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KARYA TULIS AKHIR
EFEK EKSTRAK BUAH NAGA MERAH (Hylocereus polyrhizus)
TERHADAP PERUBAHAN HISTOPATOLOGI TUBULUS PROKSIMAL
GINJAL PADA TIKUS PUTIH STRAIN WINSTAR YANG DIINDUKSI
MINYAK KELAPA SAWIT PEMANASAN BERULANG
Oleh:
PUTRI MEILISSA AJENG PERMATA SARI
201210330311157
UNIVERSITAS MUHAMMADIYAH MALANG
FAKULTAS KEDOKTERAN
2016
ii
HASIL PENELITIAN
EFEK EKSTRAK BUAH NAGA MERAH (Hylocereus polyrhizus)
TERHADAP PERUBAHAN HISTOPATOLOGI TUBULUS PROKSIMAL
GINJAL TIKUS PUTIH STRAIN WISTAR YANG DIINDUKSI MINYAK
KELAPA SAWIT PEMANASAN BERULANG
KARYA TULIS AKHIR
Diajukan Kepada
Universitas Muhammadiyah Malang
untuk Memenuhi Salah Satu Persyaratan
dalam Menyelesaikan Program Sarjana
Fakultas Kedokteran
Oleh:
PUTRI MEILISSA AJENG PERMATA SARI
201210330311157
UNIVERSITAS MUHAMMADIYAH MALANG
FAKULTAS KEDOKTERAN
2016
iii
iv
v
KATA PENGANTAR
Syukur Alhamdulillah saya panjatkan kepada Allah SWT atas rahmat dan
hidayah-Nya sehingga penulis dapat menyelesaikan tugas akhir yang berjudul Efek
Ekstrak Buah Naga Merah (Hylocereus polyrhizus) Terhadap Perubahan
Histopatologi Tubulus Proksimal Tikus Putih Strain Wistar Yang Diinduksi
Minyak Kelapa Sawit Pemanasan Berulang. Penulisan penelitian ini dilakukan
dalam rangka memenuhi salah satu syarat untuk mencapai gelar Sarjana
Kedokteran Jurusan Pendidikan Dokter pada Fakultas Kedokteran Universitas
Muhammadiyah Malang. Pada kesempatan ini perkenankanlah penulis
menyampaikan penghargaan dan terima kasih kepada:
1. dr. Desy Andari, M.Biomed selaku selaku Pembimbing I atas bimbingan,
ketelitian, perhatian, dukungan, motivasi, saran dan bantuan yang telah
diberikan dalam penyusunan karya tulis akhir ini.
2. dr. Andhika Maharani selaku selaku Pembimbing II atas bimbingan,
ketelitian, perhatian, dukungan, motivasi, saran dan bantuan yang telah
diberikan dalam penyusunan karya tulis akhir ini.
3. dr. Halida Nelasari, Sp.OG selaku penguji yang telah memberikan saran,
kritik, bimbingan dan motivasi yang membangun selama saya
menyelesaikan skripsi ini.
4. dr. Soebarkah Basuki, Sp.PA yang telah membantu pembacaan preparat
hepar untuk karya tulis akhir ini.
5. Mamaku Suparmi, SE dan ayahku Juni Wibowo tercinta yang yang selama
ini telah memberikan segala kasih sayang, dukungan, materi, menjadi
vi
motivator terbesar untuk menjalani kuliah dari awal pendidikan hingga
penyelesaian skripsi ini dan senantiasa mendoakan penulis.
6. Adik-adikku tercinta Danzen Junami Wibowo dan Tiara Tri Indah Sari yang
telah memberi doa, motivasi, dan bantuan dalam bentuk apapun selama
pendidikan hingga penyelesain skripsi ini.
7. Teman-temanku tersayang SSSH: Debby Rosyida, Hillda WP, Rahma F,
Intan Putri, Veronica Y, Fatin Chaydar, Asri Anin, Destra Putri, Afina F,
dan Tanty Tunjung yang tanpa henti memberi motivasi, saran, dan banyak
mendampingi selama pendidikan hingga penyelesian skripsi ini.
8. Teman sepenelitian Debby Rosyida, Dito Sakti dan Adhi Candra yang
selama penelitian telah banyak membantu, memberi semangat dan saran
selama penelitian berlangsung hingga penyelesaian skripsi ini.
9. Rekan sejawat lainnya yang telah memberikan dorongan dan bantuan dari
awal hingga akhir penyelesaian skripsi ini yang tidak bisa disebutkan satu-
persatu.
