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1.
Ren Fail ; 45(1): 2170243, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36721891

RESUMO

INTRODUCTION: To estimate the up-to-date prevalence of chronic kidney disease among the health check-up population in economically developed areas of China using estimated glomerular filtration rate, urinary albumin creatinine ratio, and kidney ultrasound. METHODS: Healthcare data from 38,093 subjects in 10 megalopolises of China who had an annual health check-up in 2021 were used. The overall and stratified prevalence of chronic kidney disease by sex, age, region and comorbidity group was reported. The association between chronic kidney disease and covariates of demographics, and comorbidities were analyzed in the multivariable-adjusted logistic regression model. RESULTS: A total of 3837 CKD cases were detected meeting any of the three CKD diagnostic criteria, with a crude prevalence of 10.1% in the study population. Using one criterion of decreased glomerular filtration rate, albuminuria and kidney structural abnormalities alone detected 204 (5.3%), 3289 (85.7%) and 563 (14.7%) cases, respectively. The addition of kidney ultrasound detected 427 (11.1%) structural abnormality cases without decreased GFR and albuminuria. The most common abnormalities were renal masses, hydronephrosis due to obstruction and congenital anomalies of kidney and urinary tract. Female, older age, low city-tier, hypertension, diabetes, obesity, hypertriglyceridemia as well as early disease stages such as pre-hypertension, impaired fasting glucose and overweight were significantly associated with chronic kidney disease. CONCLUSION: Kidney ultrasound helps to amplify the detection of CKD patients, which is a supplement to kidney function and urine protein.


Assuntos
Albuminúria , Insuficiência Renal Crônica , Humanos , Feminino , Estudos Transversais , Albuminúria/epidemiologia , Prevalência , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Fatores de Risco , Rim , China/epidemiologia
3.
Sci Rep ; 13(1): 1044, 2023 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-36658312

RESUMO

To assess the relationship of sodium, potassium and the ratio of sodium to potassium (Na/K) with albuminuria, a cross-sectional study was carried out in China in 2017. Sodium, potassium and albumin excretions were examined in a 24-h (h) urine sample collected from 1486 participants. Microalbuminuria was defined as 24-h urinary albumin excretion between 30 and 300 mg/24 h. The participants had an average age of 46.2 ± 14.1 years old, and 48.9% were men. The proportion of patients with microalbuminuria was 9.0%. As illustrated by the adjusted generalized linear mixed model, sodium concentration increased significantly with the increase in 24-h urinary albumin (ß = 1.16, 95% confidence interval (CI) 0.38-1.93; P = 0.003). Multivariable-adjusted logistic regression analyses demonstrated that the odds ratio (OR) of microalbuminuria increased with the quartiles of sodium [OR = 2.20, 95% CI 1.26-3.84 (the maximum quartile vs. the minimum quartile), Pfor trend = 0.006]. Potassium and the Na/K ratio did not have any association with outcome indicators. A high amount of sodium intake was potentially correlated with early renal function impairment.


Assuntos
Albuminúria , Masculino , Humanos , Adulto , Pessoa de Meia-Idade , Feminino , Albuminúria/urina , Estudos Transversais , Sódio/urina , Potássio/urina
4.
JAMA Netw Open ; 6(1): e2247868, 2023 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-36701157

