Tesis

Hubungan Kejadian Renal Artery Stenosis terhadap Derajat Lower Peripheral Arterial Disease Berdasarkan ANGIO Score di RSUPN Cipto Mangunkusumo = Relation of Incidence of Renal Artery Stenosis in Lower Peripheral Arterial Disease Based on ANGIO Score in Cipto Mangunkusumo Hospital.

Latar Belakang: Penyebab PAD yang paling sering adalah atherosclerosis. PAD berhubungan dengan penyakit atherosklerosis lain seperti renal artery stenosis (RAS). Angka harapan hidup menurun pada pasien yang mengalami RAS, terutama yag stenosisnya diatas 60% namun belum sampai ke tahap gagal ginjal kronik. Dengan penatalaksanaan yang holistik diharapkan angka harapan hidup pasien semakin meningkat. Tujuan: Untuk mengetahui prevalensi RAS pada pasien PAD serta melihat hubungan antara Angio Score, riwayat hipertensi dan diabetes melitus terhadap derajat RAS yang terjadi. Metode: Desain yang digunakan adalah desain potong lintang. Penelitian ini dilakukan di RSUPN Dr. Cipto Mangunkusumo selama periode Februari hingga Mei 2019. Penelitian dilakukan di RSUPN Dr. Cipto Mangunkusumo dengan diagnosis lower extremity PAD, dimana didapatkan skor ABI < 0,9, iskemik berat sampai nekrosis pada tungkai baik unilateral maupun bilateral dan dari pemeriksaan CT Angiografi didapatkan stenosis pada pembuluh darah tungkai, serta tampak arteri renalis pada pemeriksaan CTA yang dilakukan pada pasien tersebut. Pengambilan sampel dilakukan dengan metode total sampling. Hasil: sampel terbanyak berjenis kelamin wanita (50,8%) sedangkan pria sebanyak 32 orang (49,2%). Sebanyak 90,8% pasien yang diteliti menderita diabetes sedangkan 61,5% dari sampel menderita hipertensi. RAS derajat 1 merupakan yang terbanyak ditemukan. Tidak ada hubungan ANGIO Score terhadap usia, jenis kelamin dan diabetes mellitus, namun ada terhadap hipertensi. Terdapat hubungan antara RAS dengan usia dan hipertensi, namun tidak terdapat hubungan terhadap diabetes mellitus dan jenis kelamin. ANGIO Score dan RAS terdapat hubungan yang bermakna (p < 0,001). Simpulan: Perbandingan ANGIO Score berdasarkan derajat stenosis mendapatkan hasil uji Kruskall Wallis mendapatkan nilai p < 0,001 dan dilanjutkan dengan uji Mann Whitney mendapatkan bahwa perbedaan sudah terjadi saat perbandingan derajat stenosis 0 dengan derajat 1 dan seterusnya (p < 0,001). Semakin tinggi nilai ANGIO Score (cut off pada score 9), angka spesifitas semakin tinggi.
Kata kunci: PAD, ANGIO Score, RAS, CTA, hipertensi, diabetes mellitus


Background: The most common cause of PAD is atherosclerosis. PAD is associated with other atherosclerosis diseases such as renal artery stenosis (RAS). Life expectancy decreases in patients who experience RAS, especially those with stenosis above 60% but have not yet reached the stage of chronic renal failure. With holistic management, it is expected that the patient's life expectancy will increase. Objective: To determine the prevalence of RAS in PAD patients and to see the relationship between Angio Score, history of hypertension and diabetes mellitus to the degree of RAS that occurred. Method: The design used is a cross-sectional design. This research was conducted at RSUPN Dr. Cipto Mangunkusumo during the period February to May 2019. The study was conducted at RSUPN Dr. Cipto Mangunkusumo with a diagnosis of lower extremity PAD, which obtained an ABI score of < 0.9, severe ischemia until both unilateral and bilateral limb necrosis and CT angiography examination found stenosis in the leg veins, and the appearance of the renal artery on CTA examination performed on patients that is. Sampling is done by the total sampling method. Results: the most samples were female (50.8%) while men were 32 (49.2%). As many as 90.8% of patients studied had diabetes while 61.5% of the samples suffered from hypertension. 1st degree RAS is the most found. There is no relationship between ANGIO Score with age, gender and diabetes mellitus, but there is a hypertension. There is a relationship between RAS and age and hypertension, but there is no relationship to diabetes mellitus and gender. ANGIO Score and RAS have a significant relationship (p < 0.001). Conclusion: The comparison of ANGIO Score based on the degree of stenosis obtained the results of the Kruskall Wallis test obtained a p value of < 0.001 and continued with the Mann Whitney test found that the difference had occurred when the ratio of stenosis degrees was 0 with degrees 1 and so on (p < 0.001). The higher the ANGIO score (cut off at score 9), the higher the specificity.
Keywords: PAD, ANGIO Score, RAS, CTA, hypertension, diabetes mellitus