MAKALAH CYSTATIN C DAN MIKROALBUMINURIA
OLEH : NAMA : EVA EVA JUNITA JUNITA NIM : 1111 111141012 41012
UNIVERSITAS MH.THAMRIN PROGSUS AAK 2014 1
DAFTAR ISI COVER..............................................................................................................................1 DAFTAR ISI .................................................................................................................... 2
CYSTATIN C PENDAHULUAN ........................................................................................................... 3 LAJU FILTRASI GLOMERULUS (LFG).......................................................................4 KAPAN PENGUKURAN LFG DIPERLUKAN .............................................................4 PENANDA LFG ............................................................................................................... CYSTATIN C (CYS C) ....................................................................................................! KARAKTERISTIK CYS C ..............................................................................................! KINERJA DAN KEUNGGULAN CYS C........................................................................" METODE DAN STANDARDISASI CYS C .................................................................10 FAKTOR # FAKTOR YANG MEMPENGARUHI CYS C ........................................... 10
MIKROAL$UMINURIA PENGERTIAN MIKROAL$UMINURIA......................................................................12 MIKROAL$UMINUTIA PADA INDIVIDU NORMAL ..................................... .........1 DAFTAR PUSTAKA .................................................. ............................................... ....1%
2
CYSTATIN C PENDAHULUAN
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
LAJU FILTRASI GLOMERULUS (LFG)
G-+* 7'7-*-/- ,'97*5 ;9+8,-= -+&+ '/,/&'&-= '+/&-+ + 7'*-. LFG *5 ,*5 ,9 6&7''& ;9+8,- '/,/&'&- +8 6'+-+8 9+9/ 7'+8'5';-,-'+,- 8-+* *7 7'7'&,-5/+ '&8- ? &- &5. T56 <* 6'+9&9++ ;9+8,- 8-+* '&,-; ,-767-/ + 5+ 6 -/'59 '&,&/+ +-*- LFG. P'+9&9++ LFG *5 <* '&-+ 88* 8-+*= ,'& -'&-7 ,'& *9, ,'8- -+'/, '&-/ /','*9&95+ ;9+8,- 8-+*. The National Kidney Foundation= 7'**9- Kidney Disease Quality Outcome Initiative (KDOBI)= + *'78 # *'78 +,-+* *-++ '*5 7'&'/7'+,-/+ LFG 9+9/ ';-+-,-= /*,-;-/,-= ,/&-+-+8= + 6'7+9+ PGK. KAPAN PENGUKURAN LFG DIPERLUKAN ?
S'*-+ 9+9/ '*9,- 9797 ;9+8,- 8-+*= 6'+8'59+ 7'+- LFG 6'+-+8 9+9/ :
− M'+''/,- 6'+9&9++ <* ;9+8,- 8-+* + 7'+'85 '&- /'&9,/+ 8-+* *'-5 *+9. 4
− E*9,- 6'&/'7+8+ 6'+/- + 6&8+,-,. − M'+'+9/+ ,-, + 7'- /+&, &-8&;- +8 -'*-7-+,- *'5 8-+*. − M'+-*- /''&5,-*+ 6'+8+. − M'+'+9/+ /'995+ 9+9/ -*,-, + &+,6*+,-. − M'+8'** 6,-' &+,6*+,- 8-+*.
PENANDA LFG
