Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.955
Filtrar
1.
Medicine (Baltimore) ; 99(2): e18626, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914044

RESUMO

Detection of the chronic kidney disease (CKD) progression can begin early intervention to improve the prognosis of severe non-alcoholic fatty liver disease (NAFLD). This bi-directional cross-sectional study evaluates the roles of fatty acid-binding protein (FABP) and retinol binding protein (RBP4), which are produced from inflamed liver, adipose tissue and immune cells, for the prediction of CKD progression in severe NAFLD. Ninety severe NAFLD patients with hypertension and proteinuria (NAFLDHTN) were enrolled and divided into CKD (n = 39) and non-CKD groups (n = 51). Among 39 NAFLDHTN patients, 18 cases were categorized as CKD progression group. In comparison with CKD stable group (n = 21), the positive correlation between fold change values of hepatic fibrotic score (KPa), urinary FABP4 or urinary RBP4 versus severity of albuminuria were noted among CKD progression group. On multivariate analysis, high body mass index (BMI, >25 kg/m), high hepatic fibrosis score (>9.5 KPa), high urinary level of vascular cell adhesion molecule-1 (VCAM-1, >2239 µg/g cr), high urinary level of FABP4 (>115 ng/g cr) and high urinary level of RBP4 (>33.5 mg/g cr) are 5 independent predictors for progressive CKD during 24 months of follow-up. Synergetic effect was noted among these 5 risk factors for the prediction of CKD progression in NAFLDHTN patients. The in vitro experiments revealed that both FABP4 and RBP4 directly enhanced albumin-induced ER stress and apoptosis of human renal tubular epithelial cell line HK-2 cells and human podocytes cell lines. Through clinical and experimental approaches, this study revealed new 5 synergetic predictors including high BMI, hepatic fibrosis score, urinary level of VCAM-1, urinary level of FABP4 and RBP4, for the CKD progression in severe NAFLD patients with hypertension and proteinuria.


Assuntos
Ácidos Graxos/urina , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Proteínas de Ligação ao Retinol/urina , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Albuminúria/epidemiologia , Índice de Massa Corporal , Linhagem Celular Transformada , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/epidemiologia , Índice de Gravidade de Doença , Molécula 1 de Adesão de Célula Vascular/urina , Adulto Jovem
2.
High Blood Press Cardiovasc Prev ; 27(1): 43-49, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31916208

RESUMO

INTRODUCTION: Albuminuria is an early marker of kidney disease and reduction of albuminuria translates into a decreased occurrence of cardiovascular and renal outcomes. AIMS: To evaluate the changes in the prevalence of albuminuria in diabetic hypertensive patients treated with several combinations of renin-angiotensin aldosterone system with calcium channel blockers. METHODS: We analysed data from 668 unselected patients from the PAIT survey (mean age 60.4 ± 10.2 years, prevalence of males 38%), with and without albuminuria, maintained for 6 months with the previous treatment with amlodipine-valsartan, amlodipine perindopril, lercanidipine-enalapril, verapamil-trandolapril, nitrendipine-enalapril and felodipine-ramipril Albuminuria was assessed, as urinary albumin-creatinine ratio, using a Multistic-Clinitek device analyzer. Microalbuminuria was defined as a loss of 3.4-33.9 mg albumin/mmol creatinine (30-300 mg/g) and macroalbuminuria as a loss of > 33.9 mg albumin/mmol creatinine (> 300 mg/g). Blood pressure was measured with a validated digital device. RESULTS: At baseline, albuminuria was present in 310 subjects (46.4%) (microalbuminuria in 263 (84.8%), macroalbuminuria in 15.2%), and normoalbuminuria in 53.6% 358. After 6 months, the prevalence of subjects with albuminuria was significantly lowered (p < 0.01) by 23.5% (microalbuminuria - 23.9%, p < 0.01 and macroalbuminuria - 21.3%). The prevalence of subjects with microalbuminuria was reduced with all treatments: amlodipine-valsartan - 15.6%, amlodipine-perindopril - 11.8%, lercanidipine-enalapril - 41.3% and verapamil-trandolapril - 19.2%. Data with nitrendipine-enalapril and felodipine-ramipril were not analyzed, due to the low number of patients. The frequency of patients with normoalbuminuria was significantly higher (p < 0.01) with lercanidipine-enalapril compared with any other treatment. Blood pressure was significantly (p < 0.01) reduced, with a similar effect between treatments. CONCLUSIONS: The treatments decrease the prevalence of subjects with albuminuria, showing a significant difference among the different drug combinations, favoring the use of new dihydropyridine calcium channel blockers, such as lercanidipine, combined with RAAS inhibitors, to control albuminuria in diabetic hypertensive patients.


