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1.
Nat Med ; 25(11): 1753-1760, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31700174

RESUMO

Chronic kidney disease is common in the general population and associated with excess cardiovascular disease (CVD), but kidney function does not feature in current CVD risk-prediction models. We tested three formulae for estimated glomerular filtration rate (eGFR) to determine which was the most clinically informative for predicting CVD and mortality. Using data from 440,526 participants from UK Biobank, eGFR was calculated using serum creatinine, cystatin C (eGFRcys) and creatinine-cystatin C. Associations of each eGFR with CVD outcome and mortality were compared using Cox models and adjusting for atherosclerotic risk factors (per relevant risk scores), and the predictive utility was determined by the C-statistic and categorical net reclassification index. We show that eGFRcys is most strongly associated with CVD and mortality, and, along with albuminuria, adds predictive discrimination to current CVD risk scores, whilst traditional creatinine-based measures are weakly associated with risk. Clinicians should consider measuring eGFRcys as part of cardiovascular risk assessment.


Assuntos
Doenças Cardiovasculares/diagnóstico , Taxa de Filtração Glomerular/fisiologia , Falência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/diagnóstico , Adulto , Idoso , Albuminúria/complicações , Albuminúria/diagnóstico , Albuminúria/fisiopatologia , Albuminúria/urina , Bancos de Espécimes Biológicos , Biomarcadores/sangue , Biomarcadores/urina , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/fisiopatologia , Creatinina/metabolismo , Feminino , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/fisiopatologia , Fatores de Risco
2.
High Blood Press Cardiovasc Prev ; 26(5): 361-373, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31650516

RESUMO

High blood pressure (BP) is becoming a growing health issue even in children and adolescents. Moreover, BP elevation in youth frequently translates into children and adult hypertension contributing to the development of cardiovascular disease. The detection of early markers of vascular damage, potentially leading to overt cardiovascular disease, is important for clinical decisions about if and how to treat hypertension and can be useful in monitoring the effectiveness of the treatment. The purpose of this review is to summarize the actual knowledge about subclinical organ damage (SOD) in hypertensive children and adolescents and its association with cardiovascular disease in children and young adults. Our focus is especially put on left ventricular mass, pulse wave velocity, carotid intima-media thickness and microalbuminuria. We also want to address the scientific evidence about possible regression of SOD and cardiovascular risk with the use of behavioural and specific anti-hypertensive therapy. Indications from current guidelines are critically discussed.


Assuntos
Albuminúria/epidemiologia , Pressão Sanguínea , Cardiopatias/epidemiologia , Hipertensão/epidemiologia , Nefropatias/epidemiologia , Doenças Vasculares/epidemiologia , Adolescente , Fatores Etários , Albuminúria/diagnóstico , Albuminúria/fisiopatologia , Doenças Assintomáticas , Criança , Feminino , Cardiopatias/diagnóstico , Cardiopatias/fisiopatologia , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Nefropatias/diagnóstico , Nefropatias/fisiopatologia , Masculino , Fatores de Risco , Doenças Vasculares/diagnóstico , Doenças Vasculares/fisiopatologia , Remodelação Vascular , Rigidez Vascular
3.
F1000Res ; 82019.
Artigo em Inglês | MEDLINE | ID: mdl-31583081

RESUMO

Since the association of microalbuminuria (MAU) with cardiovascular (CV) risk was described, a huge number of reports have emerged. MAU is a specific integrated marker of CV risk and targets organ damage in patients with hypertension, chronic kidney disease (CKD), and diabetes and its recognition is important for identifying patients at a high or very high global CV risk. The gold standard for diagnosis is albumin measured in 24-hour urine collection (normal values of less than 30 mg/day, MAU of 30 to 300 mg/day, macroalbuminuria of more than 300 mg/day) or, more practically, the determination of urinary albumin-to-creatinine ratio in a urine morning sample (30 to 300 mg/g). MAU screening is mandatory in individuals at risk of developing or presenting elevated global CV risk. Evidence has shown that intensive treatment could turn MAU into normoalbuminuria. Intensive treatment with the administration of an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker, in combination with other anti-hypertensive drugs and drugs covering other aspects of CV risk, such as mineralocorticoid receptor antagonists, new anti-diabetic drugs, and statins, can diminish the risk accompanying albuminuria in hypertensive patients with or without CKD and diabetes.