LFG -/ 6 -9/9& ,'& *+8,9+8 6 7+9,-. N79+= 5&9, -'+9/+ '+8+ 7'+89/9& /*-&'+, &- 6'++ ;-*&,-. S& 6'++ ;-*&,- +8 -'* : -,&-+8 '+8+ ', *'5 8*7'&9*9,= -/ '&-/ 6&'-+ 6*,7= -/ ,'/&',- 99*&= -/ -,'&6= -,'/&',-/+ 9 -7'*-,7' *'5 8-+*= inert ,'& ;-,-*8-,= -/ 7'+895 ;9+8,- 8-+*= 7769 7'+6- /& 6*,7 +8 ,-* + 6 - '+9/+ /&+. P'+'+9+ LFG +8 /9& 6 7'+889+/+ ? '/,8'+ +8 -,9+-/+ 12 # 1 ,'6'&-+9*-+ (/9 '7,)= -+5*7= -5'*= C& ""7 T ethylenediaminetetraacetic acid (1C&EDTA) 9 diethylenethiaminepentaacetic acid (""7TDTPA). N79+= 6&,'9& '&,'9 75*= 7'7995/+ +/ ,97'& 7+9,- -+,-' /&'+ -6'&*9/+ + -/ ,'6'+95+ ', &- 6'+,- 5. O*'5 /&'+ -9= 6&,'9& '&,'9 5+ --+-/,-/+ 8- 6,-'+ '&'+9 + -/ ,',9- -89+/+ 9+9/ 7*'/9* &'+5 *-++ ,'6'&- β2M-/&8*9*-+= βtrace 6&'-+ + &'-+* -+-+8 6&'-+ 98 '*5 -'*9,- ,'8- 6'++ LFG. N79+= ,+8+ 6&'-+ # 6&'-+ '&,'9 -6'+8&95- *'5 -+;'/,- + /'8+,+ ,'& 6'+'+9++ &'*-' ,9*-. A+ /''&,+ 6'++ ;-*&,- '/,8'+ '&,'9= 6 6&/'/ /*-+-, 9797+ -*/9/+ 6'+89/9&+ /& ,'&97 ,'+< '+8'+ ,'6'&- /&'-+-+ + C,-+ C (C C). P'+-+8/+ /& ,'&97 &- ,'+< '&,'9 7'+8-+-/,-/+ + 6'+9&9++ LFG. D-,&+/+ 5< ,'-6 /*- 7'*/9/+ 6'+89/9&+= -5-9+8 ',-7,- LFG ('LFG)+ '+8+ & 7'7,9//+ /' *7 6'&,7+ 6&'-/,- ,'5-+88 /& ,'&97 &- ,'+< '&,'9 -/ -7-* ,'8- 9/9&+ LFG 9+88*. 5
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overestimate +-*- LFG. D-,76-+8 ,'/&',- 99*&= ,'97*5 ;/& '/,&&'+* 9 +8 -,'9 6'+'9 ++ # LFG 6 7'76'+8&95- 6&9/,- /&'-+-+ '+8'+ -+& 9,-= '+-, /'*7-+= /76,-,- 995 '&7,9/ 7,, = /--,= '+-,= 6'+/- /&+-,= ,96+ 7/++ ,'6'&- /+,97,- 8-+8= + + -+'&;'&'+,- +*--/. K&'+ /&'&-,-/ -+- -/ 795 '&9/9&= 6&9/,- /&'-+-+ -6'&/-&/+ ,'& /*-+-, '+8+ 7'+889+/+ /&/'&-,-/ '78&;- &- 9,-= '+-, /'*7-+= &,= + 9 7,, 995 *7 ,'95 6'&,7+ 9+9/ 7'76'&/-&/+ LFG.
6
K& 6*,7 (P) &- 6'++ ;-*&,- '+8'+ -'+9/+ *'5 6&9/,- (G) &,'* + -'= '*-7-+,- '/,&&'+* (E) *'5 9,9, + 5-= + '/,/&',- 7'**9- 9&-+ (UV) *'5 8-+*. E/,/&',- 9&-+ *5 97*5 &- '+ +8 -,&-+8 (GFR P)= ,'/&',- 99*& (TS)= + &',&6,- (TR). D*7 /+-,- steady state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creatinine blind range). P'+-+8/+ ,'&97 /&'-+-+ +8 ,-8+-;-/+ &9 '&''/,- /'-/ LFG 7'+9&9+ 7'+,'/-& %0 &- -+8/ +&7* ,'5-+88 -/ ,'+,--' 9+9/ 7'+-*- 6'+9&9++ LFG - 56 <*. K&'+ /'*'75+ '&,'9= '+8'+ + C, C *5 6'+++ *'&+-' +8 6*-+8 7'++-/+. $'&,&/+ 6'7+ The Kidney Disease : Improving Global Outcomes (KDIGO) 2012= /+;-&7,- 6'+9&9++ 'LFG '+8+ 6'+89/9&+ &- 6'++ ;-*&,- '+8'+ # *'&+-' (C, C) 9 6'+89/9&+ /*-&'+, -995/+ 6 /+-,- '&'+9 -7+ ',-7,- LFG '&,&/+ SC& (,'&97 /&'-+-+) -+886 -/ /9& + /'-/ 6'+87-*+ /'699,+ '&8+9+8 6 -+;&7,- LFG +8 *'-5 /9&= ,'6'&- /+;-&7,- -8+,-, PGK= 7'+'+9/+ /'*/+ +& 8-+* 9 6'+9,9-+ ,-, /,-/ +8 -'/,/&',-/+ *'5 8-+*.
7
CYSTATIN C (CYS C)
S'&5 C, C -79*- 59+ 1"%1 /'-/ J&8'+ C*9,'+ 7'+'*,/+ + 6&'-+ ,6',-;-/ *7 -&+ ,'&'&,6-+* 7+9,- (CSF) +8 - '&-+7 CSF. P&'-+ *7 ;&/,-
/'-/ -'*-- 7'+889+/+ '/+-/ '*'/&;&',-,.
