Peningkatan kadar Mean Platelet Volume-Lymphocyte Ratio (MPVLR) terhadap resiko diabetik nefropati pada pasien dengan diabetes melitus tipe II (DM-2) di RSUP Sanglah, Bali, Indonesia

Abstract

Background: Diabetic Nephropathy (DN) is Diabetes Mellitus’s microvascular complication with albuminuria and decrease glomerular filtration rate. DN pathogenesis is related with inflammatory process induced by chronic hyperglycaemia. Mean platelet volume (MPV) and platelet-lymphocyte ratio (PLR) are potential for reviewing systemic inflammation. The combination of MPV and PLR index into MPVLR shows significant results in prognostic patients with diabetes mellitus and acute myocardial infarction and predicted DN. This study aims to determine the MPVLR index of DN risk in type II diabetes mellitus patients at Sanglah Hospital, Denpasar.Method: Cross-sectional study of 50 DM-2 patients at Sanglah Hospital in 2016. The data is secondary data from the medical records of DM-2 patients according the inclusion and exclusion criteria with purposive sampling technique. Diabetic nephropathy is diagnose based on diagnostic criteria. Complete blood count (CBC) using the CELL-DYN Ruby System. MPVLR is an absolute comparison of the calculation of MPV and total lymphocytes. T-test and Mann-Whitney Test to assess differences mean of data. The MPVLR index for diabetic nephropathy was assessed by Receiver Operating Curve (ROC) and Area Under the Curve (AUC). p <0.05 is statistically significant.Results: 50 data were grouped into nephropathy and without nephropathy groups. Men is dominant in both groups (p>0.05). The MPVLR ratio was statistically significantly higher in the nephropathy group (5.11 ± 2.20; P = 0.004). The MPVLR index cut point value was 3.835 with a sensitivity value of 73.7% and specificity of 71%.Conclusion: MPVLR can use as independent predictor of diabetic nephropathy in diabetic patients. Latar Belakang: Diabetik Nefropati (DN) merupakan komplikasi mikrovaskular Diabetes Melitus dengan albuminuria dan penurunan estimasi laju filtrasi glomerulus. Patogenesis DN berkaitan dengan proses inflamasi terinduksi hiperglikemia kronis. Indeks rerata volume trombosit (MPV) dan rasio trombosit-limfosit (PLR) potensial untuk meninjau inflamasi sistemik. Gabungan indeks MPV dan PLR menjadi MPVLR menunjukan hasil yang signifikan dalam diagnostik prognostik pada pasien diabetes melitus dan infarksi miokardial akut serta menjadi prediktor DN. Penelitian ini bertujuan untuk mengetahui indeks MPVLR terhadap risiko DN pada pasien diabetes melitus tipe II di RSUP Sanglah, Denpasar.Metode: Studi potong lintang (cross-sectional) terhadap 50 pasien DM-2 di RSUP Sanglah tahun 2016. Data penelitian adalah data sekunder dari rekam medis pasien DM-2 yang memenuhi kriteria Inklusi dan Eksklusi dengan teknik purposive sampling. Diabetik nefropati ditegakkan berdasarkan kriteria diagnosis. Pemeriksaan darah lengkap (DL) menggunakan CELL-DYN Ruby System. Rasio MPV terhadap limfosit (MPVLR) adalah perbandingan absolut dari perhitungan MPV dan limfosit total. Uji-t dan Uji Mann-Whitney untuk menilai perbedaan antara rata-rata data dua kelompok. Indeks MPVLR terhadap diabetic nefropati dinilai dengan Receiver Operating Curve (ROC) dan Area Under the Curve (AUC). Nilai p<0,05 bermakna secara statistik.Hasil: 50 data dikelompokkan menjadi kelompok dengan nefropati dan tanpa nefropati. Jenis kelami laki-laki dominan di kedua keompok tersebut (p>0,05). Rasio MPVLR secara statistik bermakna lebih tinggi pada kelompok dengan nefropati (5,11±2,20; P=0,004). Nilai titik potong indeks MPVLR sebesar 3,835 dengan nilai sensitifitas sebesar 73,7% dan spesifisitas 71%.Simpulan: MPVLR dapat sebagai prediktor kuat dan independen diabetik nefropati pada pasien diabetes.

Association of ELMO1 Genetic Polymorphism (rs741301) with the Progression of Diabetic Kidney Disease in Balinese Patients with Type 2 Diabetes Mellitus

“…22 Inflammation in DKD involves the increase of oxidative stress in the kidney. 6,23,24 Several studies have found that ELMO1 cytokine plays an important role in the increase of oxidative stress 6 , although the specific mechanism that explains the role of SNP rs741301 polymorphism in ELMO1 gene in DKD is still unclear. In a series of studies, it is found that an increase in ELMO1 serum level causes Rac1 activation through the RhoG-ELMO-DOCK180 pathway complex, which increases the NOX and ROS 5,21 as well as fibronectin gene expression through COX-2 activity.…”