Assuntos
Albuminúria/diagnóstico , Anti-Hipertensivos/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Hipertensão/tratamento farmacológico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Diabetes Mellitus , Humanos , Hipertensão/complicações , Insuficiência Renal Crônica/complicações , Fatores de Risco
4.
Medicine (Baltimore) ; 98(39): e17297, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574853

RESUMO

As a modifiable risk factor for cardiovascular disease, presence of hypertension (HT) necessitates the awareness of asymptomatic organ damage (AOD). The aim of this study was to measure plasma micro RNA-21 (miR-21) and the parameters that reflect AOD such as carotid intima-media thickness (CIMT), microalbuminuria (MAU) in hypertensive patients compared with healthy controls. In addition, the aim of this study was to evaluate plasma miR-21 levels in HT patients with AOD.This study was designed as a cross-sectional observational study. The study includes 2 groups: 32 patients with HT and 32 healthy controls. First, we compared these 2 groups. Then, to underline the relationship between plasma miR-21 and HT, hypertensive patients were divided into 2 groups: with AOD and without AOD.Sixteen patients with HT had AOD. MiR-21 levels significantly correlated with clinical systolic and diastolic blood pressure, MAU, C-reactive protein, and CIMT. CIMT, miR-21, and MAU levels were significantly higher in patients with AOD.Our study showed increased miR-21 levels in HT patients with AOD.


Assuntos
Albuminúria , Doenças Cardiovasculares , Hipertensão , MicroRNAs/sangue , Adulto , Albuminúria/diagnóstico , Albuminúria/etiologia , Doenças Assintomáticas/epidemiologia , Pressão Sanguínea/fisiologia , Proteína C-Reativa/análise , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Espessura Intima-Media Carotídea , MicroRNA Circulante/análise , Correlação de Dados , Estudos Transversais , Feminino , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/genética , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Turquia/epidemiologia
5.
Clin Lab ; 65(8)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31414764

RESUMO

BACKGROUND: Diabetic nephropathy (DN) is the leading cause of end-stage renal disease worldwide. Several factors are known to contribute to the development and progression of diabetic nephropathy. Different microRNAs have been shown to contribute in the pathogenesis of DN. This study, aimed to evaluate the expression level of circulating miR-155 in patients with diabetic nephropathy. METHODS: In this case-control study, 83 diabetic patients and normal subjects were evaluated in four groups of normal healthy subjects without diabetes and nephropathy, diabetes without nephropathy, diabetes with microalbuminuria, and diabetes with macroalbuminuria. After RNA extraction from serum and cDNA synthesis, the expression of circulating miR-155 was evaluated by quantitative polymerase chain reaction (qPCR). RESULTS: Expression level of cell-free miR-155 was significantly lower in diabetics compared to the normal healthy controls (p < 0.05). However, no significant difference was found in miR-155 expression level between different diabetes groups with different conditions of kidney function. Furthermore, we detected a significant negative correlation between cell-free miR-155 expression and GFR only in patients with microalbuminuria (r = -0.70, p = 0.001). CONCLUSIONS: It seems that miR-155 can discriminate diabetic and nondiabetic status, but is not an appropriate biomarker for tracking of macroalbuminuria.


Assuntos
Biomarcadores/sangue , Diabetes Mellitus Tipo 2/sangue , Nefropatias Diabéticas/sangue , MicroRNAs/sangue , Idoso , Albuminúria/sangue , Albuminúria/complicações , Albuminúria/diagnóstico , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Nefropatias Diabéticas/complicações , Nefropatias Diabéticas/diagnóstico , Progressão da Doença , Feminino , Expressão Gênica , Humanos , Masculino , MicroRNAs/genética , Pessoa de Meia-Idade , Sensibilidade e Especificidade
6.
Nat Commun ; 10(1): 3605, 2019 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399600

RESUMO

Microalbuminuria is an important clinical marker of several cardiovascular, metabolic, and other diseases such as diabetes, hypertension, atherosclerosis, and cancer. The accurate detection of microalbuminuria relies on albumin quantification in the urine, usually via an immunoturbidity assay; however, like many antibody-based assessments, this method may not be robust enough to function in global health applications, point-of-care assays, or wearable devices. Here, we develop an antibody-free approach using synthetic molecular recognition by constructing a polymer to mimic fatty acid binding to the albumin, informed by the albumin crystal structure. A single-walled carbon nanotube, encapsulated by the polymer, as the transduction element produces a hypsochromic (blue) shift in photoluminescence upon the binding of albumin in clinical urine samples. This complex, incorporated into an acrylic material, results in a nanosensor paint that enables the detection of microalbuminuria in patient samples and comprises a rapid point-of-care sensor robust enough to be deployed in resource-limited settings.