Assuntos
Albuminúria/prevenção & controle , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Diabetes Mellitus/epidemiologia , Nefropatias Diabéticas/epidemiologia , Hipertensão/tratamento farmacológico , Insuficiência Renal Crônica/epidemiologia , Idoso , Albuminúria/diagnóstico , Albuminúria/epidemiologia , Albuminúria/fisiopatologia , Pressão Sanguínea/efeitos dos fármacos , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/fisiopatologia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/fisiopatologia , Quimioterapia Combinada , Europa (Continente)/epidemiologia , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/fisiopatologia , Sistema Renina-Angiotensina/efeitos dos fármacos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
3.
BMC Womens Health ; 19(1): 117, 2019 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-31590639

RESUMO

BACKGROUND: Women with a higher number of pregnancies have a higher risk of developing cardiovascular diseases. Subtle fluctuations in albumin excretion could be related to pathophysiologic changes in the vascular system. We aimed to investigate the possible association of parity with low-grade albuminuria. METHODS: We conducted a community-based study in 6495 women aged 40 years or older. Low-grade albuminuria was defined according to the highest quartile of urine albumin-to-creatinine ratio in participants free of micro- or macro-albuminuria. RESULTS: Parous women with a higher number of pregnancies had increased age, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), fasting plasma glucose (FPG), and fasting insulin, as well as decreased high-density lipoprotein cholesterol (HDL-C), estimated glomerular filtration rate (eGFR) levels, and proportion of menopause. The prevalence of low-grade albuminuria in parous women gradually increased with parity number. Compared with women with one childbirth, those with more than two childbirths were independently associated with a higher prevalent low-grade albuminuria (odds ratios [ORs] 1.41, 95% confidence interval [CI], 1.09-1.81) after multiple adjustments. In subgroup analysis after multiple adjustments, significant relation between parity number and prevalent low-grade albuminuria was detected in subjects age 55 years or older. CONCLUSION: Number of parity is associated with prevalent low-grade albuminuria in middle-aged and elderly Chinese women without micro- or macro-albuminuria.


Assuntos
Albuminúria/epidemiologia , Paridade , Adulto , Idoso , Albuminúria/etiologia , Pressão Sanguínea , Índice de Massa Corporal , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Prevalência , Circunferência da Cintura
4.
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
5.
Saudi J Kidney Dis Transpl ; 30(4): 795-802, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464235

RESUMO

Chronic kidney disease (CKD) is no longer considered just a health burden, but a major health priority owing to its high treatment costs and poor outcome. The lack of community-based screening programs has led to the detection of CKD patients at advanced stages. This study aims to estimate the prevalence of CKD and patterns of known risk factors among the general population (middle-aged and elderly) attending a screening camp in a community-based setting. The study participants constituted a part of the general population of Varanasi (aged ≥45 years) who volunteered in a screening camp that was organized as part of the World Kidney Day Initiative at Opal Hospital. Information on age, sex, height, weight, smoking and drug history, history of diabetes, hypertension, and family history of kidney disease was extensively interrogated, while laboratory investigations such as urinalysis and serum creatinine levels were recorded. More than three-fifths of the participants were middle-aged adults (i.e., 45-64 years) and the remaining 34.8% were elderly population, i.e., ≥65 years. The overall prevalence of CKD in the 198 studied participants was 29.3%. Higher number of participants (40.6%) of elderly population had CKD (P = 0.011). The serum creatinine, albuminuria, and estimated glomerular filtration rate levels were strongly associated with CKD (P <0.05). Our study suggests that elderly individuals are at risk with higher serum creatinine levels and would benefit from early detection of CKD to prevent disease progression and associated morbidity and mortality.


