Chronic Kidney Injury and Diabetes Mellitus Type 2 in a 57-year-old Woman With Holistic Management of Family Medicine


  • Annisa Dwi Anggreni Kusuma Lampung University
  • Diah Ayu Mariam
  • Azelia Nusadewiarti



: Chronic Kidney Disease, diabetes melitus, family approach, holistic diagnosis, patient centered,


Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia. The criteria for chronic kidney disease are albuminuria, urine sediment abnormalities, electrolyte abnormalities, abnormalities of histology and imaging of the kidneys, history of kidney transplantation and decreased renal filtration rate (GFR <60ml/min/1.73m2). Identify risk factors, clinical problems, holistic and comprehensive patient management with patient-centered principles and a family approach based on Evidence Based Medicine.This study is a case report. The primary data were obtained through history taking, physical examination, and home visit while the secondary data were obtained from the patient's medical record. Assessment based on a holistic diagnosis from the beginning, process, and end of the study, qualitatively and quantitatively. Mrs. L, 57 years old, working as a housewife, has complaints of shortness of breath, abdominal pain, not urinating, decreased vision and smog and tingling legs and numbness in the past 3 years. Based on the examination GDS 268mg/dl. The patient has an irregular diet and lack of physical activity. The holistic diagnosis and management with the principle of patient centered and family approach to patients has been done. Changes in knowledge and behavior occur after the intervention.


Rajeev G, Ishwarlal J. 2021. Diabetes mellitus Type 2. Teasure Island (FL): statpearl Publishing.

Carillo-Larco RM, Barengo NC, Albitres-Flores L, Bernabe-Oeritz A. The Risk of Mortality Among people with type 2 diabetes in Latin America: A systematic Review and Meta-Analysis of population-based cohort studies. Diabetes Metab Res Rev. 2019 May: 34(4):e3139.

KDIGO. 2013. Kidney International Supplements. 3(1):5-4; doi:10.1038/kisup.2012.77.

Webster AC, Nagler EV, Morton RL, Masson P. Chronic Kidney Disease. Lancet. 2017. Mar 25; 389 (100075): 1238-1252.

Ji CL, Lu XZ. 2019. Prevalence and Disease burden of Chronic Kidney Disease. Adv Ep Med Biol 1165:3-15. Doi: 10.1007/978-981-13-8871-2_1.

Khan YH, Malhi TH, Sarrif A, Khan AH, Tanveer N. 2018. Prevalence of Chronic Kidney Disease in Asia: A Systematic Review of population-Based Studies. Journal of the Collage Phycisians and Surgeons Pakistan 28(12):960-966.

Kesmas Kemkes. 2018. Riset Kesehatan Dasar. Direktorat P2PTM Kemenkes.

Damtie S, etc. 2018. Chronic Kidney Disease And Associated Risk Factors Assessment Diabetes Mellitus Patients At A Tertiary Hospital, Northwest Ethiopia. Ethiop J Health Sci 28(6):691-700. Doi : 10.431/ehjs.v28i6.3.

Napitupulu M, Sari MA, Ayutthaya SS. 2018. The Risk Factor Of Chronic Kidney Disease In Type 2 Diabetes Mellitus. 9(1). doi:

Lim AKH. 2014. Diabetic nephropathy – complications and treatment. Int J Nephrol Renovasc Dis. 2014; 7: 361–381. doi: 10.2147/IJNRD.S40172

Bello AK, etc. 2017. Complications Of Chronic Kidney Disease: Current State, Knowledge Gaps, And Strategy For Action. Kidney Int Suppl (2011). 2017 Oct; 7(2): 122–129. doi: 10.1016/j.kisu.2017.07.007

Ko GJ. etc. 2008. Pioglitazone Attenuates Diabetic Nephropathy Through An Anti-Inflammatory Mechanism In Type 2 Diabetic Rats. Nephrol Dial Transplant. 23(9): 2750-60.

Barnett AH. Etc. 2004. Angiotensin-Receptor Blockade Versus Conerting-Enzyme Inhibition In Type 2 Diabetes And Nephropathy. N Engl J Med 351 (19): 1952-61.

