Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.856
Filtrar
1.
Eur J Ophthalmol ; 30(1): 19-25, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30409042

RESUMO

PURPOSE: To investigate the effect of microalbuminuria on macular thickness in patients with type-2 diabetes mellitus with no or mild diabetic retinopathy and to investigate the relationship between macular thickness and metabolic parameters. MATERIALS AND METHODS: Fifty eight eyes of 58 patients without diabetic retinopathy (group 1) in microalbuminuria stage, 42 eyes of 42 patients with mild diabetic retinopathy (group 2) in microalbuminuria stage, and 50 eyes of 50 patients without diabetic retinopathy and microalbuminuria (group 3) were included in this study. After detailed ophthalmologic examination, all patients underwent spectral domain-optical coherence tomography measurements. Macular thickness was noted from nine different areas (fovea, four parafoveal, and four perifoveal areas) and compared between groups. The correlations between macular thickness and age, duration of diabetes mellitus, microalbuminuria, serum urea, creatinine, glycosylated hemoglobin (HbAIc), albumin, sodium (Na), and urinary Na were evaluated. RESULTS: The mean age was 53.29 ± 6.49 in group 1, 55.86 ± 6.97 in group 2, and 52.98 ± 5.66 years in group 3 (p = 0.06). The macular thickness values of superior, inferior, and nasal parafoveal areas were significantly different between groups (p = 0.001, p = 0.006, and p = 0.03, respectively). Bonferroni post test revealed that this difference originated from the difference between group 2 and 3 (p < 0.05 for all values). There were significant negative correlations between the macular thickness values of parafoveal areas and serum urea, HbA1c, albumin, microalbuminuria levels (p < 0.05 for all values). CONCLUSION: In this study, a significantly decreased parafoveal macular thickness was measured in patients with mild diabetic retinopathy and microalbuminuria compared to patients without diabetic retinopathy and microalbuminuria.


Assuntos
Albuminúria/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Retinopatia Diabética/diagnóstico , Retina/patologia , Adulto , Idoso , Albuminúria/sangue , Albuminúria/urina , Creatinina/urina , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/urina , Retinopatia Diabética/sangue , Retinopatia Diabética/urina , Feminino , Fóvea Central , Hemoglobina A Glicada/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Sódio/urina , Tomografia de Coerência Óptica/métodos , Ureia/sangue
2.
PLoS Med ; 16(11): e1002955, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31693662

RESUMO

BACKGROUND: The Kidney Failure Risk Equation (KFRE) uses the 4 variables of age, sex, urine albumin-to-creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR) in individuals with chronic kidney disease (CKD) to predict the risk of end stage renal disease (ESRD), i.e., the need for dialysis or a kidney transplant, within 2 and 5 years. Currently, national guideline writers in the UK and other countries are evaluating the role of the KFRE in renal referrals from primary care to secondary care, but the KFRE has had limited external validation in primary care. The study's objectives were therefore to externally validate the KFRE's prediction of ESRD events in primary care, perform model recalibration if necessary, and assess its projected impact on referral rates to secondary care renal services. METHODS AND FINDINGS: Individuals with 2 or more Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFR values < 60 ml/min/1.73 m2 more than 90 days apart and a urine ACR or protein-to-creatinine ratio measurement between 1 December 2004 and 1 November 2016 were included in the cohort. The cohort included 35,539 (5.6%) individuals (57.5% female, mean age 75.9 years, median CKD-EPI eGFR 51 ml/min/1.73 m2, median ACR 3.2 mg/mmol) from a total adult practice population of 630,504. Overall, 176 (0.50%) and 429 (1.21%) ESRD events occurred within 2 and 5 years, respectively. Median length of follow-up was 4.7 years (IQR 2.8 to 6.6). Model discrimination was excellent for both 2-year (C-statistic 0.932, 95% CI 0.909 to 0.954) and 5-year (C-statistic 0.924, 95% 0.909 to 0.938) ESRD prediction. The KFRE overpredicted risk in lower (<20%) risk groups. Reducing the model's baseline risk improved calibration for both 2- and 5-year risk for lower risk groups, but led to some underprediction of risk in higher risk groups. Compared to current criteria, using referral criteria based on a KFRE-calculated 5-year ESRD risk of ≥5% and/or an ACR of ≥70 mg/mmol reduced the number of individuals eligible for referral who did not develop ESRD, increased the likelihood of referral eligibility in those who did develop ESRD, and referred the latter at a younger age and with a higher eGFR. The main limitation of the current study is that the cohort is from one region of the UK and therefore may not be representative of primary care CKD care in other countries. CONCLUSIONS: In this cohort, the recalibrated KFRE accurately predicted the risk of ESRD at 2 and 5 years in primary care. Its introduction into primary care for referrals to secondary care renal services may lead to a reduction in unnecessary referrals, and earlier referrals in those who go on to develop ESRD. However, further validation studies in more diverse cohorts of the clinical impact projections and suggested referral criteria are required before the latter can be clinically implemented.


