BackgroundUric acid (UA) plays important roles in inducing renal inflammation, intra-renal vasoconstriction and renal damage. Endothelin-1 (ET-1) is a well-known profibrotic factor in the kidney and is associated with fibroblast expansion. We examined the role of hyperuricemia conditions in causing elevation of ET-1 expression and kidney injury.MethodsHyperuricemia was induced in mice using daily intraperitoneal injection of uric acid 125 mg/Kg body weight. An NaCl injection was used in control mice. Mice were euthanized on days-7 (UA7) and 14 (UA14). We also added allopurinol groups (UAL7 and UAL14) with supplementation of allopurinol 50 mg/Kg body weight orally. Uric acid and creatinine serum were measured from blood serum. Periodic Acid Schiff (PAS) and Sirius Red staining were done for glomerulosclerosis, tubular injury and fibrosis quantification. mRNA expression examination was performed for nephrin, podocin, preproEndothelin-1 (ppET-1), MCP-1 and ICAM-1. PDGFRβ immunostaining was done for quantification of fibroblast, while α-SMA immunostaining was done for localizing myofibroblast. Western blot analysis was conducted to quantify TGF-β1, α-SMA and Endothelin A Receptor (ETAR) protein expression.ResultsUric acid and creatinine levels were elevated after 7 and 14 days and followed by significant increase of glomerulosclerosis and tubular injury score in the uric acid group (p < 0.05 vs. control). Both UA7 and UA14 groups had higher fibrosis, tubular injury and glomerulosclerosis with significant increase of fibroblast cell number compared with control. RT-PCR revealed down-regulation of nephrin and podocin expression (p < 0.05 vs. control), and up-regulation of MCP-1, ET-1 and ICAM-1 expression (p < 0.05 vs. control). Western blot revealed higher expression of TGF-β1 and α-SMA protein expression. Determination of allopurinol attenuated kidney injury was based on reduction of fibroblast cell number, inflammation mediators and ppET-1 expression with reduction of TGF-β1 and α-SMA protein expression.ConclusionsUA induced glomerulosclerosis, tubular injury and renal fibrosis with reduction of podocyte function and inflammatory mediator elevation. ET-1 and fibroblast expansion might modulate hyperuricemia induced renal fibrosis.

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The aim of this study to evaluate clinical and management of penile cancer patients at Sardjito Hospital. Data were collected from medical record of Sardjito Hospital from 2006 - 2013. The clinical factors and therapy were studied from each patient. Correlation between age and stadium of disease were analyzed using Chi-Square Test while the correlation among pathological grade and T, N and M stage were analyzed by using Fisher Test. There are 35 cases of penile cancer with mostly of 40-60 years old man (45.7%) , circumcised (42.9%), squamos cell type (91.4%) and perform partial penectomy (45.7%) followed by chemotherapy (6 patients) and radiotherapy (4patients). There are no correlation between age and stadium of cancer (P>0.05), also among pathological grade with T, N and M Stage (P>0.05). Penile cancers at Sardjito Hospital mostly found on 40-60 years old, and already developed into advanced disease. Thetherapy is consist of partial penectomy followed by chemo- radiotherapy.ABSTRAKPenelitian ini bertujuan untuk mengevaluasi klinis dan manajemen kanker penis di Rumah Sakit Sardjito. Data dikumpulkan dari rekam medis RS Sardjito tahun 2006-2013. Faktor klinis dan terapi dipelajari dari tiap pasien. Hubungan antara usia dan stadium penyakit dianalisis menggunakan tes Chi-Square, sedangkan hubungan antara tingkatan histopatologi dengan stadium T, N, M dianalisis dengan tes Fisher. Ada 35 kasus kanker penis dengandominan pada usia 40-60 tahun (45,7%); telah disunat (42,9%); tipe karsinoma sel skuamosa (91,4%); dan dilakukan penektomi parsial (45,7%) diikuti dengan kemoterapi (6 pasien) serta radioterapi (4 pasien). Tidak ada hubungan antara usia dengan stadium penyakit (>0,05) dan juga antara tingkatan histopatologi dengan stadium T, N, M (p>0,05). Kanker penis di RS Sardjito kebanyakan ditemukan pada usia 40-60 tahun dan telah berkembang menjadi tingkat lanjut. Terapi terdiri dari penektomi parsial diikuti kemo-radioterapi.

Background Most of the outcomes after radical cystectomy (RC) are directly associated with the type of urinary diversion. This study sets out to evaluate the outcomes of ileal conduit (IC) and transuretero-cutaneostomy (TUC) urinary diversion after RC. Methods This retrospective study included 52 patients (IC, n = 30; TUC, n = 22) at Dr. Sardjito Hospital between January 2014 and December 2019. The clinical outcomes were compared using Chi-squared tests and independent t tests. Multivariable logistic regression analysis was performed to determine the odds of developing related complications. Results Demographically, both groups were similar in terms of age, gender, ASA score, staging, body mass index, and comorbidities. IC was associated with a high incidence of postoperative complications than TUC (56.7% vs. 27.3%; p = 0.035). Long-term postoperative complications stoma stenosis was more common in the TUC than IC (p = 0.010). Multivariate analysis showed TUC was a significant predictor for stoma stenotic with odds ratio of 1.29 (95% confidence interval, 1.03–1.62; p = 0.006). Meanwhile, metabolic change was found higher in IC (p = 0.047). No difference between the rate of required blood transfusion, postoperative ileus, re-operation, and anastomotic stricture in both groups. Operative time (p = 0.000) and length of stay (p = 0.002) were lower in patients who underwent TUC. The hospitalized cost was also lower in TUC ($ 2311.8 ± 1448 for IC vs. $ 1844.2 ± 948.8 for TUC; p = 0.005). Nonetheless, the follow-up cost was higher in the TUC but not statistically significant. Additionally, there was no difference between the overall satisfaction and diversion-related symptoms scores in both groups. The psychological score was better in IC groups. Conclusions Both of these techniques can be an option in a urinary diversion after RC with various advantages and disadvantages. TUC provides reduced complication rates, operative time, shorter length of stay, and hospitalized costs, but IC may reduce postoperative stoma stenosis complications and better psychological function.