James PA. Etc. 2014. Evidance-Based Guideline For Management Of High Blood Pressure In Adults: Report From The Panel Members Apoined To The Eightt Joint National Committee (JNC 8). JAMA 311(5):507-20.

Tonolo G. Etc. 2006. Simvastatin Maintains Stady Patterns Of GFR And Improve AER And Expression Of Slit Diaphragma Proteins In Type II Diabetes. Kidney int 70(1):177-86.

Kim SM. Etc. 2012. Reducing Serum Uric Acid Attenuates TGF-Β Induced Profibrogenic Progression In Type 2 Diabetic Nephropathy. Nephron exp neprol 121(3-4): e109-21.

Brown JM, Secinario K, Williams JS, Vaidya A. 2013. Evaluating Hormonal Mechanisms Of Vitamin D Receptor Agonist Therapy In Diabetic Kidney Disease. The VALIDATE-D. BMC Endocr Disord 13():33.

Nezu U, Kamiyama H, Kondo Y, Sakuma M, Morimoto T, Ueda S. 2013. Effect of low Protein Diet on Kidney Function in Diabetic Nephrophaty: Meta-Analysis of Randomised Controlled Trials. BMJ Open 3(5).

Kwakernaak AJ. Etc. 2014. Effect of Sodium Restriction and Hydrochlorothiazide on RAAS blokade Efficacy in Diabetic Nephropathy: a Randomised Clinical Trial. Lancet Diabetes Endocrinol 2(5): 385-95.

Morton GP. Keperawatan Kritis: Pendekatan Asuhan Holistik. Volume 2. Edisi 8. Jakarta EGC: 2012.

Bossola M, Scribano D, Colacicco L, Tavazzi B, Giungi S, Zuppi C, Luciani G, Tazza L. Bossola M, et al. J Ren Nutr. 2009 Anorexia and plasma levels of free tryptophan, branched chain amino acids, and ghrelin in hemodialysis patients. J Ren Nutr. 19(3):248-55. doi:10.1053/j.jrn.2008.11.008. Epub 2009 Feb 24.

Elgebaly MM, Arreguin J, Storke N. 2019. Target, Treatment, and Outcomes Update in Diabetic Stroke. J Stroke Cerebrovasc Dis 28 (6) :1413-1420.

Skarbez K, Priestly Y, Hoepf M, Koevary SB. 2010. Comprehensive Review of Effect of Diabetes on Ocular Health. Expert Rev Ophthalmol 5(4):557-577.

Callaghan BC, etc. 2016. Metabolic Syndrome Component Are Assosiated With Symptomatic Polyneurophaty Indipendent of Glycemic Status. Diabetes Care 39(5):801-7.

Brenner BM, etc. 2001. Effect of Lorasartan on Renal and Cardiovascular Outcomes in Patients with Type 2 Diabetes ang Nephropathy. N Engl J Med. 345(12):861-9.

Rajput R, Sinha B, Majumdar S, Shunmugavelu, Bajaj S. 2017. Consensus Statement On Insulin Therapy In Chronic Kidney Disease.Diabetes Research and Clinical Practice. Doi:

Tonolo G, etc. 2006. Simvastatin maintains steady Patterns of GFR and impreves AER and expression of slit diafragmaprotein in type II diabetes. Kidney int. 70(1):177-86.

Pinto-Sanchez, Yuan Y, Bercik P, Moayyedi P. 2017. Proton Pump Inhibitor for Fungtional Dyspepsia. Cochrane database Syst Rev. 3:CD011194.doi: 10.1002/14651858.CD011194.pub2.

Khan SA. 2017. Working Paper : Consummer Innovation Adoption Stages and Determinants. Universirta Ca’Foscari Venezia.



How to Cite

Kusuma, A. D. A., Diah Ayu Mariam, & Azelia Nusadewiarti. (2023). Chronic Kidney Injury and Diabetes Mellitus Type 2 in a 57-year-old Woman With Holistic Management of Family Medicine. Medical Profession Journal of Lampung, 13(3), 332-340.




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