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
KARAKTERISTIK CYS C
C, C *5 6&'-+ +8 -/ '&8*-/,-*,-= '&'& 7*'/9* 13/D= '&-&&- 122 ,7 7-+= +88 ,96'&;7-*- -+5--& ,-,'-+ 6&'-+,'= -/' *'5 8'+ CST3 housekeeping type’ = -6&9/,- *'5 ,'8-+ ',& ,'* '&-+- 6 -+8/ +8 /+,+ + -*'6,/+ ,'& '&56 /' *-&+ &5. C, C ,&-+8 ,'*9&95+ - 8*7'&9*9, /'79-+ -,'&6 /'7*- + ,'6'+95+ -/*-,7' -'8&,- *'5 99*9, 6&/,-7* 8-+*= '6- -/ -,'/&',-/+ *'5 ,'* # ,'* '6-'* 99*&. K&'+ 5+ -'/,/&',-/+ /' *7 9&-+ *7 97*5 /'-*= '&,-5+ 9&-++ -/ 6 -9/9&.
8
T'&*'6, &- 6'&++ *7 ',-7,- LFG= C, C 7'7-*-/- ,'97*5 ;9+8, -*8-, '&7,9/ 7'+8'+*-/+ 6&'*-,-, '/,&,'*9*'& + 79*,- ,,'7 /'/'*+ 995. D-,76-+8 -9= C, C -98 7'7-*-/- ;9+8,- +-/'&- 9 +--&9,. D- ,*5 ,9 *-'&9&' -,'9/+ 5< C, C 79+8/-+ 7'7-*-/- 6'&+ 6&'/-; '&56 '&,/*'&,-, ,'& '&6'&+ ,'8- 6&'-& 6'+/- /&-,/9*&.
KINERJA DAN KEUNGGULAN CYS C
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cross sectional = -6/+ /',-769*+ 5< ,'&97 C, C *'-5 9+889* -+-+8/+ ,'&97 /&'-+-+ 9+9/ 7'+''/,- 8+889+ LFG. R,, // 7'*/9/+ 6'+-+9+ ,'& ,-,'7-, (J+9&- 1"!4 F'&9&- 200%) 7'*-/+ ,9- cross sectional = /5& + -8+,- C, C '+8+ ,'&97 /&'-+-+ 6 6,-'+ &- 2 /'*76/ ,9- 669*,- '+8+ -,;9+8,- 8-+* '+8+ 'LFG %0 # "0 7L7'+-1=3 7 2. H,-* 6'+'*--+ 7'+9+9//+ 5< C, C 7'7-*-/- ,'+,---, + ,6',-;-,-, *'-5 -/ '&9&9 # 9&9. D*7 7' +*-,-, -+-= -,-769*/+ 5< ,'*-+ 7'7-*-/- /9&,- -8+,- +8 *'-5 -/ *7 8+89+ ;9+8,- 8-+*= C, C 98 7'&96/+ 6'++ LFG +8 6 9
-+*/+ 6 6,-'+ '+8+ 8+889+ ;9+8,- 8-+* &-+8+ ,76' ,'+8 (+-*- 'LFG %0 # "0 7L7'+-1=3 7 2).
METODE DAN STANDARDISASI CYS C
P 59+ 1""3= P'&8+' + J9+8 7'+8'7+8/+ sand!ich en"yme immunoassay 9+9/ 7'+'+9/+ /& C, C *7 ,'&97. S'*+9+= 6'&/'7+8+ 7'' particle enchanced immunoturbidimetric (PETIA) + particle enchanced immunonephelometric (PENIA) +8 7-, + '6 '*5 7'79+8/-+/+ 6'+889++ ,'&97 C, C ,/* ',& ,'8- 6'++ LFG +8 '&7+; ,'& /*-+-,. K'9+9+8+ 7'+889+/+ /'9 7'' '&,'9 7'*-69- turnaround time +8 *'-5 '6 + 6&',-,- +8 *'-5 -+88-. D-,76-+8 -9= /'9 7'' +8 7'+88+889 6'+89/9&+ ,'&97 /&'-+-+ '&7,9/ 5'7*-,-,= *-6'7-/= + -/'&-/. A<*+= /''&,+ 97 6'+'+9+ C, C 7'+889+/+ immunoassay '&,'9 '&*'/ 6 ,+&-,,- plat#orm +8 7'7'&*9/+ + 7'&-* 9+ '&,+& -+'&+,-+*. D-,76-+8 -9= -/ +/ 96 +8 -*/9/+ 9+9/ ,+&-,,- 6'+89/9&+ C, C 5-+88 International Federation o# $linical $hemistry (IFCC) 7'7'+9/ /'*76/ /'& 9+9/ 7'+85,-*/+ 7'&-* 9+ C, C. P 9*+ J9+- 2010 T5' IFCC %orking Group 9+9/ S+&-,,- C, C (>G # SCC)= '&/'& ,7 '+8+ The Institute #or &e#erence 'aterial and 'easurements (IRMM)= 7'+89797/+ /''&,'-+ 7'&-* 9+ +8 '&,'&-;-/ -+'&+,-+* (ERMDA41 IFCC). A+ 7'&-* 9+ -+7'79+8/-+/+ 5&7+-,,- + ,+&-,,- 6'7'&-/,+ C, C + 6'*6&++.
