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Aida Lydia
Divisi Ginjal Hipertensi, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia/RSUPN Dr. Cipto Mangunkusumo, Jakarta
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Rhabdomyolysis and Acute Kidney Injury Requiring Dialysis Desi Salwani; Farissa Farissa; Aida Lydia
Indonesian Journal of Kidney and Hypertension Vol 3 No 1 (2020): January - April 2020
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (488.238 KB) | DOI: 10.32867/inakidney.v3i1.39

Abstract

Background : Acute kidney injury (AKI) with myoglobinuria is the most serious complication of rhabdomyolysis, and it may be life threatening. Acute kidney injury as a complication of rhabdomyolysis represents about 7 to 10% of all cases of acute kidney injury in the United State. Case Ilustration : A 42-year-old man presented with altered mental status after being found strangulated 3 hours before admission. Five day prior to admission he had ingested detergent with the intention of suicide. He had a history of paranoid schizophrenia that had been medicated with risperidone for 2 years. He denied history of trauma or injury. History of hypertension. On initial examination, he was unresponsive with a glasgow coma score of 3, attention and orientation was not adequate, hemodynamic were stable. Vulnus Excoriatum and circular hematom were on cervical area . In the patient’s initial laboratory, evaluation showed leukocyte 19690/ul, low potassium 2,8 mEq/L, high ALT and AST, ureum 13 mg/dl, creatinine was 1,639 mg/dl and creatinine increased 6,8 mg/dL on 3th and 9,7 mg/dL on 4th day, high serum uric acid and low serum calsium. Blood gas analysis showed bicarbonate 20,5. HCV serology was positive. Cervical x rays showed swelling on retrofaring soft tissue. Chest x ray showed cardiomegaly, infilltrate on right lung and kidney ultrasonography showed no abnormality. Diagnosed were acute kidney injury, rhabdomyolysis, schizophrenia paranoid, pneumonia, hypertension, vulnus ekscoriasis regio collie caused by strangulated, hipocalcemia and reactif leukositosis. He was started on intravenous hydration with KN2 at 1000 mL daily. He also got haloperidol 5 mg daily, risperidone 2 mg daily, 2 times daily, KSR 600 mg 3 times daily and antibiotic ceftriaxone 2 gram daily and Ramipril. The intra venous fluid rate was increased to 1500 mL daily, he remained oliguria with persistent hyperkalemia. He was started intermittent conventional hemodialysis on 4 of the hospitalization. He was dialyzed for 2 sessions. Urine output started to improve on Day 6 when his 24 hours’ urine output was 1000 mL. His last dialysis was on day 6th of hospitalization after which creatinine and CK continued to improve without dialysis. After 24 days of hospitalization he was discharged, his creatinine was 1.6 mg/dL and CK was 299 IU/L. Discussion : The earlier patients receive supportive therapy. Initiate volume repletion with normal saline promptly, target urine output of approximately 3 ml per kilogram of body weight per hour. In patients who develop oliguria, administration of intravenous fluids is limited due volume expansion and pulmonary edema. In these cases, RRT is indicated. Intermittent hemodialysis, has the added benefit of correcting volume overload and pulmonary edema. Bicarbonates to induce urinary alkalinisation. Conclusion : Acute kidney injury is the most serious complication of rhabdomyolysis. Fluid overload and imbalance electrolyte need renal replacement therapy.
Early Detection Of Chronic Kidney Disease In Diabetes Population And Hypertension In SUNRISE Project In East Jakarta Donnie Lumban Gaol; Ginova Nainggolan; Aida Lydia; Tunggul Diapari Situmorang; Dwi Oktavia
Indonesian Journal of Kidney and Hypertension Vol 3 No 1 (2020): January - April 2020
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (4163.965 KB) | DOI: 10.32867/inakidney.v3i1.40

