Christiani, Laura and Dr. dr. Hani Susianti, Sp.PK.(K.) and dr. Singgih Pudjo W,, Sp.PK.(K.) (2022) Evaluasi Korelasi dan Performa Diagnostik antara Asymmetric Dimethylarginine Urine dengan eGFR dan UACR pada Penderita Nefropati Diabetik. Magister thesis, Universitas Brawijaya.
Abstract
Latar Belakang. Nefropati Diabetik adalah komplikasi diabetes melitus pada ginjal yang dapat berakhir sebagai gagal ginjal, dimana pada stadium awal nefropati diabetik terjadi disfungsi endotel yang dikarakterisasi oleh adanya peningkatan Asymmetric dimethylarginine (ADMA). ADMA adalah analog L-arginine yang secara alami berada dalam sirkulasi manusia. Sekitar 90% ADMA di metabolisme oleh dimethylaminohydrolase (DDAH) di tubulus proksimal ginjal, sedangkan 10% sisanya di ekskresi melalui urine. Hal tersebut menyebabkan ginjal memainkan peran utama dalam ekskresi ADMA. Berdasarkan hal diatas terbuka peluang untuk meneliti perubahan kadar ADMA urine pada pasien Nefropati Diabetik (ND) yang dikaitkan dengan estimated Glomerular Filtration Rate (eGFR) dan Urine Albumin-to-Creatinine Ratio (UACR). Tujuan. Untuk menentukan korelasi dan performa diagnostik antara kadar ADMA urine dengan eGFR dan UACR. Metode. Penelitian ini merupakan studi potong lintang analitik dengan total 108 pasien. Data didapatkan dari 22 pasien kontrol, 41 pasien Diabetes Melitus Tipe 2 dengan Non Nefropati Diabetik dan 45 pasien Diabetes Melitus Tipe 2 dengan Nefropati Diabetik. Analisis menggunakan uji komparasi Mann-Whitney dan uji korelasi Spearman, lalu dilakukan uji performa diagnostik. Hasil. Dari total 108 pasien, 42 (38,9%) pasien laki-laki dan 66 (61,1%) pasien perempuan dengan rentang usia 30-76 tahun. Terdapat perbedaan bermakna pada kadar HbA1C (p=<0,001), UACR (p=<0,001), ADMA urine (p=<0,001) antara kelompok kontrol dan kelompok non nefropati diabetik. Terdapat perbedaan bermakna pada kadar HbA1C (p=<0,001), UACR (p=<0,001), ADMA urine (p=<0,001) antara kelompok kontrol dan kelompok nefropati diabetik. Terdapat perbedaan bermakna pada kadar UACR (p= <0,001) dan ADMA urine (p=0,047) antara kelompok non nefropati diabetik dan kelompok nefropati diabetik. Berdasarkan uji korelasi spearman terdapat hubungan yang bermakna antara kadar ADMA urine dengan eGFR (p=0,011) dengan nilai r=0,244 dan UACR (p=<0,001) dengan nilai r=0,457. Uji diagnostik kadar Asymmetric Dimethylarginine (ADMA) urine untuk kelompok Non Nefropati Diabetik menggunakan cut off untuk kadar ADMA urine 15 ng/mL, menunjukkan nilai sensitivitas 87,8%, nilai spesifisitas 45,5% dengan AUC 0,784. Dan untuk kelompok Nefropati Diabetik menggunakan cut off untuk kadar ADMA urine 25,45 ng/mL, menunjukkan nilai sensitivitas 88,9%, nilai spesifisitas 36,4% dengan AUC 0,859. Kesimpulan. Terdapat korelasi bermakna antara kadar ADMA dan UACR dengan nilai cut off untuk kadar ADMA urine 15 ng/mL pada kelompok non nefropati diabetik, dan 25,45 ng/mL untuk nefropati diabetik
English Abstract
Background. Diabetic nephropathy is a complication of diabetes mellitus in the kidney which can lead to kidney failure, which in the early stages of diabetic nephropathy, endothelial dysfunction occurs which is characterized by elevated Asymmetric dimethylarginine (ADMA). ADMA is an L-arginine analogue that naturally occurs in the human circulation. Approximately 90% of ADMA is metabolized by dimethylaminohydrolase (DDAH) in the proximal tubule of the kidney, while the remaining 10% is excreted in the urine. This causes the kidneys to play a major role in ADMA excretion. Based on the above, there is an opportunity to examine changes in urine ADMA levels in Diabetic Nephropathy (ND) patients which are associated with the estimated Glomerular Filtration Rate (eGFR) and Urine Albumin-to-Creatinine Ratio (UACR). Purpose. To determine the relationship and diagnostic performance between urine ADMA levels and eGFR and UACR. Methods. This study was an analytic cross-sectional study with a total of 108 patients. Data were obtained from 22 control patients, 41 Type 2 Diabetes Mellitus patients with Non Diabetic Nephropathy and 45 Type 2 Diabetes Mellitus patients with Diabetic Nephropathy. Analysis used the Mann-Whitney comparison test and Spearman correlation test, then performed a diagnostic performance test. Results. Out of a total of 108 patients, 42 (38.9%) were male patients and 66 (61.1%) female patients with an age range of 30-76 years. There were significant differences in the levels of HbA1C (p=<0.001), UACR (p=<0.001), urine ADMA (p=<0.001) between the control group and the non-diabetic nephropathy group. There were significant differences in the levels of HbA1C (p= <0.001), UACR (p= <0.001), urine ADMA (p= <0.001) between the control group and the diabetic nephropathy group. There were significant differences in urine UACR (p=<0.001) and ADMA (p=0.047) levels between the non-diabetic nephropathy group and the diabetic nephropathy group. Based on the Spearman correlation test, there was a significant relationship between urine ADMA levels and eGFR (p=0.011) with a value of r=0.244 and UACR (p=<0.001) with a value of r=0.457. The diagnostic test for Asymmetric Dimethylarginine (ADMA) urine levels for the Non Diabetic Nephropathy group used a cut off for urine ADMA levels of 15 ng/mL, showing a sensitivity value of 87.8%, a specificity value of 45.5% with an AUC of 0.784. And for the Diabetic Nephropathy group using a cut off for urine ADMA levels of 25.45 ng/mL, it showed a sensitivity value of 88.9%, a specificity value of 36.4% with an AUC of 0.859. Conclusion. There is a significant correlation between ADMA and UACR levels with cut off value 15 ng/mL for Non Diabetic Nephropathy group, and 25.45 ng/mL for Diabetic Nephropathy group.
Other obstract
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| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | 0422060192 |
| Uncontrolled Keywords: | DM, nefropati diabetik, eGFR, UACR, ADMA |
| Subjects: | 600 Technology (Applied sciences) > 616 Diseases > 616.07 Pathology |
| Divisions: | Profesi Kedokteran > Spesialis Patologi Klinik, Fakultas Kedokteran |
| Depositing User: | Endang Susworini |
| Date Deposited: | 13 Jul 2023 07:08 |
| Last Modified: | 13 Jul 2023 07:08 |
| URI: | http://repository.ub.ac.id/id/eprint/201831 |
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