RESUMO
Type 2 diabetes (T2D) is associated with increased risk for chronic kidney disease (CKD). It is estimated that 40 % of people with diabetes have CKD, which consequently leads to increase in morbidity and mortality from cardiovascular diseases (CVDs). Diabetic kidney disease (DKD) is leading cause of CKD and end-stage renal disease (ESRD) globally. On the other hand, DKD is independent risk factor for CVDs, stroke and overall mortality. According to the guidelines, using spot urine sample and assessing urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) are both mandatory methods for screening of CKD in T2D at diagnosis and at least annually thereafter. Diagnosis of CKD is confirmed by persistent albuminuria followed by a progressive decline in eGFR in two urine samples at an interval of 3 to 6 months. However, many patients with T2D remain underdiagnosed and undertreated, so there is an urgent need to improve the screening by detection of albuminuria at all levels of health care. This review discusses the importance of albuminuria as a marker of CKD and cardiorenal risk and provides insights into the practical aspects of methods for determination of albuminuria in routine clinical care of patients with T2D.
Assuntos
Albuminúria , Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Humanos , Albuminúria/urina , Albuminúria/diagnóstico , Diabetes Mellitus Tipo 2/urina , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/urina , Nefropatias Diabéticas/fisiopatologia , Taxa de Filtração Glomerular/fisiologia , Insuficiência Renal Crônica/urina , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/fisiopatologia , Biomarcadores/urinaRESUMO
AIMS: This study was aimed to compare insulin sensitivity and secretion response, lipoprotein and plasminogen activator inhibitor 1 (PAI-1) levels between the subjects with and without coronary artery endothelial dysfunction (ED). METHODS: ED was detected by intracoronary injection of acetylcholine (ACh) in 47 nondiabetes subjects without stenotic coronary arteries, selected from 316 consecutive patients with coronary angiography performed for suspected coronary artery disease. The subjects were divided into two groups: presence of ACh-induced coronary spasm (group ED+, Nâ¯=â¯30) and absence of ACh-induced coronary spasm (group ED-, Nâ¯=â¯17). Insulin sensitivity (Si) was evaluated by frequently sampled intravenous glucose tolerance test (FSIGTT) with minimal model analysis and by HOMA-IR, insulin secretion by acute insulin response (AIR) (calculated from the first 8â¯min of FSIGTT) and by disposition index (DI) (Siâ¯×â¯AIR). Lipids and PAI-1 levels were determined enzymatically, and LDL particle size by gradient gel electrophoresis. RESULTS: Si was significantly lower (4.22⯱â¯0.62 vs 6.98⯱â¯1.47â¯min-1/mU/lâ¯×â¯104; pâ¯<â¯0.05) while HOMA-IR was significantly higher in EDâ¯+â¯group vs ED- group (2.8⯱â¯0.3 vs 1.7⯱â¯0.2; pâ¯<â¯0.05). Simultaneously, AIR and DI was significantly lower in EDâ¯+â¯vs ED- groups (pâ¯<â¯0.05 and pâ¯<â¯0.01, respectively). Investigated groups did not differ in fasting lipid levels but ED+ group had significantly smaller LDL particles (pâ¯<â¯0.01) and higher PAI-1 levels (pâ¯<â¯0.05). Regression analysis shown that DI was a strong independent predictor of appearance of ED, together with PAI-1 and LDL particle size. CONCLUSIONS: Both insulin resistance and impairment in insulin secretion response strongly correlate with coronary ED in subjects without diabetes.