Assuntos
Albuminas/química , Albuminúria/diagnóstico , Técnicas Biossensoriais/métodos , Albuminas/isolamento & purificação , Albuminúria/urina , Biomarcadores/sangue , Biomarcadores/urina , Proteínas Sanguíneas/análise , Ácidos Graxos , Humanos , Imobilização , Nanoestruturas/química , Pintura , Espectrometria de Fluorescência , Urina/química
7.
Anal Chim Acta ; 1080: 146-152, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31409464

RESUMO

Field-amplified stacking (FAS) is a commonly used method for enhancing the sensitivity of charged species from low conductive media in capillary electrophoresis. FAS also showed significant sensitivity enhancement effect on a uniform paper fluidic channel by proper design of the electrolyte. In this paper, a novel method of introducing electric field gradient is proposed by geometry design of a 2D paper fluidic channel, and field amplification effect was successfully demonstrated with reduced requirement on the sample's conductivity. Sensitive colorimetric detection of microalbuminuria (MAU) from urine samples was demonstrated by mobile phone camera. Experimental results showed that, with active electric field motivation, up to 93.5% of the loaded protein probe could be effectively transferred and stacked into a narrow band on the newly designed paper fluidic channel. A limit of detection (LOD) of 6.5 mg‧L-1 HSA was achieved with a dynamic range of 10-300 mg‧L-1 (linear in the range of 10-100 mg‧L-1, R2 = 0.991). Combined with selective staining of albumin with bromophenol blue (BPB), the established method was applied to the detection of MAU from clinical urine samples, and consistent results with that of the clinical method were obtained. With this paper-based analytical device (PAD), MAU from highly conductive urine samples can be directly loaded and detected without any pretreatment. This method provides a way to develop highly sensitive point-of-care test (POCT) for rapid screening of some diseases.


Assuntos
Albuminúria/diagnóstico , Colorimetria/métodos , Eletroforese Capilar/métodos , Papel , Albumina Sérica Humana/urina , Azul de Bromofenol/química , Colorimetria/instrumentação , Corantes/química , Eletroforese Capilar/instrumentação , Humanos , Limite de Detecção
8.
Diabetes Metab Syndr ; 13(4): 2633-2639, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405687

RESUMO

BACKGROUND&AIM: Mean platelet volume (MPV) is suggested as a marker of platelet reactivity and tendency for thrombosis and microvascular complications like albuminuria in patients with type 2 DM. We aimed to measure the MPV in patients with type 2 DM and its correlation with albuminuria, body mass index (BMI), duration of DM, hypertension (HTN), stroke, ischemic heart disease (IHD), and HbA1c level. METHODS: A cross sectional study included 100 patients with type 2 DM ≥ 18 y of both genders who were randomly selected from the medical units of Baghdad Teaching Hospital. After taking verbal consents; MPV was measured&correlated with aimed variables. Diabetics with HbA1c ≤ 7% were considered as having adequate control while those with (HbA1c) > 7% as having poor control. Albumin creatinine ratio (ACR) in urine was measured and classified into normal, moderately and severely increased. Odds ratios with 95% CI were calculated and P ≤ 0.05 was considered as statistically significant. RESULTS: The mean MPV was 7.7 fl ±â€¯1.2. Regarding ACR, 42% had normal level, 37% with moderately increased and 21% had severely increased level. Regarding HbA1c, 68% were having poorly controlled DM. Mean platelets' count and MPV were higher in the uncontrolled group with a statistically significant association. There was a statistically significant positive correlation between MPV and albuminuria, duration of DM, HTN, IHD, Stroke, BMI, HbA1c, and platelets count. CONCLUSIONS: The mean MPV was statistically significantly higher in the uncontrolled DM group and there was a statistically significant positive correlation between MPV and albuminuria.


Assuntos
Albuminúria/diagnóstico , Biomarcadores/análise , Diabetes Mellitus Tipo 2/complicações , Hipertensão/diagnóstico , Volume Plaquetário Médio , Acidente Vascular Cerebral/diagnóstico , Albuminúria/etiologia , Glicemia/análise , Índice de Massa Corporal , Estudos Transversais , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Acidente Vascular Cerebral/etiologia
10.
BMC Endocr Disord ; 19(1): 84, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382952