RESUMO

Importance: Caffeine is detoxified by cytochrome P450 1A2 (CYP1A2), and genetic variation in CYP1A2 impacts the rate of caffeine clearance. Factors that may modify the association between coffee intake and kidney disease remain unclear. Objective: To assess whether CYP1A2 genotype modifies the association between coffee intake and kidney dysfunction. Design, Setting, and Participants: The Hypertension and Ambulatory Recording Venetia Study (HARVEST) was a prospective cohort study of individuals with stage 1 hypertension in Italy; HARVEST began on April 1, 1990, and follow-up is ongoing. The current study used data from April 1, 1990, to June 30, 2006, with follow-up of approximately 10 years. Blood pressure and biochemical data were collected monthly during the first 3 months, then every 6 months thereafter. Data were analyzed from January 2019 to March 2019. Participants were screened and recruited from general practice clinics. The present study included 1180 untreated participants aged 18 to 45 years with stage 1 hypertension; those with nephropathy, diabetes, urinary tract infection, and cardiovascular disease were excluded. Exposures: Coffee intake and CYP1A2 genotype rs762551 were exposures analyzed over a median follow-up of 7.5 (IQR, 3.1-10.9) years. Main Outcomes and Measures: Albuminuria (defined as an albumin level of ≥30 mg/24 h) and hyperfiltration (defined as an estimated glomerular filtration rate of ≥150 mL/min/1.73 m2) were the primary outcomes as indicators of kidney dysfunction. Results: Among 1180 participants, genotyping, lifestyle questionnaires, and urine analysis data were obtained from 604 individuals (438 [72.5%] male) with a mean (SD) age of 33.3 (8.5) years and a mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) of 25.4 (3.4). A total of 158 participants (26.2%) consumed less than 1 cup of coffee per day, 379 (62.7%) consumed 1 to 3 cups per day, and 67 (11.1%) consumed more than 3 cups per day. Genotype frequencies for rs762551 (260 participants [43.1%] with genotype AA, 247 participants [40.8%] with genotype AC, and 97 participants [16.1%] with genotype CC) did not differ between coffee intake categories. The level of risk of developing albuminuria, hyperfiltration, and hypertension, assessed by Cox regression and survival analyses, was not associated with coffee intake in the entire group or among fast metabolizers. The risks of albuminuria (adjusted hazard ratio [aHR], 2.74; 95% CI, 1.63-4.62; P < .001), hyperfiltration (aHR, 2.11; 95% CI, 1.17-3.80; P = .01), and hypertension (aHR, 2.81; 95% CI, 1.51-5.23; P = .001) increased significantly among slow metabolizers who consumed more than 3 cups per day. Conclusions and Relevance: In this study, the risks of albuminuria, hyperfiltration, and hypertension increased with heavy coffee intake only among those with the AC and CC genotypes of CYP1A2 at rs762551 associated with slow caffeine metabolism, suggesting that caffeine may play a role in the development of kidney disease in susceptible individuals.


Assuntos
Cafeína , Hipertensão , Humanos , Masculino , Feminino , Estudos Prospectivos , Citocromo P-450 CYP1A2/genética , Albuminúria/genética , Hipertensão/epidemiologia , Hipertensão/genética , Variação Genética , Rim
5.
BMC Nephrol ; 24(1): 23, 2023 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-36717778

RESUMO

BACKGROUND: Globally, the World Health Organization ranks chronic kidney disease (CKD) as one of the top 10 causes of mortality. In South Africa, where noncommunicable diseases have become leading causes of mortality, the true population prevalence of CKD is unknown and associated risk factors remain understudied. This study aimed to describe the prevalence of kidney dysfunction and associated risk factors in a community from the North West province of South Africa. METHODS: This cross-sectional study included 1999 participants older than 30 years. Kidney dysfunction was defined as (i) estimated glomerular filtration rate (eGFR) < 90 ml/min/1.73m2, or (ii) urine albuminuria-to-creatinine ratio (uACR) ≥ 3.0 mg/mmol, or a combination (i and ii). Risk factors included age, sex, urban/rural locality, body mass index (BMI), blood pressure (BP), lipid profile, haemoglobin A1c (HbA1C), C-reactive protein (CRP), gamma-glutamyl transferase (GGT), tobacco use, and HIV status. RESULTS: Mean age of participants was 48 (42;56) years, and 655/1999 (33%) had eGFR < 90 ml/min/1.73m2 and/or uACR ≥ 3.0 mg/mmol. Compared to those with normal kidney function, participants with eGFR < 90 ml/min/1.73m2 and/or uACR ≥ 3.0 mg/mmol were older, female, had higher measures of adiposity, systolic, diastolic, and mean arterial blood pressure, serum lipids and C-reactive protein (CRP) (all p ≤ 0.024). In multiple regression analyses eGFR was associated with systolic BP (ß = 0.11) and HIV infection (ß = -0.09), and albuminuria was associated with elevated CRP (ß = 0.12) and HIV infection (ß = 0.11) (all p < 0.026). In both groups (individuals with and without kidney dysfunction respectively), eGFR was associated with age (ß = -0.29, ß = -0.49), male sex (ß = 0.35, ß = 0.28), BMI (ß = -0.12, ß = -0.09), low-density/high-density lipoprotein cholesterol ratio (ß = -0.17, ß = -0.09) and CRP (ß = 0.10, ß = 0.09) (all p < 0.005); and uACR was associated with female sex (ß = 0.10, ß = -0.14), urban locality (ß = -0.11, ß = -0.08), BMI (ß = -0.11, ß-0.11), and systolic BP (ß = 0.27, ß = 0.14) (all p < 0.017). CONCLUSION: In this study from the North West province, South Africa, eGFR < 90 ml/min/1.73m2 and/or uACR ≥ 3.0 mg/mmol was prevalent and associated with modifiable risk factors. The findings may inform screening strategies for kidney disease prevention, focusing on women, obesity, blood pressure control, dyslipidaemia, identifying and treating inflammation, and HIV diagnosis and treatment.