Penulis menyadari bahwa penyusunan tugas akhir ini jauh dari sempurna,
walaupun demikian penulis telah berusaha semaksimal, maka dari itu penulis ingin
menyampaikan permohonan maaf jika masih terdapat kekurangan dalam skripsi ini.
Akhir kata penulis berharap adanya saran dan kritik yang membangun dan semoga
penelitian ini dapat menambah wawasan serta bermanfaat bagi semua pihak.
Malang, 10 Agustus 2016
Penulis
vii
DAFTAR ISI
Halaman
HALAMAN JUDUL ............................................................................................. i
PENGESAHAN LAPORAN HASIL PENELITIAN ....................................... iii
LEMBAR PENGUJI ........................................................................................... iv
KATA PENGANTAR .......................................................................................... v
ABSTRAK
ABSTRACT
DAFTAR ISI ....................................................................................................... vii
DAFTAR TABEL .............................................................................................. x
DAFTAR GAMBAR.......................................................................................... xi
DAFTAR SINGKATAN ................................................................................... xii
DAFTAR LAMPIRAN ..................................................................................... xiii
BAB 1 PENDAHULUAN .................................................................................... 1
1.1 Latar Belakang ..................................................................................... 1
1.2 Rumusan Masalah ................................................................................ 3
1.3 Tujuan Penelitian ................................................................................. 3
1.3.1 Tujuan Umum ....................................................................... 3
1.3.2 Tujuan Khusus ...................................................................... 3
1.4 Manfaat Penelitian ............................................................................... 4
1.4.1 Manfaat Teoritis .................................................................... 4
1.4.2 Manfaat Aplikatif .................................................................. 4
BAB 2 TINJAUAN PUSTAKA ........................................................................... 5
2.1 Ginjal .................................................................................................... 5
2.1.1 Anatomi Ginjal .......................................................................5
2.1.2 Histologi Ginjal …................................................................. 6
2.1.3 Fisiologi Ginjal ................................................................... 11
2.1.4 Kerusakan Ginjal ................................................................. 12
2.1.5 Mikroskopis Kerusakan Ginjal ........................................... 14
2.1.6 Pengaruh Profil Lipid Terhadap Kerusakan Ginjal ........................... 16
viii
2.2 Tikus Putih Jantan (Rattus Norvegicus Strain Winstar) ...................... 17
2.2.1 Perbandingan Ginjal Tikus dan Manusia .............................. 18
2.2.2 Fisiologi Ginjal Tikus ........................................................... 21
2.3 Buah Naga Merah (Hylocereus polyrhizus) ....................................... 22
2.3.1 Senyawa Antioksidan dalam Buah Naga Merah ................. 25
2.4 Oksidan – Antioksidan ....................................................................... 31
2.4.1 Oksidan ............................................................................... 32
2.4.2 Antioksidan ......................................................................... 33
2.5 Mekanisme Flavonoid untuk Mencegah Kerusakan Ginjal ............... 37
BAB 3 KERANGKA KONSEP ......................................................................... 39
3.1 Kerangka Konsep ............................................................................... 39
3.2 Hipotesis ............................................................................................. 41
BAB 4 METODE PENELITIAN ...................................................................... 42
4.1 Rancangan Penelitian ......................................................................... 42
4.2 Lokasi dan Waktu Penelitian ............................................................. 42
4.3 Populasi dan Sampel .......................................................................... 42
4.3.1 Populasi ............................................................................... 42
4.3.2 Sampel ................................................................................. 42
4.3.3 Teknik Sampling ................................................................. 42
4.3.4 Estimasi Besar Sampel ........................................................ 43
4.3.5 Karakter Sampel Penelitian ................................................. 44
4.3.6 Variabel Penelitian .............................................................. 44
4.3.6.1 Variabel Bebas ..................................................... 44
4.3.6.2 Variabel Tergantung ............................................. 44
4.3.7 Definisi Operasional Variabel ............................................. 44
4.4 Dasar Penentuan Dosis ....................................................................... 45
4.5 Bahan dan Instrumen Penelitian ......................................................... 46
4.5.1 Pembuatan Ekstrak Buah Naga Merah ............................... 46
4.5.2 Pembuatan Minyak Kelapa Sawit Pemanasan Berulang..... 47