FAKTOR – FAKTOR YANG MEMPENGARUHI CYS C
H-+88 , -+-= '&6 ,'97*5 /+-,- +8 '*5 --'+-;-/,- 7'76'+8&95 6&9/,- C, C. G*9//&-/- ,-, ',& (7'-*6&'+-,*+ 0078) '&9/6 7'+-+8//+ /& ,'&97 C, C. S'*-/+= 8*9//&-/- ,-, &'+5 9 ,'+8 (6&'+-,+' ,-, 20 ,76- %0 78 5&-) -/ 7'76'+8&95- /& ,'&97 C, C. 10
F9+8,- -&- -/'59- 6 7'76'+8&95- /& ,'&97 C, C + /& ,'&97 /&'-+-+ ,'& -+'6'+'+ &- ;9+8,- 8-+*. D*7 ,99 ,9- 6&,6'/-;= +8 7'*-/+ 6,-'+ '+8+ -,;9+8,- -&-= F&-/'& // 7'+8'*9,- 6'&95+ 6 /& ,'&9 C, C + /&'-+-+ ,'*7 6'+8+ 5-6-&--,7' + 5-6'&-&--,7'. D&- 6'+'*--+ -+- -/'59- 5< /& C, C *'-5 &'+5 6 5-6-&- + *'-5 '9-&-. D-,76-+8 -9= 6 ,9- +8 -*/9/+ *'5 <-',*//= /''&/-+ +& / C, C '+8+ ,9, -&- 98 '&*-5 6 6,-'+ '+8+ 5-6-&--,7' + 5-6'&-&--,7' ,9/*-+-/. P /+-,- -,;9+8,- -&-= -98 '&- 6'&95+ /''6+ 6&9/,- C, C + ,'&97 /&'-+-+ /- 6'&95+ turnover ,'* + 9 -+8/ 7'*-,7 ,'5-+88 7'76'+8&95- LFG. >*969+ 7'/+-,7' +8 7'+,&- 6'&95+ /& C, C '+8+ ;9+8,- -&- '*97 -/'59- '+8+ '*,= -/ /-7 // 7969+ S57- // 7'+/+ 5< 6'+-+8/+ /& 3=3= # &-- # L # thyronine (T3) ,'& *+8,9+8 6 7'+-+8//+ 6&9/,- C, C + /-7 // 98 7'+'*,/+ 5< Trans#orming Gro!th Factor #
1 (TGF 1) 6
7'+,-79*,- ';'/ &- T3 + 5* -+- /'79+8/-++ ,'& *+8,9+8 6 7'+-+8//+ 6&9/,- C, C. O*'5 /&'+ -9= ;9+8,- -&- 5&9, -6'&-7+8/+ /'-/ C, C -89+/+ ,'8- 6'++ ;9+8,- 8-+*.
11
MIKROALBUMINURIA
PENGERTIAN MIKROALBUMINURIA
M-/&*97-+9&- *5 S99 /'+ - 7+ '&6 *97-+ - *7 9&-+ (-& /'+-+8 ) ,'',& 20 # 1"" 87'+- 6-* 7'+889+/+ ,76'* 9&-+ ,'</9 9 30 2"" 78 24 7 6-* 7'+889+/+ ,76'* 9&-+ 24 7. S/&-+-+8 M-/&*97-+9&- -,'9,'9 ,'8- *&7 -+- '&-+ 6'+/- 8-+*. M-/&*97-+9&- *5 ,99 /+-,- - 7+ '&- /'&+ 6'+&-+8+ 8-+* +8 7'+8/-/+ 6&'-+ *97-+ **, '&,7 9&-+. N&7*+ 6&'-+ *97-+ -+- -/ -9+8 '&,7 9&-+= /&'+ *97-+ 7'&96/+ 6&'-+ 6'+-+8 8- 995.
T'* 1. K'8&- *97-+9&- 7'+9&9 A7'&-+ D-'', A,,---+ ( ADA ) K'8&-
U&-+ 24 J7 ( 7824 7) N&7* 30 M-/&*97-+9&- 30 # 2"" M/&*97-+9&- 300 U&-+ +8 -/9769*/+ *7 </9 24 7
U&-+ *7 </9 '&'+9 (87'+-) 20 20 1"" 200
U&-+ ,'</9 (878 /&'-+-+) 30 30 2"" 300
K6+ ,'-/+ U- ,&-+8 M-/&*97-+9&- -*/9/+
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