Efek Ekstrak Centella asiatica terhadap Cedera Tubulus dan Ekspresi Kidney Injury Molecule 1 (KIM-1) pada Mencit dengan Cedera Iskemik/Reperfusi Ginjal

ELIDA FADHILATUL LATIFA, dr. Nur Arfian, Ph.D; dr. Ch. Tri Nuryana, M.Kes.; dr. Widya Wasityastuti, M.Sc, M.Med.Ed, Ph.D

2018 | Skripsi | S1 PENDIDIKAN DOKTER

Latar Belakang: Cedera iskemik/reperfusi merupakan penyebab umum terjadinya cedera ginjal akut. Cedera tubulus merupakan konsekuensi langsung jaras metabolik yang diinduksi oleh kondisi iskemik/reperfusi ginjal. Kidney injury molecule 1 (KIM-1) adalah reseptor membran yang paling terekspresikan pada cedera tubulus. Centella asiatica telah lama dikenal berkhasiat menyembuhkan beberapa penyakit dan terbukti mengurangi cedera iskemik/reperfusi pada beberapa organ di hewan coba, namun pengaruhnya terhadap cedera iskemik/reperfusi ginjal belum diketahui. Tujuan Penelitian: Mengkaji efek ekstrak Centella asiatica terhadap cedera tubulus dan ekspresi KIM-1 pada mencit model cedera iskemik/reperfusi. Metode Penelitian: Cedera iskemik/reperfusi ginjal diinduksi dengan menjepit pediculus renalis bilateral selama 30 menit pada mencit Swiss-Webster (3 bulan, 30-40 gram, n=20). Ada 2 kelompok mencit yang mendapatkan perlakuan pemberian ekstrak ethanol Centella asiatica, yaitu kelompok CeA-1 (dosis 210 mg/kgbb/hari) dan kelompok CeA-2 (dosis 420 mg/kgbb/hari). Pada hari ketujuh, mencit diterminasi dan ginjalnya diambil untuk dibuat parafin dan ekstraksi RNA. Pemeriksaan histopatologi skor cedera tubulus dengan pewarnaan Periodic Acid Schiff (PAS), dilihat pada 15 lapang pandang dengan perbesaran total 400x. Ekspresi KIM-1 dilihat dengan pemeriksaan Reverse Transcription Polymerase Chain Reaction (RT-PCR). Hasil Penelitian: Skor cedera tubulus pada kelompok CeA lebih rendah daripada kelompok iskemik/reperfusi tanpa pemberian CeA (IR) (p<0,05), namun belum bisa menyamai skor cedera tubulus kelompok sham operated (SO) (p<0,05). Ekspresi KIM-1 tidak menunjukkan perbedaan yang signifikan antarkelompok perlakuan (p>0,05). Kesimpulan: Derajat cedera tubulus pada mencit dengan cedera iskemik/reperfusi ginjal yang diberi ekstrak Centella asiatica lebih rendah daripada mencit yang tidak diberi ekstrak Centella asiatica. Namun, ekspresi KIM-1 pada mencit dengan cedera iskemik/reperfusi ginjal yang diberi ekstrak Centella asiatica tidak lebih rendah daripada mencit yang tidak diberi ekstrak Centella asiatica.

Background: Kidney ischemic/reperfusion (IR) injury is the common cause of acute kidney injury. Tubular injury is a direct consequence of metabolic pathway in kidney ischemic/reperfusion condition. Kidney injury molecule 1 (KIM-1) acts as membrane reseptor which highly upregulated in tubular injury. Centella asiatica has shown to give protective effect in ischemic/reperfusion injury, however the effect in kidney ischemic/reperfusion injury remains unknown. Aim: Examine the effect of Centella asiatica extract to tubular injury and KIM-1 expression in kidney ischemic/reperfusion injury. Methods: Kidney ischemic/reperfusion injury was induced by clamping bilateral renal pedicle of Swiss Webster mice (3 months, 30-40 grams, n=20) for 30 minutes. Centella asiatica extracts were given orally for CeA1 group (dosage: 210 mg/kgBW/day) and CeA2 group (dosage: 420 mg/kgBW/day). At day 7, the mice were sacrificed and the kidneys were taken for making paraffin slide and RNA extraction. Tubular injury score was examined on 15 fields for each slide which stained with Periodic Acid Schiff (PAS), with 400x total magnification. KIM-1 expression was measured using Reverse Transcription Polymerase Chain Reaction (RT-PCR). Results: Tubular injury score in CeA groups were lower than ischemic/reperfusion without CeA treatment groups (IR) (p<0,05), but CeA groups score were not as low as sham operated groups (SO) score (p<0,05). KIM-1 expression in intergroups were not significant (p>0,05). Conclusions: Tubular injury degree in mice with ischemic/reperfusion injury which given Centella asiatica extract is lower than those without given Centella asiatica extract. However, KIM-1 expression in mice with ischemic/reperfusion injury which given Centella asiatica extract is not lower than those without given Centella asiatica extract.

Kata Kunci : Centella asiatica, cedera tubulus, tubular injury, KIM-1, cedera iskemik/reperfusi ginjal, kidney ischemic/reperfusion injury