Microalbuminuria, Other Markers of Nephropathy and Biochemical Derangementsin Type 2 Diabetes Mellitus: Relationships and Determinants.

BACKGROUND: Microalbuminuria is an early indicator of Diabetic nephropathy and cerebrovascular disease. OBJECTIVE: To evaluate relationships between microalbuminuria and other predictors of morbidity and mortality in type 2 DM. METHODS: Fifty type 2 diabetic subjects were recruited each for three groups separated by disease durations. Thirty non-diabetic subjects were recruited to control each group. Urine albumin-to-creatinine ratio (ACR) was estimated. Fasting plasma glucose (FPG), serum creatinine, urea, total cholesterol (TC), triglycerides (TG), high-and low density lipoprotein (HDL, LDL) were measured. RESULTS: The diabetics with longest disease duration of >10 years were the oldest (65.86±1.71), had highest systolic BP (147.12±3.39mmHg) and least BMI (27.20±0.71Kg/m2); they had poorest lipid control (TC:5.54±0.26mmol/L), though with the least TG (0.97±0.09mmol/L); they also had the most severe microalbuminuria (33.63±8.03g/L) and ACR (65.85±10.38mg/gm). Patients with diabetes of 5-10 years had the poorest glycaemic control:FPG-7.82±0.47mmol/L; HbA1c-13.09±0.74%). Significant negative correlations exist between microalbuminuria, HBA1c(r=-2.28, p=0.028) and serum creatinine(r=-2.11, p=0.042) in patients with 5-10 years disease; a positive correlation between the ACR and TC(r=1.00,p<0.01) in those with >10 years disease. In multivariate analysis, independent predictors of microalbuminuria were disease duration (OR 2.2, p< 0.001); HBA1c (OR 7.3, p=0.02); LDL/HDL ratio (OR 13.4, p< 0.001). CONCLUSION: The severity and progression of albuminuria are associated with longer duration of diabetes and poor glycaemic control. Significant relationships exist between ACR and HBA1c, TC, HDL-C, TG, creatinine. Disease duration, ethnicity, HBA1c, TC, TG, HDL-C and LDL/HDL ratio are independent predictors of albuminuria. FUNDING: None declared.

Determinants of hypercalcemia and hypercalciuria in immobilized trauma patients.

Hypercalcemia and hypercalciuria secondary to immobilization can be occasionally severe, producing an array of symptoms. This study looked at possible determinants of hypercalcemia and hypercalciuria in immobilized trauma patients. This is a prospective observational study carried out over a period of 7 months. Fifty-five immobilized trauma patients were evaluated weekly for 4 weeks for symptoms of hypercalcemia, total serum calcium and 24-h urinary calcium. The number of limbs immobilized had a significant relationship with hypercalcemia at the end of week 1 (P<0.001) and week 4 (P=0.008) and with hypercalciuria at the end of week 1 only (P<0.001). The number of bones fractured also had a significant relationship with hypercalcemia at the end of week 1 (P=0.005) and week 4 (P=0.019), as well as with hypercalciuria at the end of week 1 (P<0.001) and week 2 (P=0.036). Weight loss was significantly associated with hypercalcemia at the end of week 4 (P=0.014) and with hypercalciuria at the end of week 3 (P<0.001) and week 4 (P<0.001), whereas polyuria and polydipsia had a significant association with hypercalciuria at the end of week 2 (P<0.001) and week 3 (P=0.030). The number of limbs immobilized and bones fractured showed an early significant relationship with the development of hypercalcemia and hypercalciuria. Weight loss showed late association with hypercalcemia and hypercalciuria, whereas polyuria and polydipsia showed early association with hypercalciuria.

Prevalence and Pattern of Chronic Kidney Disease in Antiretroviral-Naïve Patients with HIV/AIDS.

BACKGROUND: Chronic renal failure and HIV/AIDS are both prevalent in Nigeria. We performed a cross-sectional analysis of renal function in newly diagnosed, treatment-naive HIV-infected patients before initiating highly active antiretroviral therapy. METHODS: Treatment-inexperienced individuals were recruited. Patients with diabetes mellitus and hypertension were excluded. Plasma creatinine level was used to measure the estimated glomerular filtration rate ([eGFR] by Modification of Diet in Renal Disease equation). Predictors of creatinine and eGFR were determined by univariate and multivariate analyses. RESULTS: We evaluated 183 patients. In all, 44 (24%) patients had a GFR <60 mL/min/1.73 m(2), implying moderate chronic kidney disease (CKD). Considering the eGFR, 22 (12%) patients had stage 1, 117 (63.9%) stage 2, 13 (7.1%) stage 3, 27 (14.8%) stage 4, and 4 (2.2%) stage 5 CKD. Creatinine inversely correlated with CD4 (r = -.228, P = .025). CD4 predicts creatinine (odds ratio 1.6, 95% confidence interval 1.0-1.8, P = .003). CONCLUSION: In ART-naive patients, CKD is common, and low eGFR was associated with lower CD4 counts.

Comparison of serum and urinary calcium profile of immobilized and ambulant trauma patients.

BACKGROUND: Hypercalcemia occurs more frequently than is recognized in patients who are immobilized, but most of these patients are asymptomatic. This study is to determine serum and urinary calcium levels, incidence of hypercalcemia and hypercalciuria in immobilized and ambulant trauma patients. METHODS: A prospective comparative study was carried out over a period of seven months. Total serum calcium level and 24-hour urinary calcium output were measured weekly over 4weeks in 55 immobilized trauma patients as study group and 51 ambulant trauma patients as control group. RESULTS: Mean total serum calcium of immobilized patients increased progressively (on admission: 2.315±0.056mmol/l and week 4: 2.552±0.231mmol/l, p<.001) while that of ambulant patients did not change significantly (on admission: 2.306±0.041mmol/l, and week 4: 2.300±0.028mmol/l, p=.348). There is a significant difference in overall mean total serum calcium between immobilized and ambulant patients (p<.001). In immobilized and ambulant patients, mean 24-hour urinary calcium increased progressively from baseline (3.044±0.480mmol/day and 3.056±0.540mmol/day respectively), till the end of the study (8.543±2.142mmol/day and 6.783±1.372mmol/day respectively). Overall mean 24-hour urinary calcium is significantly different between immobilized and ambulant patients {multivariate Pillai F (5,100)=883.124, p<.001}. Incidence of hypercalcemia increased progressively in immobilized patients (end of week 1=7.27% and end of week 4=29.09%) while none of the ambulant patients had hypercalcemia. Incidence of hypercalciuria also increased progressively in immobilized patients (end of week 1=7.27% and end of week 4=63.64%) while ambulant patients only had hypercalciuria at the end of week 3 (9.8%) and week 4 (21.57%). CONCLUSION: Mean total serum calcium increased with increased duration of immobilization in trauma patients. Both immobilized and ambulant trauma patients developed hypercalciuria but it is worse and earlier in the immobilized trauma patients.