RESUMO

BACKGROUND: In patients with diabetes mellitus, the urinary microalbumin-to-urine creatinine ratio (UACR) can not only predict the occurrence of diabetic nephropathy but also can be a risk factor for cardiovascular disease and renal function damage. Current studies on subclinical hypothyroidism (SCH) and UACR are mainly cross-sectional studies, and the results suggest that SCH is an independent risk factor for UACR. To further explore the longitudinal effect of SCH on UACR, we carried out this study. METHODS: This was a retrospective cohort study including 46 patients with type 2 diabetes mellitus and SCH in the Department of Endocrinology, The Affiliated Huai'an Hospital of Xuzhou Medical University from January 2013 to April 2018. At the same time, 96 patients with type 2 diabetes mellitus and euthyroid were chosen according to 1:2 approximately matched with age, sex and duration of diabetes mellitus. Univariate analysis, stratified analysis, and multiple linear regression analysis were used to investigate the effect of SCH on ΔUACR(ΔUACR = UACR after 1 year - baseline UACR) in patients with type 2 diabetes mellitus. RESULTS: There was no significant difference between the baseline UACR, (p > 0.05). However, the ΔUACR was significantly higher in SCH group than euthyroid group, as shown by univariate analysis, stratified analysis and multiple linear regression analysis (ß:-1.071, 95% CI: - 1.713--0.428), and the difference was statistically significant (all p < 0.05). CONCLUSION: SCH is associated with an increased UACR in type 2 diabetes mellitus patients. It is necessary to screen for thyroid function in type 2 diabetes mellitus and increase the follow-up frequency of UACR in patients with SCH.


Assuntos
Albuminúria/etiologia , Biomarcadores/análise , Creatinina/urina , Diabetes Mellitus Tipo 2/fisiopatologia , Nefropatias Diabéticas/etiologia , Hipotireoidismo/complicações , Adolescente , Adulto , Idoso , Albuminúria/diagnóstico , China/epidemiologia , Nefropatias Diabéticas/diagnóstico , Feminino , Seguimentos , Humanos , Hipotireoidismo/epidemiologia , Hipotireoidismo/patologia , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
11.
Biosens Bioelectron ; 142: 111542, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31382096

RESUMO

Albumin is a significant prognostic marker in diabetic nephropathy and cardiovascular disease. In this work, we developed a rapid, sensitive and inexpensive method for albumin detection based on the polydopamine (PDA) bi-functionalized glass chip and surface-enhanced Raman scattering (SERS) tag. Anti-albumin antibodies were encapsulated on the glass chip and SERS tag through dopamine self-polymerization in alkaline conditions and the immunoaffinity was highly maintained to form the sandwich structure with the addition of target microalbuminuria. Under the optimum experimental conditions, this SERS immunoassay showed the wide linear range of 10-300 mg/L with the limit of detection of 0.2 mg/L. High specificity and selectivity of this SERS method were demonstrated by performing with some common proteins include human hemoglobin protein (Hgb) and human immunoglobulin G (IgG) in urine. This method was also applied to detect albumin in urine samples from 17 patients and 5 healthy control and the results were highly consistent with those obtained from clinical standard immunoturbidimetric method. The volume requirement of urine samples is only 2 µL. Compared with traditional dipstick and immunoturbidimetric methods used in clinic, SERS-based method has higher accuracy, lower sensitivity and less sample consumption.


Assuntos
Albuminúria/diagnóstico , Anticorpos Imobilizados/química , Técnicas Biossensoriais/métodos , Indóis/química , Polímeros/química , Análise Espectral Raman/métodos , Ouro/química , Humanos , Imunoensaio/métodos , Limite de Detecção , Nanopartículas Metálicas/química
12.
Diabetes Metab Syndr ; 13(2): 1245-1250, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336472

RESUMO

OBJECTIVE: To assess serum leptin in diabetic nephropathy male patients from Gaza Strip. MATERIALS AND METHODS: This case-control study comprised 132 type 2 diabetic patients and 44 non-diabetic controls. The diabetic patients were classified into three groups; 44 normoalbuminurics, 44 microalbuminurics and 44 macroalbuminurics. Data were obtained from questionnaire interview, and biochemical analysis of blood and urine samples. Patients and controls were matched for age and body mass index (BMI). RESULTS: Serum leptin was significantly higher in micro- and macro-albuminuric patients (14.6 ±â€¯11.7 and 15.6 ±â€¯13.5 ng/ml) than controls and normoalbuminurics (5.9 ±â€¯4.0 and 8.1 ±â€¯7.6 ng/ml) with P < 0.05. In general, serum glucose, urea, createnine, cholesterol, triglycerides, low density lipoprotein cholesterol (LDL-C), urinary albumin and albumin creatinine ratio (ACR) were increased in diabetic groups compared to non-diabetics, and reaching their maximum increase in macroalbuminurics whereas high density lipoprotein cholesterol (HDL-C), urinary creatinine and glomerular filtration rate (GFR) were decreased reaching its maximum decrease in macroalbuminurics. Serum leptin showed significant positive correlations with diabetes duration (r = 0.188, P = 0.020), glucose (r = 0.298, P < 0.001), cholesterol (r = 0.323, P < 0.001), triglycerides (r = 0.361, P < 0.001), LDL-C (r = 0.248, P = 0.001) and urinary albumin (r = 0.256, P = 0.001) whereas negative significant correlations were found with HDL-C (r = -0.313, P < 0.001) and urinary creatinine (r = -0.202, P = 0.007). CONCLUSION: The comitant raise of serum leptin with urinary albumin combined with decrease in GFR makes leptin eligible candidate as a biomarker for progression towards diabetic nephropathy in type 2 diabetes.