Assuntos
Falência Renal Crônica/etiologia , Medição de Risco/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Albuminúria/urina , Algoritmos , Estudos de Coortes , Creatinina/urina , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Humanos , Falência Renal Crônica/mortalidade , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Prognóstico , Insuficiência Renal/mortalidade , Insuficiência Renal/fisiopatologia , Insuficiência Renal Crônica , Reprodutibilidade dos Testes , Fatores de Risco , Reino Unido/epidemiologia
3.
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
4.
Rev Assoc Med Bras (1992) ; 65(9): 1155-1160, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618330

RESUMO

OBJECTIVE: In this study, we aimed to analyze the relationship between serum uric acid (UA) and microalbuminuria as a marker of renal injury in type 2 diabetes mellitus. METHODS: A total of 100 patients with type 2 diabetes mellitus were enrolled in the study. Participants were divided into two groups according to the urinary microalbumin/creatinine ratio: diabetic nephropathy and non-nephropathy group. UA and microalbuminuria were compared between the study groups. RESULTS: Serum UA levels of diabetic nephropathy patients were significantly higher than those in the non-nephropathy group (UA in patients with diabetic nephropathy groups: 6.3 (1.82) mg/dl, UA in patients of the non-nephropathic group: 4.85 (1.92) mg/dl) (p<0.001). There was a correlation between microalbuminuria and UA (r=0.238). This correlation was statistically significant (p=0.017). CONCLUSION: UA levels may be an important predictor of nephropathy in diabetic patients.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/etiologia , Hiperuricemia/complicações , Ácido Úrico/sangue , Idoso , Albuminúria/urina , Biomarcadores/sangue , Creatinina/urina , Diabetes Mellitus Tipo 2/sangue , Nefropatias Diabéticas/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade
5.
Int J Mol Sci ; 20(18)2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31505904

RESUMO

: Nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of kidney disease in adults and children. However, it is uncertain whether this association is influenced by major NAFLD susceptibility genes. In a sample of 230 overweight/obese children, 105 with NAFLD (hepatic fat fraction ≥5% by magnetic resonance imaging) and 125 without NAFLD, rs738409 in PNPLA3, rs58542926 in TM6SF2, rs1260326 in GCKR, and rs641738 in MBOAT7 were genotyped. Abnormal kidney function was defined as estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m2 and/or the presence of microalbuminuria (24 h urinary albumin excretion between 30 and 300 mg). In comparison with children without NAFLD, those with NAFLD showed increased prevalence of reduced eGFR (13.3% vs. 1.6%; p < 0.001) and microalbuminuria (8.6% vs. 3.4%, p = 0.025). TM6SF2, GCKR, and MBOAT7 risk alleles did not show any impact on kidney function, while the PNPLA3 G allele was associated with lower eGFR, but only in children with NAFLD (p = 0.003). After adjustment for confounders, NAFLD (OR, 4.7; 95% CI, 1.5-14.8; padj = 0.007), but not the PNPLA3 gene variant, emerged as the main independent predictor of renal dysfunction. Overall, our findings suggest that NAFLD remains the main determinant of decline in kidney function in overweight/obese children, while the PNPLA3 rs738409 prosteatogenic variant has a small impact, if any.