Assuntos
Infecções por HIV , Insuficiência Renal Crônica , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Albuminúria/diagnóstico , Infecções por HIV/epidemiologia , Prevalência , Proteína C-Reativa , Estudos Transversais , África do Sul/epidemiologia , Fatores de Risco , Rim , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Taxa de Filtração Glomerular/fisiologia , Creatinina/urina
6.
Med J Malaysia ; 78(1): 87-92, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36715197

RESUMO

INTRODUCTION: Low serum 25-hydroxyvitamin D is associated with chronic kidney disease progression, and there are limited data on the vitamin D levels in patients with Immunoglobulin A nephropathy. This study was conducted to determine the level of 25-hydroxyvitamin D in a stable immunoglobulin A nephropathy patient and its association with other parameters. MATERIALS AND METHODS: We performed a cross-sectional study involving 70 patients with biopsy-proven immunoglobulin A nephropathy with a stable estimated glomerular filtration rate and urinary albuminuria. Their demographic profiles were documented, and blood samples were taken for serum 25-hydroxyvitamin D, highly sensitive C-reactive protein, urine albuminuria and other routine blood tests. RESULTS: We found nine patients (12.9%) had sufficient 25- hydroxyvitamin D [25(OH)D] levels of more than 30ng/mL and the rest of the patients; 61 (87.1%) had serum 25(OH)D levels below 30 ng/ml. Amongst those with low vitamin D, 38 (62.3%) had serum 25(OH)D between 15-30 ng/mL (insufficient), and the remaining 23 (37.7%) had serum 25(OH)D below 15 ng/ml (deficient). Their mean level of serum 25(OH)D was 19.92 ± 9.04 ng/mL with a serum creatinine of 106.23 ± 38.56 µmol/L and mean estimated glomerular filtration rate (eGFR) at 68.11± 27.65 mL/min/1.73 m2. There was no association between urinary albuminuria, highly sensitive C-reactive protein, estimated glomerular filtration rate or systolic blood pressure with serum 25(OH)D level. CONCLUSION: Low vitamin D (insufficiency and deficiency) are indeed prevalent in stable immunoglobulin A nephropathy patients. We found no correlation between the vitamin D levels with albuminuria, renal function and highly sensitive C-reactive.


Assuntos
Glomerulonefrite por IGA , Deficiência de Vitamina D , Humanos , Deficiência de Vitamina D/complicações , Albuminúria/complicações , Glomerulonefrite por IGA/complicações , Proteína C-Reativa , Estudos Transversais , Vitamina D , Vitaminas
7.
Ann Med ; 55(1): 502-513, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36719097

RESUMO

Persons with diabetes and chronic kidney disease (CKD) have a high residual risk of developing cardiovascular (CV) complications despite treatment with renin-angiotensin system blockers and sodium-glucose cotransporter type 2 inhibitors. Overactivation of mineralocorticoid receptors plays a key role in the progression of renal and CV disease, mainly by promoting inflammation and fibrosis. Finerenone is a nonsteroidal selective mineralocorticoid antagonist. Recent clinical trials, such as FIDELIO-DKD and FIGARO-DKD and the combined analysis FIDELITY have demonstrated that finerenone decreases albuminuria, risk of CKD progression, and CV risk in subjects with type 2 diabetes (T2D) and CKD. As a result, finerenone should thus be considered as part of a holistic approach to kidney and CV risk in persons with T2D and CKD. In this narrative review, the impact of finerenone treatment on the CV system in persons with type 2 diabetes and CKD is analyzed from a practical point of view.Key messages:Despite inhibition of renin-angiotensin system and sodium-glucose cotransporter type 2, persons with type 2 diabetes (T2D) and chronic kidney disease (CKD) remain on high cardiovascular (CV) residual risk.Overactivation of mineralocorticoid receptors plays a key role in the progression of renal and CV disease, mainly by promoting inflammation and fibrosis that is not targeted by traditional treatments.Finerenone is a nonsteroidal selective mineralocorticoid antagonist that decreases not only albuminuria, but also the risk of CKD progression, and CV risk in subjects with T2D and CKD.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Insuficiência Renal Crônica , Humanos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Receptores de Mineralocorticoides/uso terapêutico , Albuminúria/complicações , Nefropatias Diabéticas/complicações , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/complicações , Rim , Fibrose , Inflamação/tratamento farmacológico , Glucose , Sódio/uso terapêutico
8.
Int J Biol Sci ; 19(2): 502-520, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36632460

