CORRELATIONS OF CADMIUM EXPOSURE WITH THE UREUM AND CREATININE SERUM LEVELS IN BATURADEN ORNAMENTAL PLANT FARMERS

Baturaden ornamental plant farmers use pesticides and fertilizers containing cadmium to increase growth and plant diseases control. Cadmium is a very toxic heavy metal. Small doses of cadmium exposure in over a long time through respiratory tract, digestion, and skin penetration causes a workload on the kidneys. It resulting kidney damage that characterized by increased ureum and creatinine serum levels. The aimed of this study was determine the correlation of cadmium exposure to kidney function in terms of urea and creatinine serum levels. The research design was an observational analytic approach with cross sectional method. The respondents were 43 farmers. Research data were collected by interviews, measured the urea and creatinine serum levels, also the cadmium urine levels. Data were analyzed by Spearman test. The results showed that there was a weak significant correlation between cadmium urine to ureum (r= 0.399 and p= 0.008) and creatinine serum levels (r= 0.331 and p= 0.03). We concluded that cadmium exposured correlated with increased ureum and creatinine serum levels.

Cadmium enter the tissues of living things through the respiratory tract, digestive tract, and skin penetration. Cadmium that has entered the body, will be absorbed and blood transported to the liver and kidneys. It bind to Metallothionein (MT) in the blood (Kim et al., 2015). Small doses of cadmium exposure in over a long time cause kidney accumulation. It cause a workload on the kidneys, resulting kidney damage characterized by proteinuria, glycosuria, increased ureum and creatinine serum levels, as well as decreased Glomerular Filtration Rate (GFR) (Sudarmadji et al., 2006). Weaver et al.

Cadmium Urine Levels
The frequency distribution of cadmium urine (µg/L) in respondents can be seen in table 1.  (Palar, 2008).
The amount of cadmium in the body can be influenced by several things, such as: age, smoking habits, sex and diet (Adnan et al., 2012;Malgorzata et al., 2008;Mortensen et al., 2011;Menke, 2009).

Ureum and Creatinine Serum levels
The frequency distribution and correlation cadmium exposure to respondents ureum-creatinine serum levels can be seen in  Heavy metal poisoning cause an increased of urea and creatinine serum levels (Sugiharto et al., 2016). In addition, the other things that affect urea and creatinine serum levels  Kim et al. (2015) also mentioned that the decrease in GFR and the increase in creatinine can be caused by continuously cadmium exposure.
Continuous cadmium exposure cause kidney function decreased. Cadmium that enters the body will mostly accumulate in the liver and kidneys. Cadmium that has entered the body be distributed through blood circulation and reach the liver. Furthermore, cadmium in the liver will bind to the protein Metalothionin (MT) to form the Cd-MT complex which produce Cd2+ which is toxic (Bernard, 2008). After passing through the liver, the Cd-MT complex will re-circulate in the blood circulation and end up in several tissues and human organs, one of which is the kidney.  (Houston, 2007).
Nephron damage occurs because the cadmium is released into the tubules lumen and causes the renal tubular protein membrane damaged (Johri et al., 2010). This damaged cause the kidney's ability to filter and reabsorb various substances lost. Albumin excretes to the urine and toxic substances such as ureum and creatinine accumulates in the body (Kim et al., 2015).

CONCLUSION AND SUGGESTION
Cadmium exposure is associated with decreased kidney function in ornamental plant farmers characterized by increased levels of ureum and creatinine serum levels.
Suggestions that can be given for ornamental plant farmers is to use personal protective equipments such as masks, gloves and boots when working to avoid exposure to pesticides and fertilizers containing cadmium.
Ornamental plant farmers are also advised to consume healthy foods such as fruits, especially those containing high vitamin C because it contains high antioxidants.