Transfusion-Related Acute Lung Injury (TRALI) In Donor Kidney Transplantation Patient A Case Report.
THE INDONESIAN JOURNAL OF NEPHROLOGY AND HYPERTENSION
Vol. 8, No.2, April - Juni 2008
DAFTAR lSI
..-
EDITORIAL
LAPORAN KASUS
TRANSFUSION - RELATEDACUTE LUNG INURY (TRAU)
TRANSFUSION-RELATEDACUTE LUNG INJURY (TRAU)
Dharmeizar
IN DONOR KIDNEY TRANSPLANTATION PATIENT - A
CASEREPORT
Nur Samsu*, Santoso Chandra*, Djoko W ibisono*,
LAPORAN PENEUTIAN
Supriyadi*,
Yenni Kandarini*,
Rudi
Bonar M Marbun**,
Dharmeizar**,zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGF
E. Susalit**
ADIPONECTINAND ASSOCIATEDFACTORSIN
CONTINUOUS AMBULATORY PERITONEALDIALYSIS
TINJAUAN PUSTAKA
(CAPO) PATIENTS
Yenny Kandarini, Raka Wid/ana and Ketut Suwitra
POUMORFISME GEN SISTEM RENJNANGIOTENSIN
HUBUNGAN PENINGKATAN KADAR TGF- B1 PADA
ALDOSTERONDAN HIPERTENSI
PENDERITA HIPERTENSI ESENSIAL DENGAN FUNGSIzyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
Fredie Irijanto
,
GINJAL DITINJAU DARI MIKROALBUMINURIA
DAN
LAJU FILTRASIGLOMERULUS
INFLAMASI PADA PENYAKITGINJAL KRONIK DAN
Rudi Supriyad/, Nanny Natalia, HM Rachmat Soelaeman,
HUBUNGANNYA DENGAN PENYAKIT
Enday Sukandar
KARDIOVASKULAR
Pringgodfgdo Nugroho, Dharmeizar
KORESPONDENSI& PANDUAN BAGI PENUUS
IS S N 0 8 5 3 -1 1 3 7
V ol. 8 , N o.2 , April - Juni 2 0 0 8
P e rhim puna n N e frologi
(P E R N E F R I)
S e kre ta ria t
Indone sia
:zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCB
Gedung YARNATI Lt. 1 Ruang 103
JI. Proklamasi No. 44, Jakarta Pusat 10320
PO. BOX 1169 - JKT 13011
Telp. (021) 314 9208, 3903837 Fax. (021) 315 5551
Web Site: www.pernefri.org
E-mail: pernerri@cbn.neUd
-------- zyxwvutsr
Ginjal Hipertensi, Vol.8, NO.2, April - Juni 2008
I Susunan
R edaksi
Pelindung:
Ketua PERNEFRI ex officio
Ketua Dewan Editor:
Dr. Parlindungan Siregar, Sp.PD-KGH
Wakil Ketua Dewan Editor:
Dr. Dharmeizar, Sp.PD-KGH
Anggota Dewan Editor:
J
DR.Dr. Suhardjono, SpPD-KGH, KGer
o
Dr. Pranawa, Sp.PD-KGH
.j
Dr. Ardaya, Sp.PD-KGH
..j
DR. Dr. Imam Effendi, SpPD-KGH
o
DR. Dr. Bimanesh Sutarjo, Sp.PD-KGH
..j
Dr. Lucky Aziza Bawazier, SpPD-KGH
.j
Dr. Dwi Juwono, Sp.PD-KGH
..j
Dr. Ginova Nainggolan, SpPD-KGH
..j
Prof. Dr. Wiguno Prodjosudjadi, Ph.D.,
.j
Dr. Tunggul Situmorang, Sp.PD-KGH,
DipI/M.Med.SizyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPO
Editor Kehormatan:
.j
Dr. J. Pudji Rahardjo, Sp.PD-KGH
.j
Prof. Dr. M. S. Markum, Sp.PD-KGH zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
Sp.PD-KGH zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONM
.j
Prof. Dr. Harun Rasyid Lubis, Sp.PD-KGH
.j
Prof. Dr. Enday Sukandar, Sp.PD-KGH
.j
Prof. Dr. Jose Roesma, Ph.D, Sp.PD-KGH
.j
Dr. E. J. Kapojos, Sp.PD-KGH
.j
Prof. DR, Dr. Endang Susalit, Sp.PD-KGH
.:J
Prof. Dr. Made Sukahatya, Sp.PD-KGH
,::;
Prof. Dr. Sutisna Himawan, Sp.PA (K)
..J
Prof. Dr. Husein Alatas, Sp. A (K)
,::; Prof. Dr. Agus Tessy, Sp.PD-KGH
Bendahara:
Dr. Aida Lydia, Sp.PD-KGH
Publikasi:
Arlinda Simanjuntak
Administrasi dan Iklan :
Ir. Tety Sidabutar
Distribusi :
PERNEFRI
Lay Out & Design:
PERNEFRI - Ferdy Lumbantobing
:/
Prof. DR. Dr. Mochammad Sja'bani,
Sp.PD-KGH
Ginjal Hipertensi, Vo1.8, NO.2, April
Juni 2008
NJAL
zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
HIPERTENS
I D aftar lsi zyxwvutsrqponmlkjihgfedcba
Editorial
TRANSFUSION
73 -74
- RELATED ACUTE LUNG INURY (TRAU)
Dharmeizar
Laporan Penelitian
ADIPONECTIN
AND ASSOCIATED FACTORS IN CONTINUOUS AMBULATORY
PERITONEAL DIALYSIS
(CAPO) PATIENTS
75 -79
Yenny Kandarini, Raka Widiana and Ketut Suwitra
HUBUNGAN
PENINGKATAN
KADAR TGF- B1 PADA PENDERITA HIPERTENSI ESENSIAL DENGAN
GINJAL DITINJAU DAR I MIKROALBUMINURIA
FUNGSI
DAN LAJU FILTRASI GLOMERULUS
RudlSupriyadi, Nanny Natalia, HM Rachmat Soe/aeman, Enday Sukandar
80 - 90
Laporan K asus
TRANSFUSION-RELATED
ACUTE LUNG INJURY (TRAU) IN DONOR KIDNEY TRANSPLANTATION
PATIENT-
A CASE REPORT
Nur Samsu*, Santoso Chandra*, Djoko Wibisono*, Rudi Supriyadi*, Yenni Kandarini*"Bonar M Marbun**,
Dharmeizar**, E. Susalit**
91- 95
Tinjauan Pustaka
POLIMORFISME
GEN SISTEM RENIN ANGIOTENSIN ALDOSTERON DAN HIPERTENSI
Fredie Irijanto
INFLAMASI
PADA PENYAKIT GINJAL KRONIK DAN HUBUNGANNYA
96
-105
DENGAN PENYAKIT
KARDIOVASKULARzyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
Pringgodigdo Nugroho, Dharmeizar
K orespondensi & Panduan Bag~Penulis
106-11 5
116- 117zyxwvutsrqponmlk
THANK YO U FO R TRUSTING
.
Nf)f'VaS~
:t
Arntodiptne
besylate
The Heart of Hypertension TreatmentzyxwvutsrqponmlkjihgfedcbaZYXWV
® Real World Experiences for More than 15 Years in the Market
® Supported by More than 700 Medical Studies including Landmark
Hypertension Trials (ALLHAT, VALUE, CAMELOT/ NORMALISE,
ASCOT BPLA) in over than Thousands of Patients in Reducing
Cardiovascular Morbidity and Mortallty"?".
® Effective and Safe in Controlling Blood Pressure for More Than 24 Hours'
Effective in Broad Range of Hypertensive Patients,
including Patients with High Cardiovascular Risk7
Safely Combined with Other Oral Hypertension Drugs and
Shows No Significant Drug lnteraction'
Can be Used for Patients with Concomitant Dlseases?"
"a5~ s zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
m9,zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
r:
(f) Nor SKES patients
available for A
Laporan Kasus
TRANSFUSION-RELATED ACUTE LUNG INJURY (TRALI) IN DONOR KIDNEY
TRANSPLANTATION PATIENT – A CASE REPORT
Nur Samsu*, Santoso Chandra*, Djoko Wibisono*, Rudi Supriyadi*, Yenni Kandarini*, Bonar M Marbun**,
Dharmeizar**, E. Susalit**.
*Peserta program pendidikan konsultan, **Divisi Ginjal dan Hipertensi FKUI-RSCM Jakarta.
Abstract
Transfusion-related acute lung injury (TRALI) is defined as noncardiogenic pulmonary edema
related to transfusion therapy. It is a potentially life-threatening, underrecognized and underreported complication of transfusion. Symptoms usually begin within 1-2 hours up to 6 hours
and severity may range from mild to severe (life threatening). Clinically indistinguishable from
acute respiratory distress syndrome (ARDS). The diagnosis of TRALI relies on excluding other
diagnoses and based primarily on clinical simptoms and signs, not laboratory findings. The
minimum requirements for diagnosis of TRALI was occurrence of acute repiratory distress
during or within 6 hrs of transfusion, absence of signs of circulatory overload, and radiographic
evidence of bilateral pulmonary infiltrates. The pathogenesis of TRALI may be explained by a
two-hit hypothesis, with the first hit being an underlying condition of the patient. The second hit
may involve the presence of biologically active lipids or leucocyte antibodies in transfused blood
component. No specific treatment for TRALI. Maintenance of hemodynamic status is the most
beneficial and appropriate therapy. Ventilatory support and saline infusion are probably the only
standard therapies for TRALI.
We reported a 24 yaers old male-kidney related transplantasion donor patien with TRALI that
occur approximately 2 hours after transfusion of pack red cell on day-3 of nephrectomy.
Transfusion was indicated for patien because of acute bleeding. Patiens developed dyspnea,
cyanosis, cough with pink frothy sputum, along with physical findings of bilateral pulmonary
edema. The CXR examination showed bilateral pulmonary infiltrates. A patien was given
intubation and ventilatory support and inproved with resolution of the pulmonary infiltrasion
within the first 4 days.
PENDAHULUAN
Transfusion-related acute lung injury (TRALI) adalah edema paru non-kardiogenik yang
berkaitan dengan terapi transfusi. TRALI merupakan salah satu penyebab tersering morbiditas
dan mortalitas terkait transfusi.1 Istilah ini pertama kali diusulkan oleh Popovsky tahun 1983
untuk menjelaskan adanya kumpulan gejala klinik dan gambaran laboratorium yang terjadi
selama 6 jam transfusi plasma yang mengandung produk-produk darah.2 Pada umumnya
gejala-gejala respiratory distress terjadi dalam 2 – 6 jam pertama dari saat permulaan transfusi
darah, hanya beberapa kasus terjadi lebih lambat, bahkan smapai 48 jam.1 Timbulnya TRALI
Vol. 8, No.2, April - Juni 2008
DAFTAR lSI
..-
EDITORIAL
LAPORAN KASUS
TRANSFUSION - RELATEDACUTE LUNG INURY (TRAU)
TRANSFUSION-RELATEDACUTE LUNG INJURY (TRAU)
Dharmeizar
IN DONOR KIDNEY TRANSPLANTATION PATIENT - A
CASEREPORT
Nur Samsu*, Santoso Chandra*, Djoko W ibisono*,
LAPORAN PENEUTIAN
Supriyadi*,
Yenni Kandarini*,
Rudi
Bonar M Marbun**,
Dharmeizar**,zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGF
E. Susalit**
ADIPONECTINAND ASSOCIATEDFACTORSIN
CONTINUOUS AMBULATORY PERITONEALDIALYSIS
TINJAUAN PUSTAKA
(CAPO) PATIENTS
Yenny Kandarini, Raka Wid/ana and Ketut Suwitra
POUMORFISME GEN SISTEM RENJNANGIOTENSIN
HUBUNGAN PENINGKATAN KADAR TGF- B1 PADA
ALDOSTERONDAN HIPERTENSI
PENDERITA HIPERTENSI ESENSIAL DENGAN FUNGSIzyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
Fredie Irijanto
,
GINJAL DITINJAU DARI MIKROALBUMINURIA
DAN
LAJU FILTRASIGLOMERULUS
INFLAMASI PADA PENYAKITGINJAL KRONIK DAN
Rudi Supriyad/, Nanny Natalia, HM Rachmat Soelaeman,
HUBUNGANNYA DENGAN PENYAKIT
Enday Sukandar
KARDIOVASKULAR
Pringgodfgdo Nugroho, Dharmeizar
KORESPONDENSI& PANDUAN BAGI PENUUS
IS S N 0 8 5 3 -1 1 3 7
V ol. 8 , N o.2 , April - Juni 2 0 0 8
P e rhim puna n N e frologi
(P E R N E F R I)
S e kre ta ria t
Indone sia
:zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCB
Gedung YARNATI Lt. 1 Ruang 103
JI. Proklamasi No. 44, Jakarta Pusat 10320
PO. BOX 1169 - JKT 13011
Telp. (021) 314 9208, 3903837 Fax. (021) 315 5551
Web Site: www.pernefri.org
E-mail: pernerri@cbn.neUd
-------- zyxwvutsr
Ginjal Hipertensi, Vol.8, NO.2, April - Juni 2008
I Susunan
R edaksi
Pelindung:
Ketua PERNEFRI ex officio
Ketua Dewan Editor:
Dr. Parlindungan Siregar, Sp.PD-KGH
Wakil Ketua Dewan Editor:
Dr. Dharmeizar, Sp.PD-KGH
Anggota Dewan Editor:
J
DR.Dr. Suhardjono, SpPD-KGH, KGer
o
Dr. Pranawa, Sp.PD-KGH
.j
Dr. Ardaya, Sp.PD-KGH
..j
DR. Dr. Imam Effendi, SpPD-KGH
o
DR. Dr. Bimanesh Sutarjo, Sp.PD-KGH
..j
Dr. Lucky Aziza Bawazier, SpPD-KGH
.j
Dr. Dwi Juwono, Sp.PD-KGH
..j
Dr. Ginova Nainggolan, SpPD-KGH
..j
Prof. Dr. Wiguno Prodjosudjadi, Ph.D.,
.j
Dr. Tunggul Situmorang, Sp.PD-KGH,
DipI/M.Med.SizyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPO
Editor Kehormatan:
.j
Dr. J. Pudji Rahardjo, Sp.PD-KGH
.j
Prof. Dr. M. S. Markum, Sp.PD-KGH zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
Sp.PD-KGH zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONM
.j
Prof. Dr. Harun Rasyid Lubis, Sp.PD-KGH
.j
Prof. Dr. Enday Sukandar, Sp.PD-KGH
.j
Prof. Dr. Jose Roesma, Ph.D, Sp.PD-KGH
.j
Dr. E. J. Kapojos, Sp.PD-KGH
.j
Prof. DR, Dr. Endang Susalit, Sp.PD-KGH
.:J
Prof. Dr. Made Sukahatya, Sp.PD-KGH
,::;
Prof. Dr. Sutisna Himawan, Sp.PA (K)
..J
Prof. Dr. Husein Alatas, Sp. A (K)
,::; Prof. Dr. Agus Tessy, Sp.PD-KGH
Bendahara:
Dr. Aida Lydia, Sp.PD-KGH
Publikasi:
Arlinda Simanjuntak
Administrasi dan Iklan :
Ir. Tety Sidabutar
Distribusi :
PERNEFRI
Lay Out & Design:
PERNEFRI - Ferdy Lumbantobing
:/
Prof. DR. Dr. Mochammad Sja'bani,
Sp.PD-KGH
Ginjal Hipertensi, Vo1.8, NO.2, April
Juni 2008
NJAL
zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
HIPERTENS
I D aftar lsi zyxwvutsrqponmlkjihgfedcba
Editorial
TRANSFUSION
73 -74
- RELATED ACUTE LUNG INURY (TRAU)
Dharmeizar
Laporan Penelitian
ADIPONECTIN
AND ASSOCIATED FACTORS IN CONTINUOUS AMBULATORY
PERITONEAL DIALYSIS
(CAPO) PATIENTS
75 -79
Yenny Kandarini, Raka Widiana and Ketut Suwitra
HUBUNGAN
PENINGKATAN
KADAR TGF- B1 PADA PENDERITA HIPERTENSI ESENSIAL DENGAN
GINJAL DITINJAU DAR I MIKROALBUMINURIA
FUNGSI
DAN LAJU FILTRASI GLOMERULUS
RudlSupriyadi, Nanny Natalia, HM Rachmat Soe/aeman, Enday Sukandar
80 - 90
Laporan K asus
TRANSFUSION-RELATED
ACUTE LUNG INJURY (TRAU) IN DONOR KIDNEY TRANSPLANTATION
PATIENT-
A CASE REPORT
Nur Samsu*, Santoso Chandra*, Djoko Wibisono*, Rudi Supriyadi*, Yenni Kandarini*"Bonar M Marbun**,
Dharmeizar**, E. Susalit**
91- 95
Tinjauan Pustaka
POLIMORFISME
GEN SISTEM RENIN ANGIOTENSIN ALDOSTERON DAN HIPERTENSI
Fredie Irijanto
INFLAMASI
PADA PENYAKIT GINJAL KRONIK DAN HUBUNGANNYA
96
-105
DENGAN PENYAKIT
KARDIOVASKULARzyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
Pringgodigdo Nugroho, Dharmeizar
K orespondensi & Panduan Bag~Penulis
106-11 5
116- 117zyxwvutsrqponmlk
THANK YO U FO R TRUSTING
.
Nf)f'VaS~
:t
Arntodiptne
besylate
The Heart of Hypertension TreatmentzyxwvutsrqponmlkjihgfedcbaZYXWV
® Real World Experiences for More than 15 Years in the Market
® Supported by More than 700 Medical Studies including Landmark
Hypertension Trials (ALLHAT, VALUE, CAMELOT/ NORMALISE,
ASCOT BPLA) in over than Thousands of Patients in Reducing
Cardiovascular Morbidity and Mortallty"?".
® Effective and Safe in Controlling Blood Pressure for More Than 24 Hours'
Effective in Broad Range of Hypertensive Patients,
including Patients with High Cardiovascular Risk7
Safely Combined with Other Oral Hypertension Drugs and
Shows No Significant Drug lnteraction'
Can be Used for Patients with Concomitant Dlseases?"
"a5~ s zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
m9,zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
r:
(f) Nor SKES patients
available for A
Laporan Kasus
TRANSFUSION-RELATED ACUTE LUNG INJURY (TRALI) IN DONOR KIDNEY
TRANSPLANTATION PATIENT – A CASE REPORT
Nur Samsu*, Santoso Chandra*, Djoko Wibisono*, Rudi Supriyadi*, Yenni Kandarini*, Bonar M Marbun**,
Dharmeizar**, E. Susalit**.
*Peserta program pendidikan konsultan, **Divisi Ginjal dan Hipertensi FKUI-RSCM Jakarta.
Abstract
Transfusion-related acute lung injury (TRALI) is defined as noncardiogenic pulmonary edema
related to transfusion therapy. It is a potentially life-threatening, underrecognized and underreported complication of transfusion. Symptoms usually begin within 1-2 hours up to 6 hours
and severity may range from mild to severe (life threatening). Clinically indistinguishable from
acute respiratory distress syndrome (ARDS). The diagnosis of TRALI relies on excluding other
diagnoses and based primarily on clinical simptoms and signs, not laboratory findings. The
minimum requirements for diagnosis of TRALI was occurrence of acute repiratory distress
during or within 6 hrs of transfusion, absence of signs of circulatory overload, and radiographic
evidence of bilateral pulmonary infiltrates. The pathogenesis of TRALI may be explained by a
two-hit hypothesis, with the first hit being an underlying condition of the patient. The second hit
may involve the presence of biologically active lipids or leucocyte antibodies in transfused blood
component. No specific treatment for TRALI. Maintenance of hemodynamic status is the most
beneficial and appropriate therapy. Ventilatory support and saline infusion are probably the only
standard therapies for TRALI.
We reported a 24 yaers old male-kidney related transplantasion donor patien with TRALI that
occur approximately 2 hours after transfusion of pack red cell on day-3 of nephrectomy.
Transfusion was indicated for patien because of acute bleeding. Patiens developed dyspnea,
cyanosis, cough with pink frothy sputum, along with physical findings of bilateral pulmonary
edema. The CXR examination showed bilateral pulmonary infiltrates. A patien was given
intubation and ventilatory support and inproved with resolution of the pulmonary infiltrasion
within the first 4 days.
PENDAHULUAN
Transfusion-related acute lung injury (TRALI) adalah edema paru non-kardiogenik yang
berkaitan dengan terapi transfusi. TRALI merupakan salah satu penyebab tersering morbiditas
dan mortalitas terkait transfusi.1 Istilah ini pertama kali diusulkan oleh Popovsky tahun 1983
untuk menjelaskan adanya kumpulan gejala klinik dan gambaran laboratorium yang terjadi
selama 6 jam transfusi plasma yang mengandung produk-produk darah.2 Pada umumnya
gejala-gejala respiratory distress terjadi dalam 2 – 6 jam pertama dari saat permulaan transfusi
darah, hanya beberapa kasus terjadi lebih lambat, bahkan smapai 48 jam.1 Timbulnya TRALI