SENSITIVITAS DIAGNOSTIK TOTAL PROTEIN CREATININE RATIO URIN UNTUK DIAGNOSIS NEFROPATI DIABETIKA

FATRINAWATI, dr. Windarwati, M.Sc, Sp.PK-K.; dr.Osman Sianipar, DMM., M.Sc, Sp.PK-K

2016 | Tesis-Spesialis | SP ILMU PATOLOGI KLINIK

Latar Belakang: Nefropati diabetika merupakan sindrom klinis komplikasi DM yang ditandai proteinuria dan diagnosis dapat ditegakkan dengan albumin excretion Rrate (AER) dengan nilai 30-300 mg/24 jam atau albumin creatinine ratio (ACR) 30300 mg/g atau total protein creatinine ratio (TPCR) 150-500 mg/g. Berdasarkan rekomendasi AACE/ACE 2015, TPCR merupakan alternatif untuk menegakkan diagnosis nefropati diabetika karena lebih nyaman, cepat dan tidak memerlukan persiapan khusus dibandingkan dengan AER. Tujuan penelitian: Menguji penampilan diagnostik TPCR untuk diagnosis nefropati diabetika pada populasi Diabetes Melitus tipe 2. Cara Penelitian: Penelitian ini merupakan uji diagnostik dimana TPCR secara bebas dan tersamar dibandingkan dengan AER sebagai baku emas yang melibatkan 86 pasien DM tipe 2. Data dianalisis dengan menggunakan tabel 2x2 untuk menghitung sensitivitas, spesifisitas, nilai ramal positif, nilai ramal negatif, rasio kemungkinan untuk tes positif, dan rasio kemungkinan untuk tes negatif. Hasil: Hasil penelitian menunjukkan bahwa TPCR pada nilai 150 mg/g memiliki sensitivitas, spesifisitas, nilai ramal positif (NRP), nilai ramal negatif (NRN), likelihood ratio positif/LR (+), likelihood ratio negatif/LR (-), akurasi dan prevalensi berurutan sebesar 97,4%, 100%, 100%, 81,8%, , 0.03 , 97,7% dan 89,5% untuk diagnosis nefropati diabetika. Simpulan: Total protein creatinine ratio (TPCR) dengan nilai 150 mg/g dalam sampel urin pagi dapat digunakan untuk diagnosis nefropati diabetika.

Background: Diabetic nephropathy was clinical syndrome of DM complication which is characterized by proteinuria and diagnosed either by albumin excretion rate (AER) with a value of 30-300 mg/24 hours or albumin creatinine ratio (ACR) 30-300 mg/g or total protein creatinine ratio (TPCR) 150-500 mg/g. Based on the recommendation of AACE/ACE 2015, TPCR measurement is an alternative test to diagnose diabetic nephropathy because it is more convenient, faster and does not require special preparation. Objective: The objective of this study is to examine the diagnostic performance of TPCR for diagnosis of diabetic nephropathy in type 2 DM population. Methods: This was a diagnostic test study design where TPCR blindly and independently compared with AER as the gold standard. The study involves 86 type 2 DM patients. The data are analyzed by 2x2 table in order to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio, negative likelihood ratio, accuracy and prevalence. Results: The result of the study showed that TPCR at level of 150 mg/g, has sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio/LR (+), likelihood ratio/LR (-), accuracy and prevalence respectively 97,4%, 100%, 100%, 81,8%, , 0.03 , 97,7% and 89,5% to diagnose diabetic nephropathy. Conclusion: Total protein creatinine ratio (TPCR) at the level of 150 mg/g in the morning urine sample can be used to diagnose diabetic nephropathy in type 2 DM population.

Kata Kunci : Sensitivity, total protein creatinine ratio (TPCR), diabetic nephropathy, diagnostic test study