Abstract

Background: Hypertension and diabetes are two of the most prevalent causes of CKD. Screening for kidney disease in primary health facilities in patients with diabetes and hypertension plays a significant role in the early detection of CKD. Dipstick proteinuria is the easiest and widely used method to detect proteinuria in epidemiologic studies, and it is relatively cheaper and easier than examining the urinary ACR, however, some patients with negative proteinuria might have increased urinary albumin-to-creatinine ratio (ACR). Methods: This is a cross-sectional multicenter descriptive study conducted in four district’s community health centers in East Jakarta. Subjects are patients aged > 45 in community health centers and were not enrolled in their respective community health center’s Chronic Disease Management Program (Program Pengelolaan Penyakit Kronis). Patients were classified as diabetic, hypertensive, diabetic and hypertensive, and no known history of both diseases. Subjects were then examined for proteinuria using a dipstick examination. Patients with negative proteinuria were then examined for urine ACR. Data analysis was performed in this study with a univariate analysis to describe the characteristics of each variable. Results: There were 400 subjects included in this study. The majority of subjects were female (76%) and a large proportion of patients was aged 51-69 years (40%). Subjects have hypertension (51%), diabetes (17%), both diabetes and hypertension (26%), and no known history of both (4%). In the group of diabetes patients with negative proteinuria, urinary ACR 30-300 mg/g were found in 4 subjects (16.7%), whereas in patients with both hypertension and diabetes and negative dipstick proteinuria, urinary ACR 30-300 mg/g was found in 12 subjects (30.8%). Conclusion: Examination of ACR in subjects with negative dipstick proteinuria shows some subjects have increased ACR. This data should prompt further investigations in the prevalence of albuminuria and reduced glomerular filtration rate in patients with risks of CKD in primary health care settings.
Pengaruh Fungsi Ginjal Sebelum Intervensi Koroner Perkutan Primer Terhadap Perbedaan Kesintasan 30 Hari Pasien Infark Miokard Elevasi Segmen ST Fahmi Razi Darkuthni; Sally Aman Nasution; Aida Lydia; Murdani Abdullah; Dono Antono; Cleopas Martin Rumende; Maruhum Bonar Hasiholan Marbun; Hamzah Shatri; Arif Mansjoer; Ika Prasetya Wijaya; Lusiani Lusiani
eJournal Kedokteran Indonesia Vol 10, No. 3 - Desember 2022
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.23886/ejki.10.195.204-11

Abstract

Penyakit jantung koroner merupakan penyebab kematian penyakit kardiovaskular utama di Indonesia. Revaskularisasi fase akut secara mekanis maupun farmakologis merupakan tatalaksana utama pada STEMI. Mortalitas paska revaskularisasi masih tinggi. Salah satu faktor penting yang memengaruhi kesintasan pasien STEMI adalah fungsi ginjal. Gangguan fungsi ginjal yang dicerminkan dengan estimated glomerulus filtration rate (eGFR) < 60 diketahui berhubungan dengan perfusi miokard yang buruk paska IKP primer. Penelitian ini bertujuan untuk memberikan gambaran karakteristik pasien STEMI yang menjalani IKP primer berdasarkan fungsi ginjal sebelum IKP dan menganalisa perbedaaan kesintasan dalam 30 hari pasien STEMI-IKP primer berdasarkan fungsi ginjal sebelum IKP. Metode studi observasional kohort retrospektif dan pengukuran fungsi ginjal dikelompokkan berdasarkan eGFR dengan rumus CKD-EPI menjadi dua yaitu eGFR < 60 dan eGFR ≥ 60. IKP primer dilakukan pada 211 pasien STEMI. Insiden mortalitas eGFR < 60 sebesar 14,7%, sedangkan dengan eGFR ≥ 60 sebesar 4,4%. Perbedaan kesintasan pasien STEMI-IKP antar-kelompok eGFR (p < 0,05) dengan crude HR (IK95%) 3,433 (1,269-9,284). Tidak terdapat perbedaan kesintasan pasien STEMI-IKP antar-kelompok eGFR setelah di-adjusted. Mortalitas dalam 30 hari pada kelompok eGFR < 60 lebih tinggi dibandingkan dengan kelompok eGFR ≥ 60. Kata kunci: infark miokard akut, intervensi koroner perkutan, fungsi ginjal, mortalitas.
Co-Authors Arief Pattiiha Arif Mansjoer Cleopas Martin Rumende Desi Salwani, Desi Donnie Lumban Gaol Donnie Lumban Gaol Dono Antono Dwi Oktavia Fahmi Razi Darkuthni Farissa Farissa Ginova Nainggolan Grecia Rachmaningrum Hamzah Shatri Hamzah Shatri Ika Prasetya Wijaya Lusiani Lusiani Maruhum Bonar Hasiholan Marbun Muhammad Yamin Murdani Abdullah Murdani Abdullah Pringgodigdo Nugroho, Pringgodigdo Sally Aman Nasution Suhardjono Suhardjono Tunggul Diapari Situmorang