Assuntos
Albuminúria , Variação Genética , Nefropatias , Lipase/genética , Proteínas de Membrana/genética , Hepatopatia Gordurosa não Alcoólica , Obesidade Pediátrica , Adolescente , Albuminúria/genética , Albuminúria/urina , Criança , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Nefropatias/genética , Nefropatias/urina , Masculino , Hepatopatia Gordurosa não Alcoólica/genética , Hepatopatia Gordurosa não Alcoólica/urina , Obesidade Pediátrica/genética , Obesidade Pediátrica/urina
6.
J Diabetes Res ; 2019: 9718370, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31534974

RESUMO

Objective: In general population, resting heart rate (RHR) is associated with cardiovascular disease. However, its relation to chronic kidney disease (CKD) is debated. We therefore investigated the relationship between RHR and urinary albumin/creatinine ratio (UACR, an indicator of early kidney injury) in general population at different levels of blood pressure and blood glucose. Methods: We screened out 32,885 subjects from the REACTION study after excluding the subjects with primary kidney disease, heart disease, tumor history, related drug application, and important data loss. The whole group was divided into four groups (Q1: RHR ≤ 71, Q2: 72 ≤ RHR ≤ 78, Q3: 79 ≤ RHR ≤ 86, and Q4: 87 ≤ RHR) according to the quartile of average resting heart rate. The renal function was evaluated by UACR (divided by quartiles of all data in the center to which the subject belonged). Ordinary logistic regression was carried out to explore the association between RHR and UACR at diverse blood pressure and blood glucose levels. Results: The subjects with higher RHR quartile tend to have a higher UACR, even multifactors were adjusted. After stratifying the subjects according to blood pressure and blood glucose, the positive relationship between RHR and UACR remained in the subjects with normal blood pressure and normal glucose tolerance, while in the hypertension (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg) group and the diabetic mellitus (FPG ≥ 7.0 mmol/L and/or PPG ≥ 11.1 mmol/L) group, the relationship disappeared. In the subjects without hypertension, compared with the Q1 group, the UACR is significant higher in the Q3 group (OR: 1.11) and the Q4 group (OR: 1.22). In the subjects with normal glucose tolerance (NGT), compared with the Q1 group, the UACR is significantly higher in the Q3 group (OR: 1.13) and the Q4 group (OR: 1.19). Conclusions: The population with higher RHR tend to have a higher UACR in the normal blood pressure group and the normal glucose tolerance group.


Assuntos
Albuminúria/urina , Creatinina/urina , Frequência Cardíaca/fisiologia , Idoso , Pressão Sanguínea/fisiologia , China , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Urinálise
7.
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
9.
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
10.
Urology ; 133: 199-203, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31454657

RESUMO

OBJECTIVE: To investigate the role of albuminuria as a clinical marker of early renal disease in children with neurogenic bladder (NGB) in association with commonly used predictors of renal risk. METHODS: Catheterized urine was obtained from 40 patients with NGB at a tertiary pediatric hospital. Albumin-to-creatinine ratio (ACR) was analyzed for associations with estimated glomerular filtration rate, vesicoureteral reflux, hydronephrosis, bladder dynamics, and renal scarring. RESULTS: About 32% (13/40) of NGB patients had elevated ACR (≥30 mg/g. Elevated ACR was associated with Caucasian race, clean intermittent catheterization, hydronephrosis, and vesicoureteral reflux on univariate analysis. In multivariable analysis, presence of vesicoureteral reflux and use of anticholinergic medication were significant predictors of ACR elevation. CONCLUSION: Albuminuria is an established clinical predictor of renal disease and risk for progression to renal failure. The presence of albuminuria in NGB patients with urinary tract abnormalities suggests these patients may be at increased risk for progressive renal disease. This supports the clinical utility of adding ACR to the evaluation of renal risk in pediatric NGB.