Assuntos
Serviços de Saúde Comunitária , Programas de Rastreamento/métodos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Distribuição por Idade , Idoso , Albuminúria/diagnóstico , Albuminúria/epidemiologia , Biomarcadores/sangue , Biomarcadores/urina , Creatinina/sangue , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Fatores de Risco
6.
Saudi J Kidney Dis Transpl ; 30(4): 832-842, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464240

RESUMO

Microalbuminuria (MA) has been recognized as a sensitive marker of early glomerular injury and a predictor of kidney dysfunction in patients with sickle cell disease (SCD). Limited data are available about MA in SCD children in the Arab countries and none from Yemen. The aim of this study is to determine the prevalence and correlates of MA among 101 children aged 1-16 years, with SCD at their steady state. Children were recruited during their routine health-care visits to the pediatric outpatient clinic in Al-Sadaqa general teaching hospital, Aden, Yemen, between September 2014 and February 2015. A random spot urine sample for each child was screened for MA using Micral-Test strips method. Data on clinical history, anthropometry, blood pressure (BP), and laboratory investigations were obtained. The overall prevalence of MA in this sample was 30.7%, with male predominance (80.6%) (P <0.05). The mean age of children with MA was 7.5 ± 3.2 years, and 10% of them were under five years of age. MA was correlated to both hemoglobin and hematocrit levels, which found to have protective effect against MA (Odds ratio = 0.17 and 0.59, respectively, P <0.05). No correlations were found between MA with age, height, weight, body mass index, recurrent clinical events (painful crises, blood transfusions, and hospitalizations), or fetal hemoglobin levels. BP measurements for all individuals were within the normal ranges, but systolic and diastolic BP were significantly higher in those with MA than without. This study demonstrated a high prevalence of MA in Yemeni children with SCD, and affecting young children as early as 2.5 years of age. Screening for MA as one of the early renal injury markers in children with SCD may help in the prevention of permanent loss of renal function and subsequent renal insufficiency in adulthood.


Assuntos
Albuminúria/epidemiologia , Anemia Falciforme/epidemiologia , Nefropatias/epidemiologia , Adolescente , Fatores Etários , Albuminúria/diagnóstico , Albuminúria/urina , Anemia Falciforme/sangue , Anemia Falciforme/diagnóstico , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Nefropatias/diagnóstico , Nefropatias/urina , Masculino , Prevalência , Fatores de Risco , Fatores Sexuais , Iêmen/epidemiologia
7.
Diabetes Metab Syndr ; 13(2): 1491-1496, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336511

RESUMO

AIMS: Albuminuria is an established marker for endothelial dysfunction and cardiovascular risk in diabetes and prediabetes. So we aimed to explore the prevalence of albuminuria (microalbuminuria and macroalbuminuria) in patients with type2 diabetes mellitus (DM) in the Palestinian community and to determine the association between albuminuria and other health care and biochemical indicators. MATERIALS AND METHODS: A cross-sectional study was carried out at private health care center. A total of 550 diabetic patients aged 35 years and above with type 2 diabetes mellitus who attended the clinic from May 2017 through February 2018 were included. Socio-demographic, clinical, and laboratory data were obtained from the medical records of patients. Statistical analysis was carried out using the Statistical Package for the Social Sciences (SPSS, version 23). RESULTS: Out of the 550 patients recruited, the mean age and duration of diabetes were 57.8 years and 9.5 years, respectively. Approximately 62% were being managed by oral hypoglycemic agents alone, 4.3% by insulin alone, 31.7% were on a combination of oral hypoglycemic agents and insulin and slightly less than 2% were on dietary measures alone. The mean value for HbA1c was 7.71%. The overall prevalence of albuminuria among participants was found to be 34.6%; microalbuminuria (29.3%) and macroalbuminuria (5.3%). CONCLUSION: Albuminuria is highly prevalent among Palestinian population with type 2 diabetes. This calls for early and universal screening of urinary albumin. There is also an urgent need for measures that target tight glycemic and optimal blood pressure control and the use of renin-angiotensin system blockade.