4.5.3 Pembedahan Tikus .............................................................. 47
4.6 Alur Penelitian ................................................................................... 48
4.7 Prosedur Penelitian ............................................................................. 50
ix
4.7.1 Pembagian Kelompok Tikus ............................................... 50
4.7.2 Adaptasi ............................................................................... 50
4.7.3 Pemberian Minyak Kelapa Sawit Pemanasan Berulang ..... 51
4.7.4 Pemberian Ekstrak Buah Naga Merah ............................... 51
4.7.5 Proses Anastesi dan Pembedahan Hewan Coba ................. 51
4.7.5.1 Proses Anastesi .................................................... 51
4.7.5.2 Proses Pembedahan ............................................. 52
4.7.6 Proses Pembuatan Preparat Histologi ................................. 52
4.8 Analisis Data ...................................................................................... 52
BAB 5 HASIL PENELITIAN DAN ANALISA DATA .................................. 54
5.1 Hasil Penelitian .................................................................................. 54
5.2 Analisa Data ....................................................................................... 56
BAB 6 PEMBAHASAN ..................................................................................... 57
BAB 7 KESIMPULAN DAN SARAN .............................................................. 64
7.1 Kesimpulan ....................................................................................... 64
7.2 Saran .................................................................................................. 65
DAFTAR PUSTAKA ......................................................................................... 66
LAMPIRAN ........................................................................................................ 74
x
DAFTAR TABEL
Halaman
2.1 Perbedaan antara ginjal manusia dan tikus..................................................... 20
2.2 Kandungan Zat Gizi Buah Naga Merah per 100 gram ................................. 24
2.3 Kandungan Zat Antioksidan Buah Naga ...................................................... 26
2.4 Konsentrasi Betasianin Buah Naga Merah (Hylocereus polyrhizus) ........... 28
2.5 Konsentrasi EC50 dan anti-radical scavenger dari buah (kulit dan daging
buah) dan daging buah H. polyrhizus dan H. undatus.................................... 29
2.6 Kandungan Asam Askorbat (Vitamin C) dari buah (kulit dan daging buah)
dan daging buah H. polyrhizus dan H. undatus ............................................. 30
5.1 Hasil Uji Analisis Statistik Tukey .................................................................. 56
xi
DAFTAR GAMBAR
Halaman
2.1 Struktur Anatomis Ginjal .............................................................................. 5
2.2 Struktur Mikroskopik Ginjal .......................................................................... 7
2.3 Perubahan Histologis Ginjal Tikus Jantan yang Mengalami Nekrosis ......... 15
2.4 Struktur Histologis Ginjal Tikus ................................................................... 19
2.5 Struktur Histologis Ginjal Manusia ............................................................... 19
2.6 Pewarnaan PAS tubulus proksimal dan tubulus distal ................................... 19
2.7 Tanaman Buah Naga ..................................................................................... 21
2.8 Buah Naga Merah (Hylocereus polyrhizus) .................................................. 23
2.9 Kerangka C6-C3-C6 Flavonoid ..................................................................... 28
2.9 Scavenging of ROS (Ro) by Flavonoid .......................................................... 29
3.1 Skema Langkah – Langkah Penelitian ........................................................... 49
5.1 Preparat Ginjal Perbesaran 400x .................................................................... 54
5.2 Grafil Rata-rata Sel Tubulus Proksimal ......................................................... 55
5.3 Grafik Hasil Uji Regresi Linier ...................................................................... 57
xii
DAFTAR SINGKATAN
µm : Mikrometer
BB : Berat badan
CE : Catechin equivalents
cm : Sentimeter
DNA : Deoxyribonucleic acid
EC50 : Efficient concentration
GAE : Gallic Acid Equivalents
HDL : High Density Lipoproteins
HE : Hematosiklin Eosin
IL-2 : Interleukin-2
LDL : Low Density Lipoproteins
mg : Miligram
ml : Mililiter
mm : Milimeter
PAS : Periodic Acid Schiff
ppm : part per million
ROS : Reactive Oxygen Species
S.D : Sprague-Dawley
SOD : Superoxide dismutase
TE : Trolox equivalents
TG : Trigliserida
TNF-α : Tumor Necrosis Factor Alpha
xiii
DAFTAR LAMPIRAN
Halaman
Lampiran 1. Data Hasil Pengamatan Histopatologi ........................................ 74
Lampiran 2. Analisis Data Penelitian .............................................................. 75
Lampiran 3. Dokumentasi Penelitian ............................................................... 78
Lampiran 4. Surat Keterangan Pembacaan PA. ............................................... 81
Lampiran 5. Surat Keterangan Pembuatan Preparat …............................... 82
Lampiran 6. Surat Keterangan Telah Melakukan Penelitian ...................... 83
Lampiran 7. Surat Laik Etik ....................................................................... 84
Lampiran 8. Kartu Konsultasi Tugas Akhir ............................................... 85
xiv
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