Objective: Urolithiasis could be caused by urinary tract infection (UTI). UTI in patients with urolithiasis need to be diagnose and manage as soon as possible. This study was aim to determine the diagnostic value of urinalysis examination to diagnose urinary tract infection (UTI) in patients with urolithiasis.Material & method: This study was an observational analytic with cross sectional study design, comparing one diagnostic tool with the gold standard tool to diagnose UTI. Total samples collected were 186 patients at Sardjito General Hospital, Yogyakarta. Urine culture and urinalysis were performed in patients with urinalysis and UTI. The results of urine culture and urinalysis were then compared by 2x2 table.Results: The sensitivity results on leukocyte esterase, eritrocyturia, bacteriuria, and nitrite respectively were 82.7%, 57.14%, 37.59%, and 13.53%. The specificity results on nitrite, bacteriuria, eritrocyturia, and leukocyte esterase respectively were 63.26%, 56.60%, 50.94%, and 33.96%. The highest level of accuracy was leukocyte esterase with 68.81% accuracy.Conclusion: This study showed that leukocyte esterase had good sensitivity with an accuracy of 68.81%. Examination of nitrite had the highest specificity compared to the other variables in urinalysis examination.

Background: Chronic kidney disease (CKD) is a non-communicable disease with high morbidity and mortality. Treatment options for CKD patients are kidney transplantation, hemodialysis, and peritoneal dialysis. Kidney transplantation remains the best option for CKD patients, which has the best Quality of Life compared to other therapies. The cost of therapy for CKD patients is relatively high. Even in developed countries, renal replacement therapy costs are still a burden on the health system and a public health problem. Therefore, this study aims to compare the cost of care for CKD patients undergoing kidney transplantation, hemodialysis, and peritoneal hemodialysis at dr. Sardjito General Hospital, Indonesia. Methods: This study was a retrospective cohort study of patients who underwent kidney transplantation, continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis from January 2018 to December 2020 at dr. Sardjito General Hospital. We reviewed the medical records, and the data collected was ordinal, numeric, and categorical data. The data was then coded and processed using SPSS version 25.0. The results are presented in descriptive form, tables, or diagrams. Results: In this study, we found 87 CKD samples. Thirty patients underwent kidney transplantation, 27 patients underwent CAPD, and 30 patients were randomly assigned to undergo routine hemodialysis. Based on the data obtained from this study, the average cost incurred in the first year for patients undergoing kidney transplantation at dr. Sardjito General Hospital amounted to 384.6 million IDR. For CAPD patients, it was 93.7 million IDR, and the average cost for patients undergoing outpatient hemodialysis routinely was 104.1 million IDR. The estimated average cost incurred in the third year after the procedure for kidney transplant patients is 393.7 million IDR, CAPD patients 273.7 million IDR, and patients undergoing routine hemodialysis 307.8 million IDR. The estimated average cost incurred for CKD patients undergoing kidney transplantation was 402.7 million IDR in the fifth year. For CAPD patients was 273.7 million IDR, and for patients undergoing routine hemodialysis was 511.5 million IDR. Conclusions:The results showed a difference in costs between kidney transplantation, CAPD and hemodialysis. The kidney transplant cost is much more expensive than CAPD and hemodialysis, but the monthly cost is much cheaper than the other two procedures. In the third year estimation, the costs incurred for CAPD and hemodialysis will be close to the costs incurred for kidney transplantation. In the fifth year, the costs for kidney transplantation will be smaller than the costs for CAPD and hemodialysis.

Objective: To know if pre-morbid factors such as maximum power, maximum frequency, repeated extracorporeal shock wave lithotripsy (ESWL), age, hypertension, diabetic, nutrition, blood coagulation disorders, kidney function disorders, pain perception, stone burden, and stone location, can be use to predict ESWL complication. Material & methods: This study is done retrospectively. Analysis was done on 50 patients undergoing ESWL between July 2014 to December 2015. Free variables which evaluated were maximum power, maximum frequency, repeated ESWL, age, hypertension, diabetic, nutrition, blood coagulation disorders, kidney function disorders, pain perception, stone burden, and stone location. Dependent variable which evaluated was steinstrasse event, post ESWL fever, post-ESWL renal colic, post-ESWL hematuria. Age variable were distributed normally and done bivariate analysis by student T-test. Others were abnormally distributed and analyzed univariately by Mann U Whitney. Results: During study period, 50 patients were collected. Among them, 60% were men and 40% were women. Mean age of patients undergo ESWL were 50.9 +12.7 years. Mean stone size that undergo ESWL were 172.7 + 277.8 mm2. Patients with hypertension before ESWL were 9 patients. Stones were mostly located on kidney pyelum (29 patients), inferior calix (11 patients), superior calix (5 patients), middle calix (4 patients), and 1 patients has staghorn stone. After ESWL, none of the patients complaining severe pain, 35 patient complaining mild pain, and 15 patient complaining moderate pain. Repeated ESWL done in 16 patients (32%). Post-ESWL complication such as hematuria happened on 12 patients, steinstrasse on 1 patient, and colic on 6 patients. None of patients complaining fever. Repeated ESWL happened on 32% patients and have complication risk of hematuria (p=0.043). Hypertension is significantly effecting on hematuria event after ESWL (p=0.015). Conclusion: Hypertension and repeated ESWL can be used as predicting factor of hematuria complication.