Assuntos
Albuminúria/diagnóstico , Biomarcadores/análise , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/sangue , Taxa de Filtração Glomerular , Leptina/sangue , Adulto , Albuminúria/etiologia , Índice de Massa Corporal , Estudos de Casos e Controles , Nefropatias Diabéticas/etiologia , Nefropatias Diabéticas/urina , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Oriente Médio , Prognóstico
13.
J Stroke Cerebrovasc Dis ; 28(10): 104260, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31350166

RESUMO

OBJECTIVE: This study aimed to clarify the association between an increased spot urine albumin-to-creatinine ratio (UACR) and the risk of stroke. METHODS: We performed a systematic review and meta-analysis of cohort studies, case-control studies, and ancillary data randomized controlled trials (RCTs), which were treated as cohorts in this study, and estimated the association between albuminuria, as measured with the UACR, and the risk of stroke. We performed a comprehensive search of PubMed, Embase, and the Cochrane Library and conducted a systematic review and cumulative meta-analysis of cohort studies with a cross-sectional with prospective design in which stroke incidence was reported and the baseline UACR was measured. Ancillary data from RCTs were also included as part of the cohort study. We studied the characteristics of the participants, quality scores and risk ratios (RR, with confidence intervals, CI) of stroke associated with normal and high UACRs, and we synthesized the data via a meta-analysis. RESULTS: Twelve eligible studies including a total of 32,888 participants and 3,944 cases of stroke were identified. A high UACR (>30 mg/mmol) increased the risk of stroke by 1.67 times (RR: 1.67, 95% CI: 1.49-1.86, P<0.001 I2 = 26%). The results were not different between Asian and non-Asian patients (RR: 1.64, 95% CI: 1.41-1.91, P<0.001, I2 = 23% compared with RR: 1.67, 95% CI: 1.50-1.85, P<0. 00, I2 = 39%) or between subgroups classified by old age (RR: 1.61, 95% CI: 1.39-1.88, P<0.001, I2 = 34% compared with RR: 1.68, 95% CI: 1.52-1.87, P<0.001, I2 = 13%). A sensitivity analysis did not significantly change the results. CONCLUSION: The incidence of stroke increased significantly in the high UACR group compared with the normal UACR group. The UACR could be a clinical addition for the early indication of high-risk stroke patients.


Assuntos
Albuminúria/epidemiologia , Biomarcadores/urina , Creatinina/urina , Acidente Vascular Cerebral/epidemiologia , Idoso , Albuminúria/diagnóstico , Albuminúria/urina , Diagnóstico Precoce , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/urina , Urinálise
14.
Afr Health Sci ; 19(1): 1607-1616, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31148990

RESUMO

Background: The aim of this study was to determine the prevalence and factors associated with microalbuminuria among newly diagnosed diabetic patients in Mulago National Referral Hospital, Uganda. Methods: In this cross-sectional study conducted between June 2014 and January 2015, we collected information on patients' socio-demographics, biophysical profile, blood pressure, biochemical testing and echocardiographic findings using a pre-tested questionnaire. Bivariate and multivariate logistic regression analyses were used to investigate the association of several factors with microalbuminuria. Results: Of the 175 patients recruited, males were 90(51.4%) and the mean age was 46±15 years. Majority of patients had type 2 DM 140 (80.0%) and the rest had type 1 DM 35 (20.0%). Mean glycated hemoglobin (HbA1C) was 13.9±5.3%. Mean duration of diabetes was 2 months. Prevalence of microalbuminuria was 47.4 % (95% CI: 40.0%-54.9%) overall. Pregnancy was associated with microalbuminuria (OR7.74[95%CI.1.01-76.47] P=0.050) while mild and moderate physical activity at work were inversely associated with microalbuminuria respectively (OR0.08[95%CI0.01-0.95] P=0.046) and (OR0.07[95%CI0.01-0.77] P=0.030). Conclusion: Prevalence of microalbuminuria was high in this group. Physical activity at work may be protective against microalbuminuria and this calls for longitudinal studies. Early detection and management of microalbuminuria in diabetics may slow progression to overt diabetic nephropathy (DN).


