Albumin/creatinine ratio as an indicator of diabetic foot in a Barbados population

OBJECTIVE: High levels of circulating glucose affect the vasculature in diabetes leading to complications such as retinopathy, nephropathy and diabetic foot. In diabetic nephropathy, the elevated glucose levels also serve to alter the physiology of the glomerulus resulting in elevated albumin excretion. In this case-control study, we examined the Albumin/Creatinine ratio in persons with self-reported type II diabetes, with and without non-healing foot wounds (failure to heal <30 days). DESIGN AND METHODS: Fasting EDTA blood (2ml) samples and urine samples (15ml) were obtained from 90 persons self reported as living with diabetes. Cases were described as persons with non healing foot wounds and controls as persons with no current foot wounds or history of non healing foot wounds. HbA1c levels and Albumin/Creatinine ratios were assessed using a Bayer DCA2000+ Analyser. Fasting glucose levels were determined using a Roche Reflotron+ Analyser. Results were compiled and analysis performed using STATA SE 12.1 (Stata Corporation). RESULTS: Mean HbA1c in cases was 9.1% (ñ2.1 SD) and in controls was 8.3% (ñ1.9 SD) (p=0.05). Mean fasting glucose in cases was 142.19mg/dL (ñ50.76 SD) and in controls 134.57mg/dL (ñ60.10 SD) (p=0.52). Mean Albumin/Creatinine ratio in cases was 210.23 mg/g (ñ275.44 SD) and in controls 42.62 mg/g (ñ103.49 SD) (p<0.001). CONCLUSIONS: In this diabetic case control study, Albumin/Creatinine ratio was markedly higher in persons with diabetes and non-healing foot wounds. This may be a marker of interest as an early indicator of the diabetic foot.

Is it time to replace 24-hour urinary albumin excretion (UAE) assessment in Trinidad and Tobago

OBJECTIVE The aim of this study is to compare albuminuria measured by conventional 24-hour urine collection and by spot urine albumin and by determining ACR, in a spot sample of urine. METHODS: A first morning spot sample and 24 hour urine samples were collected from 64 subjects, irrespective of the prevailing pathology. The urinary albumin and creatinine in both the spot and 24 hour urine samples was analyzed using the fully automated chemistry analyzer. RESULTS: Of the 64 participants studied the 24 hour albumin varied from 30-3000 gm, the interquartile range 450-2814 mg. The sensitivity and specificity of the spot urine sample was 81.3% (95% CI 70.9-91.7) and 83.3% (95% CI 76.6-92). CONCLUSION: ACR did not provide any advantage over microalbumin measurement alone and in fact there was satisfactory agreement between the two measurements. ACR in addition requires a higher laboratory effort therefore in a low resource setting microalbumin measurement alone is the more convenient screening method in routine clininical practice especially in the developing world.

Albumin kinetics in edematous and nonedematous protein-energy malnourished children

The kinetic changes responsible for decreased plasma albumin and the relation between plasma albumin and the edema of protein-energy malnutrition (PEM) were investigated by measuring the plasma concentration, fractional (FSR) and intravascular absolute (ASR) synthesis rates of albumin in seven edematous and seven nonedematous children with PEM by using constant intragastric infusions of [2H3] leucine. Studies were done 2 d postadmission (study 1), 8 d postadmission (study 2), and at recovery (study 3). In study 1 there were no significant differences in plasma albumin concentrations in nonedematous and edematous children. In both groups, albumin concentrations but not FSRs were lower in studies 1 and 2 than in study 3. The ASR was lower only in edematous patients. These results suggest that repletion of the albumin pool of children with PEM is not mediated by changes in the FSR, and the edema of malnutrition is not solely due to hypoalbuminemia. (AU)

Reference ranges for thirteen biochemical parameters in Barbadian blood donors - abstract

At the Queen Elizabeth Hospital, the reference ranges of thirteen (13) biochemical constituents in plasma where determined, using blood donors. Prior to the establishment of these reference ranges, we were using either the European or the North American reference ranges. Differences between the Barbadian population and both of these groups are expected since we have different diets and optimal nutritional standards. Significant differences were found to be present in the plasma potassium, albumin and urate levels (p<0.01). In Jmaica, it has been shown that a reversal of the usual albumin/globulin ratio is associated with the nutritional and infectious disease status of that population. The total protein and albumin ranges appear to be wide. This is not a reflection of the precision of the methods used, but may be due to the fact that we sampled a fairly large cross-section of the population, with varying dietary habits. The low potassium range need further investigation. It must, however, be mentioned that many of our patients have a plasma potassium value at the lower limits of the European and North American reference ranges without any apparent symptoms of hypokalaemia. The explanation for the low plasma potassium value may be dietary deficiency, as the traditional Barbadian diet in the lower socio-economic group is low in fresh fruits and vegetables (AU)

Albumin metabolism: effect of the nutritional state and the dietary protein intake

Nine malnourished and nine children who had recovered from malnutrition were given a single injection of albumin-131I and were studied during consecutive periods in which the dietary protein was changed. Malnourished children had significantly lower catabolic rates of albumin than had recovered children on the same protein intake. Both nutritional groups, however, showed a progressive fall in catabolic rate after 3-5 days on a low protein diet (0.7-1.0g/kg per day), and the maximum effect was seen in the 2nd wk of low protein feeding. The catabolic rate could return to normal within 3wk in a malnourished child fed 4g of protein/kg per day. The albumin synthetic rate was measured by a computer technique suitable for nonsteady-state conditions. The synthyetic rate in the malnourished groups (101mg/kg per day) fed on a low protein diet was significantly lower than the rate in the recovered groups (148mg/kg per day). The synthetic rate responded rapidly to a change in diet; when the rate fell, the intavascular albumin mass was maintained by two compensating mechanisms: (1) a net transfer of extravascular albumin into the intravascular pool; and (2) by a delayed fall in the catabolic rate. The net transfer of albumin into the intravascular compartment diminished as the catabolic rate fell. Adaptation to a low protein diet was associated with: (a) low synthetic and catabolic rates of albumin; (b) a reduced extravascular albumin mass; and (c) a capacity for a rapid return to normal in the synthetic rate when the dietary protein was increased (AU)

Albumin metabolism in malnourished infants

Albumin metabolism was studied with I131 labelled human serum albumin in malnourished infants before and after treatment. Calculation of the rate of breakdown of albumin from the slope of the decay curve of plasma radioactivity was shown to be erroneous under the conditions of these measurements. When turn-over rates were calculated from the urinary excretion of I131 it was found that the rate of catabolism of albumin was significantly less in the malnourished stated than after recovery. This may represent a compensatory reaction to protein depletion. The rapid regeneration of plasma albumin which occurs in reponse to treatment may be due mainly to the decreased catabolic rate rather than an increased rate of albumin synthesis (AU)

Observation on evans blue dye as a tracer for human plasma albumin

1. Evans blue dye and 131I-labelled albumin were injected intravenously into a normal adult, a 16 year old patient with the nephrotic syndrome, and 5 infants recovering from malnutrition. 2. In all subjects the rate of disappearance of the dye was faster than that of the radio-active iodine, although in the adult after repeated injections the half-life of the dye compound aproached that of the iodinated albumin. 3. The apparent volume of distribution of albumin was larger when calculated from the Evans blue results than that given by the labelled albumin. 4. Evans blue is evidently not a valid label for plasma albumin. The larger volume of distribution and the more rapid destruction probably result from phagocytosis by the reticulo-endothelial system. 5. The dye may nevertheless be useful, since when the half-lives found in the pathological subjects are expressed as a percentage of the half-life in the normal adult, the two tracers give almost identical results (SUMMARY)

Serum protein levels in a group of East Indians in a hospital

The paper is based on the results obtained in the examination of blood from a group of "East Indian patients at the Georgetown Hospital". The object of this study is to ascertain the serum protein level as well as that of albumin and globulin and to determine whether the group as a whole showed any characteristic features. This study indicates that the mean total protein of 6.6 g per 100 ml is lower than the generally accepted normal for Europeans, and that the albumin level of 3.2 g per 100 is also lower. The level of globulin is higher than the European normal. The interpretation of the findings is difficult without further work. This study shows the need for the investigations of samples from the general population in order to obtain "normal" figures for the various races living in the Caribbean area. (Summary)