Assuntos
Albuminúria/epidemiologia , Biomarcadores/análise , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/etiologia , Idoso , Albuminúria/etiologia , Albuminúria/patologia , Glicemia/análise , Estudos Transversais , Nefropatias Diabéticas/patologia , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Oriente Médio/epidemiologia , Prevalência , Prognóstico , Fatores de Risco
8.
Diabetes Metab Syndr ; 13(2): 1623-1627, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336531

RESUMO

BACKGROUND: Vascular endothelial growth factor (VEGF) and angiopoietin (Ang-2) systems have a central role in vasculogenesis and neoangiogenesis during glomerular development. disruption, their levels are associated with alterations in the glomerular filtration barrier and proteinuria as in diabetic nephropathy. Aim of this study to assess the validity of blood Ang-2 and VEGF as biomarkers for early detection of diabetic nephropathy as well as to study the relation between them and inflammation in diabetic nephropathy patients. SUBJECTS AND METHODS: Cross-sectional study included 180 diabetic nephropathy patients. Patients were classified to non-albuminuric, microalbuminuria and macroalbuminuria patients. Patients with macroalbuminuria complicated to renal impairment and ESRD on top of diabetic nephropathy. Ang-2 and VEGF were measured beside urinary albumin creatinine ratio (UACR). RESULTS: Significant increase of Ang-2 and VEGF levels among patients with normoalbuminuric state compared to control but there is no significant difference of UACR between both groups. Ang-2 and VEGF concentrations were significantly higher in patients with microalbuminuria and macroalbuminuria compared to healthy. Ang-2 and VEGF levels increase with the progression of albuminuria. There were significant positive correlation between CRP and Ang-2 in addition to VEGF. Significant negative correlation between eGFR, Ang-2 and VEGF. CONCLUSION: VEGF and Ang-2 were significantly elevated in diabetic nephropathy patients without albuminuria, their levels steadily increase with the progress of albuminuria, So can use them as markers for diagnosis of diabetic nephropathy onset and progression specially in patients without an increase in albumin excretion.


Assuntos
Albuminúria/epidemiologia , Angiopoietina-2/sangue , Biomarcadores/sangue , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/diagnóstico , Fator A de Crescimento do Endotélio Vascular/sangue , Glicemia/análise , Estudos Transversais , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/etiologia , Feminino , Seguimentos , Taxa de Filtração Glomerular , Hemoglobina A Glicada/análise , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico
9.
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
10.
PLoS One ; 14(6): e0218024, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31211789

RESUMO

BACKGROUND: Little is known on how the interaction between Sickle Cell Disease (SCD) and renal insults caused by other coexisting conditions in Sub Saharan Africa such as urinary schistosomiasis, malnutrition and HIV affect the prevalence of renal dysfunction in children with SCD. OBJECTIVES: To determine the prevalence and factors associated with renal dysfunction among children with SCD aged 6 months to 12 years attended at a tertiary hospital in Northwestern Tanzania. METHODS: A cross sectional hospital-based study with a short follow up component of 3 months for 153 children with SCD was done to document demographics, clinical characteristics and features of renal dysfunction including urine dipstick albuminuria (>20mg/l) and eGFR (<60ml/ml/min/1.73m2). Other potential renal insults such as HIV infection and Schistosomiasis were also evaluated. RESULTS: At enrollment, 48/153(31.37%) children had renal dysfunction declining to 31(20.3%) at 3 months follow up. Acute chest syndrome (OR 3.04, 95% CI [1.08-8.96], p = 0.044), severe anemia (OR 0.44, 95% CI [0.26-0.76],p = 0.003), urinary schistosomiasis (OR 7.43, 95% CI [2.10-26.32] p<0.002) and acute malnutrition (OR 4.92, 95% CI [1.29-18.84], p = 0.020). were associated with renal dysfunction. CONCLUSION: Where prevalent, urinary schistosomiasis and acute malnutrition increase the risk for renal dysfunction in children with SCD. We recommend albuminuria routine screening in children with SCD especially those presenting with acute chest syndrome, severe anemia and features of acute malnutrition for early detection of renal dysfunction among children with SCD.