RESUMO

Podocyte injury is a common hallmark of chronic kidney disease (CKD). The podocin-nephrin complex localized in lipid rafts of podocyte is vital to reduce podocyte injury and proteinuria, however, the mechanism underlying its localization remains unclear. This study uncovers an important role of Flot2 in stabilizing the podocin-nephrin complex localized in lipid rafts. We first confirmed that Flot2 was expressed in podocyte and demenstrated that podocyte-specific Flot2 deletion worsen albuminuria, podocyte injury and glomerular pathology in LPS/ADR-induced nephropathy mouse models. Meanwhile, podocyte injury, albuminuria and pathologic aberrance were prevented in podocyte-specific Flot2 overexpression transgenic mice when challenged with LPS or ADR. Further found that Flot2 was vital to recruit podocin and nephrin into rafts and ameliorated podocyte injury. Flot2 and podocin directly interacted with each other via their SPFH domain. Meanwhile, we also showed that Flot-2 is a direct target of Krüppel-like factor (KLF15). Importanly, we observed that Flot2 was downregulated in renal biopsies from patients with podocytopathies and its expression negatively correlated with proteinuria and positively correlated with eGFR, indicating that Flot2 may be a novel therapeutic target for proteinuric kidney disease.


Assuntos
Nefropatias , Podócitos , Camundongos , Animais , Podócitos/metabolismo , Albuminúria/metabolismo , Albuminúria/patologia , Lipopolissacarídeos , Nefropatias/metabolismo , Proteinúria/metabolismo , Proteinúria/patologia , Camundongos Transgênicos
9.
Sci Rep ; 13(1): 295, 2023 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-36609387

RESUMO

Diabetes mellitus (DM) is a well-known risk factor for mortality, and the risk is exacerbated by coexisting diabetic kidney disease (DKD). We aimed to explore the impact of DM on each cause of mortality according to kidney function and the presence of albuminuria. Data on subjects with DM were extracted from the Nationwide Health Insurance Database of South Korea between 2009 and 2012. Subjects were divided by eGFR and albuminuria into five groups. To evaluate the risk of diabetes, we used the Cox proportional hazards model. A total of 2,614,662 patients were enrolled in this study. Most causes of death showed a higher incidence in an advanced stage of DKD. In addition to all-cause mortality and cardiovascular death, the risk of death from neoplasms and diseases of the endocrine, respiratory, and digestive systems is increased by albuminuria. The synergistic effect of a reduced eGFR and the presence of albuminuria was prominent in death from circulatory diseases, and endocrine and metabolic diseases. The risk for mortality was different according to the stage of DKD. Even in patients with a favorable eGFR, the presence of albuminuria significantly increased the risk for mortality, especially that due to cardiovascular causes.


Assuntos
Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Humanos , Causas de Morte , Albuminúria , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/complicações , Fatores de Risco , Taxa de Filtração Glomerular
10.
J R Soc Interface ; 20(198): 20220634, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36628531

RESUMO

Albuminuria occurs when albumin leaks abnormally into the urine. Its mechanism remains unclear. A gel-compression hypothesis attributes the glomerular barrier to compression of the glomerular basement membrane (GBM) as a gel layer. Loss of podocyte foot processes would allow the gel layer to expand circumferentially, enlarge its pores and leak albumin into the urine. To test this hypothesis, we develop a poroelastic model of the GBM. It predicts GBM compression in healthy glomerulus and GBM expansion in the diseased state, essentially confirming the hypothesis. However, by itself, the gel compression and expansion mechanism fails to account for two features of albuminuria: the reduction in filtration flux and the thickening of the GBM. A second mechanism, the constriction of flow area at the slit diaphragm downstream of the GBM, must be included. The cooperation between the two mechanisms produces the amount of increase in GBM porosity expected in vivo in a mutant mouse model, and also captures the two in vivo features of reduced filtration flux and increased GBM thickness. Finally, the model supports the idea that in the healthy glomerulus, gel compression may help maintain a roughly constant filtration flux under varying filtration pressure.