Assuntos
Albuminúria/etiologia , Nefropatias/diagnóstico , Nefropatias/etiologia , Bexiga Urinaria Neurogênica/complicações , Adolescente , Albuminúria/urina , Biomarcadores/urina , Criança , Pré-Escolar , Estudos Transversais , Diagnóstico Precoce , Feminino , Humanos , Nefropatias/urina , Masculino , Bexiga Urinaria Neurogênica/urina
11.
Scand J Immunol ; 90(5): e12810, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31325389

RESUMO

MicroRNAs (miRNAs) play a vital role in the occurrence and development of many human diseases, including systemic lupus erythematosus (SLE). SLE is an autoimmune disease characterized by the production of autoantibodies against nuclear antigens and multiorgan involvement. Study of miRNAs involved in SLE provides new insights into the pathogenesis of SLE and might lead to the identification of new therapeutic interventions. The aim of this study was to investigate the effect of miR-183 injection on the progression of SLE by using MRL/lpr mouse model. The expression levels of miR-183 and mTOR mRNA were detected by quantitative real-time PCR assay. The effect of miR-183 on the course of spontaneous disease progression in the MRL/lpr mice was examined by intraperitoneal injection of miR-183 into mice and followed by monitoring lifespan, anti-dsDNA antibody levels, urinary albumin levels, blood urea nitrogen (BUN) levels, and Tregs and Th17 cell population. We found that miR-183 injection resulted in reduction of anti-DNA antibody and immune complex component levels, restoration of Tregs and Th17 cell population and prolongation of survival. Our findings suggest that miR-183 injection may serve as an effective therapeutic treatment for delaying or easing pathologic features of SLE.


Assuntos
Nefrite Lúpica/terapia , MicroRNAs/genética , MicroRNAs/uso terapêutico , Serina-Treonina Quinases TOR/antagonistas & inibidores , Serina-Treonina Quinases TOR/genética , Adulto , Albuminúria/urina , Animais , Anticorpos Antinucleares/sangue , Nitrogênio da Ureia Sanguínea , Modelos Animais de Doenças , Feminino , Humanos , Nefrite Lúpica/genética , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , RNA Mensageiro/genética , Linfócitos T Reguladores/imunologia , Serina-Treonina Quinases TOR/metabolismo , Células Th17/imunologia
14.
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
15.
Clin Nephrol ; 92(3): 113-122, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31319905

RESUMO

BACKGROUND: Reduced estimated glomerular filtration rate (eGFR) in older adults is common and may reflect normal aging or significant kidney disease. Our objective was to develop a predictive model to better triage these individuals using routine laboratory data. MATERIALS AND METHODS: Using a large US laboratory data set, we calculated individual eGFR regression slopes for 43,523 individuals aged 60 - 75 years with baseline eGFRs between 30 and 59 mL/min/1.73m2. We developed general linear models to predict the eGFR regression slope using urine protein measurements and other routinely available laboratory data as dependent variables. We validated these models on a similar data set comprised of 11,979 individuals. RESULTS: In a model utilizing log10 urine albumin/creatinine (UACR), the variables that significantly predicted the eGFR regression slope were log10 UACR, initial eGFR, serum albumin, chloride, glucose, and aspartate aminotransferase (AST). In an otherwise identical model substituting log10 urine protein/creatinine (UPCR) for UACR, results were similar except that serum calcium was significant and AST was not. We analyzed the correspondence between actual eGFR regression slopes and those predicted by our models using receiver operator characteristic (ROC) statistics to calculate areas under the curves (AUC) for four eGFR slope cut points: -2, -3, -4, and -5 mL/min/year. AUCs using the UACR and UPCR models ranged from 0.716 to 0.900 and 0.751 to 0.868, respectively, for the training data set. Results were nearly identical for the validation data set. CONCLUSION: Use of a laboratory-based predictive model of eGFR decline for older adults with eGFR 30 - 59 mL/min/1.73m2 may help distinguish between individuals with and without risk for further decline in kidney function.


