Correlation between Diabetes Mellitus Onset with Diabetic Nephropathy Case of the In-Patients Treated in RS Muhammadiyah Ahmad Dahlan Kediri

The average number of diabetes mellitus patients who underwent hospitalization in RS Muhammadiyah Ahmad Dahlan Kediri reached 11.6% per month. The age range of the patients was between 5-15 years. They usually suffered from complications such as DM nephropathy, hypertension and hyperglycemia, that this fact should be inspected further. This study was intended to cover as to how significant is the correlation between diabetes mellitus onset and the case of diabetic nephropathy suffered by patients. The design of this study was cross sectional correlative descriptive. The sample of this study was the DM in-patients with the complication of diabetic nephropathy taken using total sampling. Spearman Rank was used as the data analysis technique. This study has found that 49 (84.48%) out of 58 diabetes mellitus patients were suffered from diabetic nephropathy too. Meanwhile, according to the result of hypothesis test, the r-count value was 0.743 and the significance rate was 0.000, which mean that there was a relation between the variable of diabetes mellitus onset and variable of diabetic nephropathy case occurred to the in-patients of RS Muhammadiyah Ahmad Dahlan Kediri.


INTRODUCTION
Diabetes Mellitus (DM) is a kind of carbohydrate, fat, and chronic protein metabolism disruption caused by the damage or the lack of insulin secretion, leading the patients to hyperglycemia (Pratama, Chasani & Santoso, 2013). Most of the diabetes mellitus pathologic depictions can be linked to the decrease of cell's activities in utilizing glucose, escalation of fat metabolism and reduction of protein in the tissue Satria (Decroli & Afriwardi, 2018).
It has been assumed by World Health Organization (WHO) that prevalence of diabetes mellitus in the whole world will continuously be increasing (Shaw et al., 2009). According to Sistem Informasi Rumah Sakit (SIRS) of 2010-2011, Diabetes Mellitus was ranked 5 th of the top 10 of non-2010 (Kemenkes RI, 2012).
In 2000, percentage of Diabetes Mellitus prevalence was approximately 0.19% for the patient age of < 20 years, 8.6% for the age of > 20 years and 20.1% for the age of > 65 years. This percentage was applicable for both men and women, except for the age range of > 60 years in which the amount of male patients is higher (Waspadji, 2005). Laporan Nasional of 2007confirmed that, in the suburban of Jawa Timur, 6.8% of Diabetes Mellitus prevalence was occurred mainly to the people who don't attend school, unemployed housewives, employees and entrepreneurs (Kemenkes RI, 2008). (2015) stated that the causes of diabetes mellitus include overweight, excessive stress, DM history from family, particular conditions occurred to woman, smoke addiction, excessive high-sugar and high-fat food consumption, avoidance of skin blackening and fries consumption. More than 85% of type 2 DM patients are found to be overweight. Meanwhile, prolonged stress may increase epinephrine and cortisol which are known as the enhancer of blood sugar and energy (that should be utilized to perform activities). But, if the amount of blood sugar grows continuously, or unbalanced, it will bring negative effect to human's body.

Ministry of Health
Heredity factor can be one of the causes of diabetes mellitus. If a person's parents have ever been diagnosed to be suffered from type 2 diabetes, it is most likely that the person will be suffered from diabetes. A woman that is suffered from polycystic ovary syndrome is more probably to undergo diabetes. This syndrome can be defined as hormonal imbalance which causes irregular menstruation period. American entity has noted that the risk of diabetes mellitus will be raised up to 22% for the active smokers. Excessive consumption to sugary and lardy foods, as well as the lack of Vitamin D intake, will also trigger diabetes mellitus (Kemenkes, 2015).
Uncontrolled diabetes mellitus will cause either micro vascular or macro vascular chronic complications. Manifestations of macro vascular complications are coronary heart, cerebral thrombosis and gangrene. Meanwhile, diseases caused by micro vascular complications include diabetic retinopathy and diabetic nephropathy (Waspadji, 2005). Diabetic Nephropathy is a kidney disease which usually follows the next stadium of diabetes mellitus, starting from hyper filtration, renal hypertrophy,mikro-albuminuria, hypertension and proteinuria, which is indicated by reduction of renal function and the existence of kidney failure disease (Hartanto et al., 2000).
According to Bethesda (2002) from National Institute of Health, diabetic nephropathy was found in 35-45% of diabetes mellitus patients, and 40% of diabetic nephropathy prevalence was the culprit of kidney failure. Almost sixty percent of hypertension and diabetes mellitus patients in Asia are suffered from diabetic nephropathy. 18.8% of them are suffered from macro albuminuria which is the first stadium of nephropathy. Clinically, diabetic nephropathy is indicated by progressive proteinuria escalation, degradation of Laju Filtrasi Glomerulus (LFG)/Glomerulus Filtration Rate and hypertension. Patients of diabetic nephropathy are more prone to cardiovascular (Pratama, Diabetic Nephropathy is most probably due to the genetics, relating to certain chromosome. In fact, the onset and development of kidney disease (which is caused by diabetes mellitus) are quite varied. A descriptive researchon the distribution of chronic complication caused by vascular disruption suffered by type 2 diabetes mellitus patients which are being treated in RSUD Dr. Soetomo Surabaya, has found that 58.4% of the patients were suffered from nephropathy, while 32.1%of it were suffered from retinopathy and the 10.5 % were suffered from neuropathy (Amalia, 2010). Pratama et al (2013) have found that there is a significant relation between diabetes mellitus onset and the case of diabetic nephropathy. Meanwhile, a research conducted by Markum & Galastri (2004) implies that sickness duration and the retinopathy suffered by diabetes mellitus patients are significantly related to the case of diabetic nephropathy.
Due to the above conditions, this research studied the relation between diabetes mellitus onset and diabetic nephropathy of the in-patients treated in RS Muhammadiyah Ahmad Dahlan Kediri.