Assuntos
Anemia Falciforme/epidemiologia , Rim/fisiopatologia , Insuficiência Renal/epidemiologia , Esquistossomose/epidemiologia , Albuminúria/complicações , Albuminúria/epidemiologia , Albuminúria/fisiopatologia , Instituições de Assistência Ambulatorial , Anemia Falciforme/complicações , Anemia Falciforme/fisiopatologia , Criança , Pré-Escolar , Feminino , Taxa de Filtração Glomerular , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Infecções por HIV/fisiopatologia , Humanos , Lactente , Masculino , Insuficiência Renal/complicações , Insuficiência Renal/fisiopatologia , Esquistossomose/complicações , Esquistossomose/fisiopatologia , Tanzânia/epidemiologia , Centros de Atenção Terciária
11.
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
12.
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
13.
Diabetes Metab Syndr ; 13(3): 2226-2229, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31235161

RESUMO

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) was considered one of the most common causes of chronic liver disease and is considered the hepatic manifestation of type 2 diabetes mellitus (T2DM). The factors that lead to marked fibrosis and liver cell injury in NAFLD are still remaining undiscovered. PATIENTS AND METHODS: This study included (40) type 2 diabetic patients with NAFLD and (40) diabetic patients without NAFLD beside 15 healthy persons as a control group. All of them were subjected to full history taking, thorough clinical examination with especial stress on body weight (BW), height, body mass index (BMI), waist-hip ratio, blood pressure. Laboratory tests included serum total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL) and high-density lipoprotein (HDL), fasting blood glucose (FBG) and 2-h postprandial blood glucose (PBG), serum Ferritin and urine microalbuminuria (MAU). RESULTS: Duration of diabetes, BW, BMI and blood pressure were significantly higher in NAFLD group (P = 0.001). FBG, PBG, TC, TG, LDL, serum Ferritin and MAU were significantly increased in NAFLD group with significant difference between two studied groups as regard HDL. There was a highly significant correlation between serum Ferritin with BW, BMI, duration of diabetes, TC, TG, LDL and MAU. There was a significant correlation between serum Ferritin with age, waist hip ratio, duration of diabetes, SBP, FBG, PBG and HDL. There was a significant correlation between MAU and age, weight, BMI, waist hip ratio, duration of diabetes, DBP, FBG TC, TG, LDL and HDL. CONCLUSION: NAFLD is a common liver disorder in diabetic patients. NAFLD is significantly associated with microalbuminuria and elevated serum Ferritin.


Assuntos
Albuminúria/epidemiologia , Biomarcadores/análise , Glicemia/análise , Diabetes Mellitus Tipo 2/fisiopatologia , Ferritinas/sangue , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Adolescente , Adulto , Idoso , Albuminúria/metabolismo , Pressão Sanguínea , Índice de Massa Corporal , Estudos de Casos e Controles , Estudos Transversais , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Lipoproteínas HDL , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/sangue , Prognóstico , Fatores de Risco , Triglicerídeos , Adulto Jovem
14.
J. bras. nefrol ; 41(2): 193-199, Apr.-June 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1012542

RESUMO

Abstract Objective: To describe the frequency of albuminuria in overweight and obese children and adolescents and to relate it to the severity of obesity, pubertal staging, associated morbidities and the glomerular filtration rate. Method: Cross-sectional study including 64 overweight and obese children and adolescents between 5 and 19 years of age. Data collected: weight, height, waist circumference and systemic arterial pressure. Laboratory tests: lipid profile; glycemia and insulin, used to calculate the Homeostasis Model Assessment (HOMA-IR); C-reactive protein; glutamic-pyruvic transaminase and albuminuria in an isolated urine sample (cutoff <30 mg/g). Creatinine was used to calculate the estimated glomerular filtration rate (eGFR, mL/min/1.73 m2). Results: The mean age was 11.6 ± 3.4 years, 32 (50%) and 29 (45.3%) were male and prepubertal. Forty-six (71.9%) had severe obesity. The frequency and median (min/max) of the observed values for albuminuria (> 30 mg/g) were 14 (21.9%) and 9.4 mg/g (0.70, -300.7 mg/g). The mean eGFR was 122.9 ± 24.7 mL/min/1.73 m2. There was no significant correlation between body mass index, pubertal staging, insulin and HOMA-IR with albuminuria values and neither with eGFR. Children with albuminuria tended to have higher values of diastolic blood pressure (75.0 ± 12.2 vs. 68.1 ± 12.4, p = 0.071). Conclusion: Albuminuria, although frequent in children and adolescents with obesity, was not associated with other morbidities and the glomerular filtration rate in these patients.


