Tesis

Perbandingan Kadar D-dimer Urin Pada Pasien Hamil Normotensif, Preeklampsia Berat Dengan Oligouria Dan Preeklampsia Berat Non-Oligouria Di RSCM = Comparison of Urine D-dimer in Normotensive,Severe Preeclampsia with Oligouria and Non- Oligouria in RSCM.

Latar Belakang: Angka kematian ibu yang diakibatkan oleh kasus preeklampsia bervariasi antara 4-16%. Salah satu komplikasi yang diakibatkan oleh preeklampsia adalah Acute Kidney Injury (AKI), berkaitan dengan peningkatan produksi thrombus yang berhubungan dengan peningkatan produksi D-dimer di urin. Pada studi 2013 menunjukkan bahwa D-dimer urin merupakan alat diagnostik yang baik untuk menilai adanya penumpukan fibrin pada endotel glomerulus pada pasien preklampsia dengan AKI. Tujuan: Penelitian ini bertujuan melihat perbandingan kadar D-dimer urin pada wanita hamil normotensif, preeklampsia berat disertai oligouria dan non oligouria sehingga dapat dijadikan pilihan pemeriksaan awal preventif lain terhadap komplikasi AKI. . Metode: Penelitian potong lintang dilakukan sejak September 2016 sampai Januari 2017 di Instalasi Gawat Darurat, Poliklinik, Instalasi Rawat Inap Departemen Obstetri dan Ginekologi, RSCM. Sebanyak 140 pasien hamil yang telah memenuhi syarat dan ditawarkan untuk ikut penelitian untuk diperiksa kadar D-dimer darah dan urinnya. Subyek penelitian diambil dengan metode consecutive sampling, kemudian dibagi menjadi 3 kelompok yaitu hamil dengan normotensi (45 subyek), pasien hamil dengan PEB tanpa oligouria (44 subyek), dan pasien hamil dengan oligouria (51 subjek). Kadar D-dimer diperiksa dengan menggunakan Abcam Human D-dimer ELISA. Penelitian ini telah disetuji oleh Komite Etik dan Penelitian di tahun 2016. Hasil: Terdapat perbedaan kadar D-dimer urin antara ketiga kelompok (p 0,013) dan secara spesifik perbedaan terletak antara kelompok normotensi dibandingkan dengan PEB tanpa oligouria (p 0,005), tidak terdapat perbedaan bermakna antara PEB non oligouria dibandingkan PEB oligouria (p 0,019). Nilai diagnostik D-dimer urin dalam mendeteksi AKI pada PEB dengan sensitivitas 78% dan spesifisitas 55% memiliki nilai AU 0,407 (40,7%) dengan titik potong > 308,45 ng/dL. Hal ini menunjukkan bahwa meningkatnya kadar D-dimer urin tidak secara signifikan mendiagnosis AKI. Kesimpulan: Kadar D- dimer urin tidak berbeda bermakna pada kelompok pasien PEB dengan oligouria maupun tanpa oligouria.
Kata Kunci: Preeklampsia Berat, Kadar D-dimer urin, Acute Kidney Injury.



Background: Maternal Mortality Rate caused by preeclampsia range between 4-16%. One of the complication of preeclampsia is Acute Kidney Injury (AKI) which is related to increase of thrombus formation that correlates with the production of D-dimer level in urine. In 2013, study showed urine D-dimer could be a good diagnostic tool to asses fibrin deposits in glomerular endothelial layer in preeclampsia patient with AKI. Objective:.This aim of this study is to see urine D-dimer level in normotensive, severe preeclampsia with oliguria and nonoliguric patients. Urine D-dimer is expected to be another good preventive screening tool for complication such as AKI. Method: This is a cross-sectional study from September 2016 until January 2017 had been done to patients who are taken care in Obstetric Emergency Unit, Policlinic, ward and ICU, Obstetric and Gynecology Department Ciptomangunkusumo Hospital. 140 subjects of pregnant women fulfilled the subject’s criteria and were offered to be included in the study. Subjects were obtain with consecutive sampling method, and were divided into 3 groups; pregnant normotensive (45 subjects), severe preeclampsia with oliguria (44 subjects), and pregnant with no oliguric severe preeclampsia (51 subjects). The presence of D-dimer in urine screened using Abcam Human D-dimer ELISA. Research was approved by our institutional Ethics Commitee for Health Researches in 2016. Result: Urine D-dimer levels were different between each group (p 0,013) and specific difference were found between normotensive group and no oliguric severe preeclampsia (p 0,005). No difference were found between group of no oliguric and oliguric severe preeclampsia (p 0,119). Urine D-dimer provided sensitivity 78% dan spesificity 55% to support the diagnosis of acute kidney injury in severe preeclampsia, with cut-off level > 308,45 ng/dL but AUC’s of urine D-dimer was 0,407 (40,7%). Its shown that high levels of urine D-dimer does not specifically diagnose AKI. Conclusion: Urine D-dimer level have no statistical significant difference between severe preeclampsia patient with oliguria and no oliguria. High level of urine D-dimer doesn’t specifically diagnose acute kidney injury. Conclusion: Urinary D-dimer level have no significant difference between severe preeclampsia patient with oliguria and no oliguria.
Keywords: Severe preeclampsia, Urine D-dimer, Acute Kidney Injury.