METHODS
This was a correlative descriptive study with Cross Sectional approach. The population of this study was the data in the form of diabetes mellitus in-patients (suffering from diabetic nephropathy complication) medical record provided by RS Muhammadiyah Ahmad Dahlan Kediri for August until December 2018. The sample data (belonging to DM patients with diabetic nephropathy complication) were secondary and were taken using total sampling method. The inclusion criteria included complete medical record, as in patient's registration number, age, gender, blood pressure, blood glucose level, total cholesterol level, HDL, LDL, and triglyceride level. The exclusion criterion was diabetes mellitus patients with diabetic nephropathy and heart infection/ heartbreak. The study was conducted in August until December using Spearman Rank analysis method with significance level of 0.01.

FINDINGS AND DISCUSSION
The samples were 58 diabetes mellitus in-patients suffered from diabetic nephropathy complication and treated in RS Muhammadiyah Ahmad Dahlan Kediri. The results of this study included the number of patients based on month, occurrence of diabetic nephropathy, hypertension, duration of the DM sickness and the relation between diabetes mellitus onset and diabetic nephropathy occurrence. The results of this research were than processed and tabulated in the form of this frequency table.      According to Table 7, the r-count value as 0.743 and the significance was 0.000. Due to the fact that the r-count value was higher than r-table value (0.743>0.432), and that the significance value was less than 0.05 (0.000<0.01), then it is safe to say that there was a relation between diabetes mellitus onset occurred to the in-patients of RS Muhammadiyah Ahmad Dahlan Kediri and diabetic nephropathy case.
It was found through the result that several of the patients enduring diabetes mellitus also had diabetic nephropathy, hypertension and hyperglycemia. This fact was even worsened by the factor of sickness duration and the DM history obtained from family. During Augustus 2018, there were 11 diabetes mellitus patients and 9 of them (81.81%) were suffering from diabetic nephropathy, while 7of them (63.63%) were suffering from hypertension and 8 of them (72.72%) were suffering from hyperglycemia. Two of the patients (18.18%) endured diabetes mellitus for less than 5 years, the other two (18.18%) had been enduring diabetes mellitus for 5-10 years, while five of them (45.45%) had been enduring diabetes mellitus for 10-15 years and the other five of the patients (45.45%) were proven to be diagnosed with diabetes mellitus from their relatives who also suffered from diabetes mellitus.
In September 2018, there were 10 diabetes mellitus patients and 8 of them (80%) were suffering from diabetic nephropathy, while 5of them (50%) suffering from hypertension and 6 of them (60%) were suffering from hyperglycemia. One of the patients (10%) endure diabetes mellitus for less than 5 years, three of them (30%) have been enduring diabetes mellitus for 5-10 years, while four of them (40%) have been enduring diabetes mellitus for 10-15 years and five of the patients (50%) were proven to be diagnosed with diabetes mellitus from their relatives who also suffered from diabetes mellitus.
In November 2018, there were 14 diabetes mellitus patients and 12 of them (85.71%) were suffering from diabetic nephropathy, while 7 of them (50%) suffering from hypertension and 9 of them