Resumo Objetivo: Descrever a frequência de albuminúria em crianças e adolescentes com sobrepeso e obesidade e relacioná-la com a gravidade da obesidade, estadiamento puberal, morbidades associadas e com a taxa de filtração glomerular. Método: Estudo transversal incluindo 64 crianças e adolescentes com sobrepeso e obesidade entre 5 e 19 anos de idade. Dados coletados: peso, estatura, circunferência abdominal e pressão arterial sistêmica. Exames laboratoriais: perfil lipídico; glicemia e insulina, utilizados para cálculo do Homeostasis Model Assessment (HOMA-IR); proteína C reativa; transaminase glutâmico-pirúvica e albuminúria em amostra isolada de urina (ponto de corte < 30 mg/g). A creatinina foi utilizada para o cálculo da taxa de filtração glomerular estimada (eTFG, mL/min/1,73m2). Resultados: A média de idade foi 11,6±3,4 anos, 32 (50%) e 29 (45,3%) eram do gênero masculino e pré-púberes. Quarenta e seis (71,9%) apresentavam obesidade grave. A frequência e a mediana (min/max) dos valores observados para albuminúria (> 30 mg/g) foram 14 (21,9%) e 9,4 mg/g (0,70; -300,7 mg/g). A média da eTFG foi 122,9±24,7 mL/min/1,73 m2. Não houve correlação significante entre o índice de massa corporal, estadiamento puberal, insulina e HOMA-IR com os valores de albuminúria e nem com a eTFG. Crianças com albuminúria tiveram tendência a valores mais elevados de pressão arterial diastólica (75,0±12,2 vs 68,1±12,4, p = 0,071). Conclusão: A albuminúria, apesar de frequente em crianças e adolescentes com obesidade, não se associou com outras morbidades e nem com a taxa de filtração glomerular nesses pacientes.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Albuminúria/epidemiologia , Obesidade Pediátrica/epidemiologia , Taxa de Filtração Glomerular , Índice de Gravidade de Doença , Pressão Sanguínea , Índice de Massa Corporal , Prevalência , Estudos Transversais , Morbidade , Puberdade , Creatinina/sangue , Insulina/sangue
15.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(5): 459-463, 2019 May 06.
Artigo em Chinês | MEDLINE | ID: mdl-31091601

RESUMO

Objective: To analyze the association between 24 h urinary sodium excretion and microalbuminuria (MAU) among Chinese people aged from 18 to 69 years old. Methods: 2 400 subjects aged from 18 to 69 years old were selected form Gaomi and Fushan sites of Shandong Province and Xinyi and Ganyu sites of Jiangsu Province in 2013 by using multi-stage stratified cluster random sampling method. Questionnaire survey, physical measurement and 24 h urine collection were conducted. 2 262 subjects were finally included in the analysis. According to the quartile of 24 h urinary sodium, all subjects were divided into Q1-Q4 groups and the levels of urinary microalbumin and MAU among different groups were compared. The relationship between urinary sodium and MAU was analyzed by multivariate logistic regression analysis. Results: The age of subjects was (42.1±13.5) years old, including 1 124 males (49.7%). The 24 h urine volume, urinary sodium, urine albumin M (P(25), P(75)) and MAU detection rate were (1 411±495) ml, (166.4±71.6) mmol/d, 12.5 (9.6, 17.4) mg/d and 9.0% (203 cases), respectively. With the increase of urinary sodium level, the level of urinary albumin increased (P(trend)<0.001), and the prevalence of MAU also showed an upward trend (P(trend)<0.001). Multivariate logistic regression analysis showed that after adjusting for age, gender, smoking, alcohol consumption, BMI, hypertension and diabetes, the risk of MAU in Q4 group increased by 174% compared with Q1 group, and OR (95%CI) value was 2.74 (1.80-4.16). Conclusion: 24 h urinary sodium is associated with the prevalence of MAU and salt reduction can help reduce MAU.