Assuntos
Algoritmos , Taxa de Filtração Glomerular , Idoso , Albuminúria/urina , Área Sob a Curva , Creatinina/urina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteinúria/urina
16.
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
17.
Ren Fail ; 41(1): 540-546, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31234687

RESUMO

Low serum 25 hydroxyvitamin D (25 OH D) is common among chronic kidney disease (CKD) patients. This cross-sectional study is looking for the different factors associated with serum 25 OH D among pre-dialysis CKD. 1624 adult stage 3-5 CKD patients were studied beside 200 normal control subjects. All candidates were tested for body mass index (BMI), estimated glomerular filtration rate (eGFR), calcium (Ca), phosphorus (P), parathormone (PTH), 25 OH D, albumin, and uric acid (UA), and urine albumin/creatinine ratio (ACR). Multivariate linear regression analysis was done to determine predictors of 25 OH D. 98.6% of CKD patients have inadequate level of 25 OH D vs 48% of normal subjects. Serum 25 OH D was significantly lower in CKD patients (mean ± S.D = 16.54 ± 5.8 vs 37.79 ± 3.58 ng/mL for CKD vs control group respectively, p < .001). Serum level of 25 OH D has significant positive correlation with Ca (r = 0.337, p < .001), and significant negative correlation with P, PTH, UA, and ACR (r = -0.440, -0. 679, -0.724, and -0.781respectively, p < .001 in all). The independent predictors of 25 OH D were Ca, P, UA, PTH, and ACR (R square = 0.7, ß = -0.087, -0.226, -0.313, -0.253, and -0.33 respectively, p < .001 in all). In conclusion, pre-dialysis CKD patients frequently suffer low 25 OH D. Among the different abnormalities related to CKD, urine albumin excretion rate and UA are the most important predictors of 25 OH D in these patients.


Assuntos
Albuminúria/urina , Insuficiência Renal Crônica/complicações , Ácido Úrico/sangue , Deficiência de Vitamina D/diagnóstico , Vitamina D/análogos & derivados , Adolescente , Adulto , Albuminas/análise , Albuminúria/sangue , Albuminúria/etiologia , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/urina , Vitamina D/sangue , Deficiência de Vitamina D/etiologia , Adulto Jovem
18.
J Obstet Gynaecol ; 39(8): 1075-1080, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31177888

RESUMO

The aim of this study was to determine the accuracy of the 24-h urine collection in preeclamptic pregnant women. This study included 65 singletons with preeclampsia and 53 singleton patients in a control-matched group. The ratio of inaccurate 24-h urine collection was measured by calculating expected urine creatinine excretion according to the proportion of pre-pregnancy weight and the lean body mass (LBM) of the patients. Comparisons were made between the accurately-collected 24-h urine protein excretion rates and the instant and 24-h urine protein/creatinine (P/Cr) and albumin/creatinine (A/Cr) ratios. Twenty-four-hour urine collection used to diagnose patients with preeclampsia was incorrectly collected 15-73.5% of the time among the patients and the control group. Instant and 24-h urine P/Cr and A/Cr ratios were correlated with total 24-h proteinuria among the patients in whom urine was collected correctly. Considering the 24-h urine P/Cr ratio, rather than the 24-h urine protein excretion value, is a better way to diagnose preeclampsia. IMPACT STATEMENT What is already known on this subject? Twenty-four-hour urine collection is considered as the gold standard of diagnosing proteinuria in preeclampsia, in case of the correctly collected. What do the results of this study add? Generally, in the literature the correctness of 24-h proteinuria is not questioned. However, it is actually quite important in daily practice to make the correct diagnosis of the proteinuria not to misdiagnose preeclampsia. What are the implications of these findings for clinical practice and/or further research? In this article, we aimed to show the importance of accurately collected 24-h urine in preeclampsia. We consider and advise to change the gold standard of this technique to 24-h protein/creatinine (P/Cr) ratio, in order to make correct diagnosis of the preeclampsia.