Assuntos
Albuminúria/diagnóstico , Creatinina/sangue , Creatinina/urina , Diabetes Mellitus Tipo 2/epidemiologia , Adolescente , Adulto , Albuminúria/epidemiologia , Albuminúria/etiologia , Biomarcadores/urina , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Uganda/epidemiologia
15.
Clin Nephrol ; 92(2): 73-80, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31198168

RESUMO

BACKGROUND: Diabetic kidney disease (DKD) is the most common cause of end-stage renal disease (ESRD) worldwide. Clinical manifestations of DKD consist of a progressive increase in albuminuria and a decline in estimated glomerular filtration rate (eGFR). Hence, the diagnosis of DKD in patients with declining renal function without albuminuria is more difficult. Although there are several reports of such patients in other geographic regions, the data in this regard are limited. OBJECTIVE: To determine the prevalence of normoalbuminuria with renal impairment and the decline in eGFR relative to their albuminuric status in type 2 diabetes mellitus (T2DM) among Thai patients. MATERIALS AND METHODS: Retrospective review was conducted on medical records of T2DM patients at a tertiary referral hospital dated from January 1, 2013, until June 30, 2016. Based on study inclusion criteria, T2DM patients with renal impairment identified by an eGFR of less than 60 mL/min/1.73m2 were eligible. Albumin excretion rate was determined by urine albumin-to-creatinine ratio from a single random urine collection. RESULTS: Of the 4,597 patients with T2DM, 16.5% had an eGFR below 60 mL/min/1.73m2. The overall prevalence rates of normoalbuminuria, moderate proteinuria, and severe proteinuria were 45.4, 30.9, and 23.7%, respectively. In the normoalbuminuria group, the incidences of chronic kidney disease at stage 3a, 3b, and 4 were 67.5, 27, and 5.5%, respectively. None of the patients with stage 5 chronic kidney disease had normoalbuminuria. The decline in eGFR with normoalbuminuria was less significant than in positive albuminuria. CONCLUSION: The association of normoalbuminuria is common in DKD. The decline of renal function is slower in normoalbuminuria; however, the risk factors, clinical progression, and renal pathology in these patients need to be further explored.


Assuntos
Albuminúria/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/epidemiologia , Insuficiência Renal/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Albuminúria/diagnóstico , Nefropatias Diabéticas/diagnóstico , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal/diagnóstico , Estudos Retrospectivos
16.
Clin Nephrol ; 92(2): 81-88, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31232268

RESUMO

BACKGROUND: This study was performed to determine whether the urinary albumin excretion rate (%UAE) could distinguish myeloma cast nephropathy (MCN) without glomerular amyloid deposition from MCN with glomerular amyloid deposition. MATERIALS AND METHODS: We retrospectively reviewed clinicopathological data on 16 patients with MCN diagnosed by renal biopsy at Toranomon Hospital from 2004 to 2014. RESULTS: A total of 10 patients had pure MCN without glomerular amyloid deposition (group 1), and 6 patients had MCN with glomerular amyloid deposition (group 2). In all 10 patients from group 1, the underlying disease was multiple myeloma (MM), while 4 patients had MM, and 2 patients had lymphoplasmacytic lymphoma/Waldenström macroglobulinemia (LPL/WM) in group 2. Total protein did not show a significant difference between the two groups, but serum albumin was significantly higher in group 1 than group 2 (p = 0.0101). Serum-adjusted calcium did not show a significant difference between the groups, while serum creatinine (Cre) was significantly higher in group 1 than group 2 (p = 0.0343). Although urinary protein excretion did not differ significantly between the groups, the %UAE was significantly lower in group 1 than group 2 (p = 0.00198). In group 2, 3 of the 4 patients with MM died within 15 months of diagnosis, but the 2 patients with LPL/WM are alive after 32 months. In group 1, only 1 patient died (of unknown causes) within 15 months after diagnosis. CONCLUSION: In patients with MCN, %UAE may be a useful marker for the detection of coexistence of glomerular lesions, such as amyloidosis, which are associated with a poor outcome.


Assuntos
Albuminúria/diagnóstico , Nefropatias/diagnóstico , Nefropatias/metabolismo , Mieloma Múltiplo/complicações , Idoso , Albuminúria/etiologia , Biomarcadores/metabolismo , Creatinina/sangue , Feminino , Humanos , Nefropatias/etiologia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/metabolismo , Estudos Retrospectivos , Albumina Sérica/metabolismo
17.
Ren Fail ; 41(1): 489-496, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31215304

RESUMO

Purpose: This meta-analysis aimed to determine the diagnostic performance of neutrophil gelatinase-associated lipocalin (NGAL) in diabetic nephropathy (DN). Methods: We searched the PubMed, Embase, Wanfang, and China National Knowledge Infrastructure databases for articles published up to 24 April 2019. The meta-analyses were conducted by Stata 11.0, and diagnostic accuracy, sensitivity, specificity, negative and positive likelihood ratios (NLR and PLR), diagnostic odds ratio (DOR), and receiver operating characteristic (ROC) curve data were pooled. Moreover, heterogeneity and small trials bias were evaluated. Results: Six cross-sectional studies were included in the meta-analysis. For the studies of microalbuminuria versus normoalbuminuria, the estimates (95% confidence interval) were as follows: sensitivity, 0.75 (0.51-0.89); specificity, 0.78 (0.70-0.84); PLR, 3.37 (2.49-4.56); NLR, 0.33 (0.16-0.69); DOR, 10.31 (4.05-26.25); and area under the ROC curve (AUC), 0.81 (0.77-0.84). For the studies of microalbuminuria + macroalbuminuria versus normoalbuminuria, the results were as follows: sensitivity, 0.83 (0.66-0.93); specificity, 0.88 (0.67-0.97); PLR, 7.20 (1.97-26.31); NLR, 0.19 (0.08-0.46); DOR, 37.83 (4.84-295.65); AUC, 0.92 (0.90-0.94). Deeks' funnel plot suggested that small trials bias was insignificant in this study. Conclusions: Our findings suggest that NGAL is a potential diagnostic marker for patients with DN and that its diagnostic value for microalbuminuria + macroalbuminuria is superior to that for microalbuminuria. Highlights The first meta-analysis to investigate NGAL diagnostic role in DN. NGAL is valuable for the early diagnosis of DN. The diagnostic value of NGAL in microalbuminuria + macroalbuminuria was much higher.


Assuntos
Albuminúria/diagnóstico , Nefropatias Diabéticas/diagnóstico , Lipocalina-2/análise , Adulto , Albuminúria/sangue , Albuminúria/urina , Biomarcadores/análise , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/urina , Humanos , Curva ROC
18.
Cardiovasc Diabetol ; 18(1): 57, 2019 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-31054570

RESUMO

BACKGROUND: Dyslipidaemia has always been regarded as the cornerstone of arteriosclerosis and is related to the pathogenesis of renal insufficiency. However, it is unclear which routinely available lipid parameter is related to urinary albumin to creatinine ratio (UACR). The purpose of this study was to examine the lipid abnormalities associated with UACR in the general population in China. METHODS: The present study was nested in an ongoing Risk Evaluation of cAncers in Chinese diabetic Individuals: A lONgitudinal (REACTION) study, which was designed to demonstrate the association of abnormal glucose metabolism with the risk of cancer in the Chinese population. This cross-sectional study included 34, 569 subjects (11, 390 males and 23, 179 females) from 8 different regional community cohorts, with an average age of 57.9 years. The UACR data were divided into the < 25% group, the 25-49% group, the 50-74% group, and the ≥ 75% group according to the quartile division of the centre where the subjects visited. The lipid classes were defined according to the guidelines for the prevention and treatment of dyslipidaemia in Chinese adults. Multiple logistic regression analysis was used to evaluate the association of the lipid parameters and UACR. RESULTS: Multivariable regression analysis revealed that compared with the other lipid parameters, triglycerides (TG) showed an adjusted odds ratio that was significant in model 1-4. This relationship was attenuated after adjusting for Haemoglobin A1c (HbA1c) and blood pressure (BP), but TG ≥ 2.3 mmol/L was still significantly associated with UACR in total subjects and in both men and women (OR: 1.131, 95% CI 1.065-1.203, P < 0.001 in total subjects; OR: 1.134, 95% CI 1.022-1.258, P = 0.017 in men; OR: 1.129, 95% CI 1.046-1.219, P = 0.002 in women). In the stratified analysis, elevated TG was significantly associated with increased urinary albumin in subjects with eGFR ≥ 90 mL/min per 1.73 m2, 5.6 ≤ FBG < 7.0 or 7.8 ≤ PBG < 11.1 mmol/L, 24 ≤ BMI < 28 kg/m2, 120 ≤ SBP < 140 and/or 80 ≤ DBP < 90 mmHg. CONCLUSIONS: We conclude that high TG levels rather than total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, or non-high-density lipoprotein cholesterol levels are associated with UACR in the general population in China.