Assuntos
Albuminúria/epidemiologia , Sódio/urina , Adolescente , Adulto , Idoso , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
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
17.
Postgrad Med ; 131(5): 342-347, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31032695

RESUMO

Objectives: To investigate the prevalence and risk factors for microalbuminuria in patients with lacunar infarction. Methods: 702 lacunar infarction patients and 234 controls were recruited in this study, the concentration of urinary albumin and clinical characteristics were collected for each participant. We analyzed the prevalence of microalbuminuria in lacunar infarction patients, as well as the risk factors of microalbuminuria in patients with lacunar infarction. Results: The prevalence of microalbuminuria in patients with lacunar infarction was 32.8%, which was significantly higher than that in controls (9.8%, P<0.001). Multiple linear regression analysis indicated that age, alcohol abuse, fasting blood glucose, systolic blood pressure, and triglyceride were positively associated with albumin/creatinine ratio levels. Multiple logistic regression analysis indicated that age (odds ratio [OR] = 1.067, 95% confidence interval [CI] = 1.029 to 1.105), alcohol abuse (OR = 3.001, 95% CI = 1.668 to 5.398), fasting blood glucose (OR = 2.014, 95% CI = 1.794 to 2.260), and systolic blood pressure (OR = 1.033, 95% CI = 1.010 to 1.056) were the independent risk factors for microalbuminuria in acute lacunar infarction patients, with high sensitivity, specificity, positive predictive value, and negative predictive value. Receiver operating characteristic curve analysis showed that the area under the curve for age, systolic blood pressure, and fasting blood glucose were 0.618 (cutoff value, 63.5 years; sensitivity, 54.8%; and specificity, 62.9%), 0.736 (cutoff level, 149.5 mmHg; sensitivity, 78.3%; and specificity, 61.2%) and 0.893 (cutoff value, 7 mmol/L; sensitivity, 92.2%; and specificity, 86%), respectively. Conclusion: Lacunar infarction was associated with higher microalbuminuria prevalence. Age, alcohol abuse, fasting blood glucose, and systolic blood pressure were individually significant and correlated factors of microalbuminuria in patients with lacunar infarction. More attention should be provided to this group of patients.


Assuntos
Albuminúria/epidemiologia , Índice de Gravidade de Doença , Acidente Vascular Cerebral Lacunar/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
18.
Transplant Proc ; 51(3): 692-700, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30979452

RESUMO

BACKGROUND: Adequate kidney donor management after donation is increasingly emphasized due to concerns of renal function impairment after nephrectomy with increasing life expectancy. In this study, the clinical impact of a protocolized kidney donor follow-up system by nephrologists was evaluated. METHODS: A total of 427 living kidney donors underwent nephrectomy from January 2010 to December 2014 and were followed for at least 2 years at the Samsung Medical Center. Donors were followed-up by nephrologists after the establishment of a donor clinic with systemized protocols in January 2013. The primary outcomes were incidence of post-donation low estimated glomerular filtration rate (eGFR) and renal function adaptability. Secondary outcomes were changes in compliance and incidence of hyperuricemia and microalbuminuria. RESULTS: The patients were divided into 2 groups according to the time of nephrectomy: the pre-donor clinic period (n = 182) and the donor clinic period (n = 172). Preoperative eGFR in patients in the pre-donor clinic period was higher than that in patients in the donor clinic period. After donation, poor renal adaptation was less frequent in the donor clinic period compared to the pre-donor clinic period. Low eGFR tended to be less common during the donor clinic period. Shorter mean outpatient clinic visit intervals with more visits within 6 months after donation and earlier detection of de novo hyperuricemia were found during the donor clinic period. CONCLUSION: A protocolized donor clinic run by nephrologists may improve post-nephrectomy renal outcomes and compliance and facilitate better management of potential risk factors of chronic kidney disease in donors.