Assuntos
Albuminúria/urina , Creatinina/urina , Pré-Eclâmpsia/urina , Proteinúria/urina , Adulto , Feminino , Idade Gestacional , Humanos , Gravidez , Sensibilidade e Especificidade
19.
Niger J Clin Pract ; 22(6): 750-753, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31187757

RESUMO

Objective: To study the role of hypoxia inducible factor-1α (HIF-1α) in patients with diabetic nephropathy (DN). Methods: In total, 133 participants were selected to conduct the investigation, parameters such as fasting blood sugar (FBS), blood urea nitrogen (BUN), and urine albumin-creatinine ratio (UACR) were tested and recorded. The biopsy assessment was conducted when renal function or urinary abnormalities. Western blotting was used to test the expression of serum HIF-1α in all patients and control group. Results: The values of FBS, BUN, and UACR were higher in DN and diabetes groups than in the healthy control. The values of FBG, BUN, and UACR were higher in DN patients than in the diabetes patients with no nephropathy. eGFR in DN patients was lower than the other two groups. The expression of HIF-1α was higher than both diabetes patients with no nephropathy and healthy control, P < 0.05. Patients with lots of albuminuria showed the highest expression of HIF-1α than the other groups. HIF-1α in normoalbuminuria and microalbuminuria groups showed no significant difference. Conclusions: HIF-1α was up-regulated in DN patients, which might give clinical basis to the role of HIF-1α in the development of DN.


Assuntos
Albuminúria/sangue , Diabetes Mellitus Tipo 2/sangue , Nefropatias Diabéticas/sangue , Subunidade alfa do Fator 1 Induzível por Hipóxia/sangue , Adulto , Idoso , Albuminúria/urina , Glicemia/metabolismo , Nitrogênio da Ureia Sanguínea , Estudos de Casos e Controles , Creatinina/urina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Regulação para Cima
20.
Transplant Proc ; 51(5): 1331-1336, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31076148

RESUMO

BACKGROUND: The albumin to creatinine ratio (ACR) has been shown to be an important prognostic marker in kidney disease. The ACR has been shown to predict graft failure and patient death after kidney transplant. METHODS: From March 1, 2011, to December 31, 2013, we checked the urine ACR and blood for highly sensitive C-reactive protein in 93 kidney recipients who regularly follow up at out institute. We tested the linear correlations of these parameters with estimated glomerular filtration rate. Furthermore, we used multivariate linear regression to examine its value in predicting graft function. Finally, we used receiver operating characteristic curve analysis to validate their predictive value on creatinine clearance > 45 mL/min. RESULTS: With multivariate linear regression, the latest estimated glomerular filtration rate has a strong linear relationship with initial ACR (B = -0.032; P = .02), suggesting each unit rise in ACR with a decrease in creatinine clearance by 0.032 mL/min. To investigate their value in predicting good functional graft defined as creatinine clearance >45 mL/min, a receiver operating characteristic curve analysis was applied on these parameters. The area under curve for age is 0.496, for body weight is 0.539, and for highly sensitive C-reactive protein is 0.582, which are all around the chance of 0.5 by flipping coins. The area under ACR curve is 0.825, better than above parameters, and only second to serum creatinine level. CONCLUSIONS: Urine ACR is a simple and effective measure to predict graft function after a kidney transplant. It has similar independent strong correlations to creatinine clearance comparing with serum creatinine without requirement of a blood draw.


Assuntos
Albuminúria/urina , Creatinina/urina , Sobrevivência de Enxerto , Testes de Função Renal/métodos , Transplante de Rim , Adulto , Feminino , Taxa de Filtração Glomerular , Humanos , Nefropatias/urina , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Urinálise
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA