive function decline is prevalent on routine hemodialysis patients. Many factors contribute to the increased risk of cognitive function impairment, one of them is the accumulation of uremic toxins. Methylglyoxal (MG) has been identified as one of the uremic toxins found in dialysis patients by the European Uremic Toxin Group. It has also been found much higher on CKD patients; over five times higher in non-dialysis CKD and 18-40 times higher in CKD patients on dialysis, and cause impaired cognitive function in rats with diabetes. Aim: To find the correlation between blood MG levels and cognitive function of patients who underwent routine hemodialysis. Methods: This study is an observational cross-sectional study done in Hemodialysis Unit of Dr. M Djamil General Hospital, Padang, West Sumatera, Indonesia. Fifty-seven subjects aged 40-60 years old were included in this study, where the blood MG levels were obtained. Cognitive function was measured using the Mini Mental State Examination (MMSE) questionnaire. Result: Among 57 subjects, 29 (50.8%) were male, and 33 (57.9%) were 50-60 years old. The subjects’ mean methylglyoxal levels were 10.8 (SD ± 3.2) µmol/L. The subjects’ mean MMSE score was 26 (SD ± 1.8), with 35% of the subjects had low (<25) scores. Spearman correlation analysis showed a statistically significant negative correlation between methylglyoxal level and MMSE score (r = -0.6, p >< 0.001). Conclusion: High levels of methylglyoxal negatively correlates with cognitive function in chronic hemodialysis patients. Future research should include analysis regarding age, gender, hypertension, and other confounding factors.

Correlation between Urinary Cyclophilin A and Urinary Albumin Levels on Diabetic Kidney Disease Harnavi Harun; Rangga Lunesia; Syaiful Azmi
Indonesian Journal of Kidney and Hypertension Vol 2 No 2 (2019): May - August 2019
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Introduction: Diabetic kidney disease (DKD) is a complication of diabetes mellitus characterized by albuminuria persisting within 3 to 6 months, the earliest clinical evidence is microalbuminuria (30-299 mg/24hours or 20-199 ug/i). Cyclophilin A (Cyp A) is an 18 k-Da 165-amino acid long cytosolic protein also known as peptidylprolyl isomerase A. In DN, hyperglycemia will cause Cyp A secretion by human kidney-2 (HK-2) cells from PTEC and mesangial-13 cells (MES-13) and causes kidney damage. Material and Methods: This study was an analytic observational, cross sectional study conducted at the clinic and inpatient internal medicine installation at dr. M. Djamil General Hospital Padang for 6 months. Samples were selected by consecutive sampling, as many as 60 people with post prandial blood glucose > 180 mg/dl and urinary albumin > 30 mg/24 hours and met the inclusion and exclusion criteria. The samples were examined for urinary Cyp A and albumin levels. Results: The mean level of urinary Cyp A in patients with DKD is 4.96 (2.03) ng/ml. Median urinary albumin levels in DKD patients is 287.89 (30.79-394.57) mg/24 hours. Correlation analysis between urinary Cyp A and albumin levels showed a significant (p < 0.05) with a positive and strong correlation (r = 0.776) in DKD patients. Conclusion: There was an increase of urinary Cyp A and urinary albumin levels, with a positive and strong correlation between them in DKD patients. Keywords: Urinary Cyclophilin A, urinary albumin, diabetic kidney disease

Plasma Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Creatinine Levels after Percutaneous Coronary Intervention Radias Zasra; Harnavi Harun; Syaiful Azmi; Yerizal Karani
Indonesian Journal of Kidney and Hypertension Vol 2 No 3 (2019): September - December 2019
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Abstract Background. Contrast-induced nephropathy (CIN) is defined as an increase in serum creatinine ≥ 25% or ≥0.3 mg/dl in 48 hours after the administration of a contrast agent in the absence of other causative factors (KDIGO 2012). Neutrophil Gelatinase-Associated Lipocalin (NGAL) is a substance produced by the kidneys in acute kidney injury (AKI) caused by various insults from ischemia to toxin-induced nephropathy. NGAL is known to increase earlier than serum creatinine level. NGAL is also a protease-resistant polypetide; it is released from the distal tubule, secreted to the urine or returned to the plasma (back leak), freely filtered in the glomerulus, reabsorbed in the proximal tubule through the megalin receptor endocytosis or secreted to urine. This makes NGAL detectable both in the blood and urine. Aim. To elucidate the effect of contrast administration to serum NGAL and serum creatinine levels with in patients undergoing PCI. Methods. The study was done in the Cardiovascular Care ward in M. Djamil General Hospital, Padang, West Sumatra, Indonesia. Through consecutive random sampling, 21 subjects were selected. The subjects’ serum NGAL and creatinine levels were acquired before PCI and 6 hours after contrast administration. Results. The mean serum NGAL and creatinine levels of the subjects before and after contrast administration were 52.26 ng/ml vs 64.78 ng/ml and 1.1 mg/dl vs 1.09 mg/dl, respectively. The serum NGAL level difference before and after contrast administration was statistically significant (p=0.003) whereas the serum creatinine level was not (p>0.005). Conclusion. There is an increase of serum NGAL levels before and after contrast administration in patient undergoing PCI, whereas serum creatinine level was not. Future studies should elaborate on the use of NGAL as an early diagnostic marker for CIN.

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