Assuntos
Doadores Vivos , Nefrectomia/efeitos adversos , Adulto , Albuminúria/epidemiologia , Albuminúria/etiologia , Estudos de Coortes , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Hiperuricemia/epidemiologia , Hiperuricemia/etiologia , Rim/fisiopatologia , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/etiologia , Estudos Retrospectivos , Fatores de Risco
19.
South Med J ; 112(4): 210-214, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30943538

RESUMO

With the increase in participation in endurance events in the general population, patient concern may arise as to whether endurance exercise is safe. Acute but not chronic increases in blood urea nitrogen, creatinine, and urine albumin occur in endurance exercise. Iron-deficiency anemia may be observed in female athletes. Upper respiratory illness is increased in elite athletes but decreased in intense recreational athletes. No convincing evidence of developing osteoarthritis exists. Common gastrointestinal symptoms occur and isolated reports of gastrointestinal bleeding exist. Nevi are increased and the minimal erythematous dose is decreased. Exercising in the presence of air pollution has negative pulmonary effects, but overall, benefit exists. Numerous reports pertain to the cardiovascular system. The risk of cardiac arrest increases during exercise, troponin is elevated after exercise, and a predisposition for atrial fibrillation exists. Ventricular myocardial scar formation as assessed by gadolinium enhancement on magnetic resonance imaging is inconsistently observed, and increased coronary plaque of a more stable variety is reported. Left ventricular compliance is chronically increased and no decrease in longevity is found. Although some concerns exist, endurance exercise is safe.


Assuntos
Treino Aeróbico/estatística & dados numéricos , Exercício Físico/fisiologia , Poluição do Ar , Albuminúria/epidemiologia , Anemia Ferropriva/epidemiologia , Fibrilação Atrial/epidemiologia , Nitrogênio da Ureia Sanguínea , Cicatriz/diagnóstico por imagem , Cicatriz/epidemiologia , Complacência (Medida de Distensibilidade) , Doença da Artéria Coronariana/epidemiologia , Creatinina/sangue , Exposição Ambiental/estatística & dados numéricos , Coração/diagnóstico por imagem , Hemoglobinas/metabolismo , Humanos , Imagem por Ressonância Magnética , Nevo/epidemiologia , Osteoartrite/epidemiologia , Placa Aterosclerótica/epidemiologia , Infecções Respiratórias/epidemiologia , Troponina/sangue
20.
PLoS One ; 14(4): e0215920, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31022266

RESUMO

BACKGROUND: The impact of low-normal hemoglobin (Hb) levels and anemia on the risk of end-stage renal disease (ESRD) in general populations has rarely been examined. METHODS: 510,620 Korean adults aged 40-80 years without known chronic kidney disease (CKD) underwent health examinations during 2002-2003 and were followed-up until 2013. Incidence of ESRD was identified by hospital discharge and clinical visit records. RESULTS: During a mean follow-up of 10.5, 575 women and 1047 men were diagnosed with ESRD. Lower Hb levels were associated with an increased risk of ESRD at given severity of albuminuria and at given estimated glomerular filtration rate (eGFR). Hb 13-13.9 g/dL in men, Hb 11-11.9 g/dL in women, and trace albuminuria assessed by dipstick urinalysis were associated with more than doubled risk. The risk associated with lower Hb was stronger in older (≥60 years) than younger women. Among 349,993 participants with information on eGFR, the multivariable-adjusted HRs associated with 1 g/dL lower Hb in participants with eGFR values ≥60, 30-59, and <30 mL/min/1.73 m2 were 1.34 (95% CI, 1.17-1.54), 1.55 (1.38-1.74), and 1.75 (1.47-2.09), respectively (Pinteraction between eGFR groups = .06). CONCLUSIONS: Low-normal Hb levels and anemia are risk factors for ESRD incidence in person without CKD and for CKD progression to ESRD. Lower Hb increases the risk of ESRD through synergistic biological interactions with lower eGFR and albuminuria. The impacts of lower Hb may be stronger in older than younger women. Proper management and screening at earlier stage of Hb decline and anemia might reduce the burden of CKD.


Assuntos
Anemia/complicações , Hemoglobinas/metabolismo , Falência Renal Crônica/complicações , Adulto , Idoso , Albuminúria/complicações , Albuminúria/epidemiologia , Albuminúria/fisiopatologia , Anemia/fisiopatologia , Feminino , Taxa de Filtração Glomerular , Humanos , Incidência , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA