Indonesian Journal of Kidney and Hypertension

Kidney Injury Molecule-1 (KIM-1): Biomarker of Tubular Injury and Predictor of Kidney Disease Progression

2026-08-24T16:17:41+07:00

Diagnostic Value of Urinary Kidney Injury Molecule-1 in Diagnosis of Sepsis Associated Acute Kidney Injury

2026-08-24T16:17:41+07:00

Abstract

Background: Sepsis asscociated acute kidney injury (SA-AKI) is common condition that found in sepsis. Due to the lack of creatinine serum, this condition possibly makes therapy delayed. Kidney Injury Molecule-1 (KIM-1) is a a type 1 transmembrane protein with immunoglobulin and mucin domains, which is expressed increased in the proximal tubules of the kidney. Elevated urinary KIM-1 levels are an indicator of AKI. However, previous studies have shown varies results.

Objectives: This study aims to determine early diagnosis biomarkers for the presence of AKI in sepsis.

Methods: This diagnostic test was conducted at Dr. M. Djamil General Hospital Padang in sepsis patients. The diagnosis of AKI was established based on the 2012 KDIGO criteria.

Results: The study involved 94 sepsis patients, only 22,34% (n=21) of them experienced AKI. Serum creatinine levels at admission and within 48 hours of hospitalization were 0,7 (IQR 0,2-1,6) mg/dl and 0,8 (IQR 0,3-2,2m) mg/dl. An urinary KIM-1 level at admission ≥11,74 ng/mL had sensitivity of 44,68%, specificity of 59,57%, positive predictive value of 52,5%, negative predictive value of 51,85%, and accuracy of 52,12% in early diagnosis of AKI in sepsis.

Conclusion: Urinary Kidney injury molecule-1 level has poor diagnostic value in diagnosis of AKI in sepsis.

Keywords: Sepsis, Kidney injury molecule-1, AKI.

Differences in Neutrophil-to-Lymphocyte Ratio, Hemoglobin, and Ferritin Between Arteriovenous Shunt and Hemodialysis Catheter in Maintenance Hemodialysis Patients

2026-08-24T16:17:41+07:00

Introduction: Vascular access type may influence systemic inflammation and hematologic profiles in patients undergoing maintenance hemodialysis. This study aimed to compare neutrophil-to-lymphocyte ratio, hemoglobin, and ferritin levels between patients using arteriovenous fistulas and hemodialysis catheters.

Methods: This cross-sectional analytical study included 128 patients undergoing maintenance hemodialysis, consisting of 85 patients with arteriovenous fistulas and 43 with hemodialysis catheters. Neutrophil-to-lymphocyte ratio and ferritin levels were compared using the Mann–Whitney U test, whereas hemoglobin levels were analyzed using the independent-samples t-test. Multiple linear regression was performed to assess the independent association between vascular access type and each laboratory parameter after adjustment for potential confounders.

Results: Patients using hemodialysis catheters had significantly higher neutrophil-to-lymphocyte ratio than those with arteriovenous fistulas (median 4.92 vs. 4.13; p=0.049). Hemoglobin levels were also higher in the catheter group (8.82 ± 1.57 vs. 8.19 ± 1.62 g/dL; p=0.038). Ferritin levels were numerically higher among catheter users but were not significantly different in unadjusted analysis (p=0.154). After multivariable adjustment, hemodialysis catheter use remained independently associated with higher neutrophil-to-lymphocyte ratio, hemoglobin, and ferritin levels.

Conclusion: Hemodialysis catheter use was associated with higher inflammatory and hematologic biomarker levels compared with arteriovenous fistula use among patients undergoing maintenance hemodialysis.

Risk Factors Associated with Intradialytic Hypotension among Patients with Stage 5 Chronic Kidney Disease on Hemodialysis at a Tertiary Referral Hospital in Banjarmasin Indonesia: A Retrospective Cross-sectional Study

2026-08-24T16:17:41+07:00

Background: Intradialytic hypotension (IDH) remains one of the most frequent acute complications of maintenance hemodialysis. Local data from Indonesian hemodialysis units remain limited, although patient characteristics, dialysis practices, comorbidity burden, and nutritional status may influence IDH risk.

Methods: This retrospective cross-sectional study used secondary medical record data from adult patients with stage 5 chronic kidney disease undergoing maintenance hemodialysis at Ulin General Hospital, Banjarmasin, Indonesia. Patient-related and dialysis-related factors were evaluated. Variables with p<0.25 in bivariate analysis entered a multivariable binary logistic regression model.

Results: A total of 145 patients were included. IDH occurred in 72 patients (49.66%). In multivariable analysis, age >=60 years was associated with higher odds of IDH compared with age <60 years (adjusted prevalence odds ratio [aPOR] 3.537, 95% confidence interval [CI] 1.185-10.562, p=0.024). Compared with body mass index (BMI) >=30 kg/m2, BMI 23.0-24.9 kg/m2 was associated with lower odds of IDH (aPOR 0.101, 95% CI 0.015-0.677, p=0.018).

Conclusions: Nearly half of CKD-5HD patients experienced IDH. Older age, BMI category, antihypertensive medication burden, and pre-hemodialysis blood pressure category were associated with IDH. These findings support structured IDH risk assessment in routine hemodialysis care, especially among older patients and patients with severe pre-hemodialysis hypertension.

Persistent Hypertension Awareness Gap and Temporal Trends in Indonesia: A 16-Year Analysis of National Health Surveys

2026-08-24T16:17:41+07:00

Background:
Hypertension is a key modifiable risk factor for cardiovascular and chronic kidney diseases. In Indonesia, surveys show a high prevalence based on measurements, but healthcare detection remains limited.

Objective:
To assess trends in measured hypertension, physician-diagnosed hypertension, and the diagnostic gap in Indonesia over 16 years.

Methods:
This secondary analysis used nationally representative surveys (Riskesdas 2007, 2013, 2018, and SKI 2023). Adults ≥18 years were included. Measured hypertension was defined as systolic ≥140 mmHg and/or diastolic ≥90 mmHg. Diagnosed hypertension was based on self-reported physician diagnosis or antihypertensive use. The diagnostic gap was the difference between measured and diagnosed prevalence.

Results:
Measured hypertension remained high (25.8%–34.1%), while diagnosed cases were low (7.2%–9.4%). The diagnostic gap persisted: 24.5 percentage points (2007), decreased to 16.4 (2013), then increased to 25.7 (2018) and remained high at 22.2 (2023). Overall, only a minority of individuals were aware of their condition. This gap was consistent across sociodemographic groups and regions.

Conclusion:
The hypertension diagnostic gap in Indonesia remains substantial and has tended to widen. Detection efforts have not kept pace with disease burden, highlighting the need to strengthen early screening and diagnosis to reduce cardiovascular and kidney disease risk.

Diagnostic Challenge of Cardiorenal Involvement in Active Systemic Lupus Erythematosus:

2026-08-24T16:17:41+07:00

Renal and cardiac involvement in active systemic lupus erythematosus (SLE) may pose a diagnostic challenge because clinical, serological, and histopathological findings do not always correlate. A 20-year-old woman with a history of SLE presented with edema, foamy urine, decreased urine output, arthralgia, oral ulcers, and orthopnea. Laboratory and imaging findings revealed severe proteinuria, hematuria, urinary casts, hypocomplementemia, elevated serum creatinine, heart failure with reduced ejection fraction with an ejection fraction of 37%, pericardial effusion, and cardiomegaly. Kidney biopsy demonstrated class III+V lupus nephritis, with an activity index of 8/24, chronicity index of 8/12, fibrous and fibrocellular crescents each found in 1 of 5 viable glomeruli, and 60% interstitial fibrosis/tubular atrophy. Immunofluorescence showed granular deposition of IgG, IgA, IgM, C3, and C1q. Although the clinical course resembled rapidly progressive glomerulonephritis, the non-dominant crescentic lesions made “rapid decline in kidney function” a more appropriate term than classic RPGN. Cardiac dysfunction may represent suspected myocardial involvement, volume overload, anemia, uremia, or a combination of these factors. Kidney biopsy and integrated cardiac evaluation are essential for assessing disease activity, chronicity, and prognosis in cardiorenal involvement of active SLE.