Assuntos
Albuminúria/urina , Creatinina/urina , Dislipidemias/sangue , Triglicerídeos/sangue , Adulto , Idoso , Albuminúria/diagnóstico , Albuminúria/epidemiologia , Biomarcadores/sangue , Biomarcadores/urina , China/epidemiologia , Estudos Transversais , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Regulação para Cima
19.
Clin Biochem ; 69: 48-51, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31002773

RESUMO

INTRODUCTION: The request of Urinary albumin in primary care in Spain is insufficient to monitor patients with diabetes and hypertension (HTN). Our aim was to evaluate a strategy designed in consensus with general practitioners (GPs) to improve the request of urinary albumin in primary care patients with HTN according to guidelines, and to study its financial implications. MATERIALS AND METHODS: In a meeting with GPs, we decided that the Laboratory Information System (LIS) would automatically register the albumin-to-creatinine ratio (ACR) test in patients with HTN when the former had not been requested in the previous year. We counted the number of ACRs requested by the GPs, those that were automatically added through the intervention, and if they were measured through the strip assay or additionally through quantification. We calculated the economic cost of the additional registered ACR based on reagent cost. RESULTS: In the 6 months study period, the laboratory received 48,075 requests for primary care patients. For 3816 (7.9%), HTN was the indication that prompted the request. 386 ACR were automatically registered through the intervention. Use of strip analysis cost of 275.8 € but resulted in savings of 1450.3€ in albumin reagent. CONCLUSIONS: By making use of the laboratory technology, the strategy achieved a better adherence to the guidelines at no additional cost.


Assuntos
Albuminúria/diagnóstico , Testes de Química Clínica/economia , Hipertensão/urina , Atenção Primária à Saúde , Idoso , Albuminúria/urina , Sistemas de Informação em Laboratório Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
20.
Diab Vasc Dis Res ; 16(5): 431-439, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31023084

RESUMO

OBJECTIVE: Circulating microvesicles, released from activated/apoptotic cells, are involved in vascular complications and may be looked upon as biomarkers. Albuminuria is characteristic of disease progression in type 2 diabetes mellitus. We aimed to investigate quantitative and qualitative differences of circulating microvesicles in type 2 diabetes mellitus with and without albuminuria and whether 12-month exercise training influenced expression of circulating microvesicles. METHODS: Coronary artery disease patients with type 2 diabetes mellitus (n = 75), of which 25 had albuminuria, were included. Annexin V+ (AV+) circulating microvesicles were analysed by flow cytometry in citrated plasma. The exercise volume was 150 min per week. RESULTS: In albuminuria patients, circulating microvesicles from endothelial-(CD146+/CD62E+/AV+) and endothelial-progenitor-(CD309+/CD34+/AV+) cells were significantly higher compared to those without (p ⩽ 0.01, both). Receiver operating characteristic curve analysis of the endothelial circulating microvesicles shows an area under the curve of 0.704 (95% confidence interval: 0.57-0.84; p = 0.004). Albuminuria patients had more circulating microvesicles derived from activated leukocytes and monocytes and monocytes carrying tissue factor (CD11b+/AV+, CD11b+/CD14+/AV+, CD142+/CD14+/AV+, respectively, p ⩽ 0.05, all) and higher number of circulating microvesicles from activated platelets (CD62P+/AV+). Within exercising patients, circulating microvesicles from progenitor cells increased (p = 0.023), however, not significantly different from controls. CONCLUSION: Coronary artery disease patients with type 2 diabetes mellitus and albuminuria had elevated number of circulating microvesicles from activated blood and vascular cells, rendering them as potential predictors of disease severity. The circulating microvesicles were limitedly affected by long-term exercise training in our population.


Assuntos
Albuminúria/terapia , Plaquetas/patologia , Doença da Artéria Coronariana/terapia , Diabetes Mellitus Tipo 2/terapia , Células Progenitoras Endoteliais/patologia , Terapia por Exercício , Leucócitos/patologia , Microvasos/patologia , Idoso , Albuminúria/diagnóstico , Albuminúria/urina , Biomarcadores/sangue , Plaquetas/metabolismo , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/patologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/patologia , Progressão da Doença , Células Progenitoras Endoteliais/metabolismo , Feminino , Humanos , Leucócitos/metabolismo , Masculino , Microvasos/metabolismo , Pessoa de Meia-Idade , Ativação Plaquetária , Fatores de Tempo , Resultado do Tratamento
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