Assuntos
Albuminúria , Podócitos , Camundongos , Animais , Membrana Basal Glomerular , Modelos Animais de Doenças , Albuminas
11.
Rev Med Liege ; 78(1): 24-28, 2023 Jan.
Artigo em Francês | MEDLINE | ID: mdl-36634063

RESUMO

The inhibition of the renin-angiotensin system represents the first preventive treatment of the chronic kidney disease (CKD), especially in presence of albuminuria. Recently, sodium-glucose cotransporter type 2 inhibitors (SGLT2i, gliflozins) demonstrated a nephroprotective effect, first in patients with type 2 diabetes at cardiovascular risk, then in diabetic patients with CKD assessed by a reduction of the glomerular filtration rate (GFR) and albuminuria (CREDENCE with canagliflozin), and finally in patients with CKD and albuminuria, with or without diabetes (DAPA-CKD with dapagliflozin). EMPA-KIDNEY study compared the effects of empagliflozin 10 mg/day versus placebo in patients with CKD, with or without diabetes. In comparison with the two previous renal studies, this clinical trial randomised patients with a lower GFR (78 % of patients with GFR inferior to 45 mL/min/1.73 m²) and a lower level of albuminuria (20 % of patients without pathological albuminuria). EMPA-KIDNEY demonstrated a reduction by 28 % (p inferior to 0.001) of the primary composite outcome (progression of CKD or cardiovascular death) and of several renal endpoints, including the shift to terminal CKD (-33 %), independently of the presence of diabetes, and with a tolerance profile comparable to what is already known. EMPA-KIDNEY results reinforce the use of SGLT2is, in general, and of empagliflozin, in particular, in a broader population with CKD and, thus, the indication of this pharmacological class in nephrology in combination with inhibitors of the renin-angiotensin system.


L'inhibition du système rénine-angiotensine représente le premier traitement de prévention de la maladie rénale chronique (MRC), en particulier chez les patients avec albuminurie. Récemment, les inhibiteurs des cotransporteurs sodium-glucose de type 2 (iSGLT2, gliflozines) ont démontré une néphroprotection, d'abord chez les patients avec un diabète de type 2 à risque cardiovasculaire, puis chez des patients avec MRC avec diminution du débit de filtration glomérulaire (DFG) et albuminurie (CREDENCE avec la canagliflozine), puis chez des patients avec MRC albuminurique, avec ou sans diabète (DAPA-CKD avec la dapagliflozine). L'étude EMPA-KIDNEY a comparé les effets de l'empagliflozine 10 mg/jour à un placebo chez des patients avec MRC, avec ou sans diabète. Par comparaison aux deux études précédentes, cet essai a recruté des patients avec un DFG plus bas (78 % de patients avec un DFG inf�rieur a 45 mL/min/1,73 m²) et avec un niveau d'albuminurie plus faible (dont 20 % de patients sans albuminurie pathologique). EMPA-KIDNEY a démontré une réduction de 28 % (p inf�rieur a 0,001) du critère primaire composite (progression de la MRC ou mort cardiovasculaire) et de divers critères rénaux secondaires, dont l'évolution vers la MRC terminale (-33 %), indépendamment de la présence d'un diabète, et avec un profil de tolérance de l'empagliflozine comparable à celui déjà connu. EMPA-KIDNEY consolide l'utilisation des iSGLT2, en général, et de l'empagliflozine, en particulier, dans une population plus diversifiée en ce qui concerne la MRC et, donc, l'indication de cette classe pharmacologique en néphrologie en combinaison avec les inhibiteurs du système rénine-angiotensine.e.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Insuficiência Renal Crônica , Humanos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Albuminúria , Doenças Cardiovasculares/prevenção & controle , Rim , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico , Compostos Benzidrílicos/farmacologia , Compostos Benzidrílicos/uso terapêutico
12.
Physiol Rep ; 11(2): e15579, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36695822

RESUMO

Podocytes are terminally differentiated epithelial cells in glomeruli. Podocyte injury and loss are features of many diseases leading to chronic kidney disease (CKD). The developmental origins of health and disease hypothesis propose an adverse intrauterine environment can lead to CKD later in life, especially when a second postnatal challenge is experienced. The aim of this study was to examine whether a suboptimal maternal environment would result in reduced podocyte endowment, increasing susceptibility to diabetes-induced renal injury. Female C57BL/6 mice were fed a low protein diet (LPD) to induce growth restriction or a normal protein diet (NPD) from 3 weeks before mating until weaning (postnatal Day 21, P21) when nephron and podocyte endowment were assessed in one male and one female offspring per litter. Littermates were administered streptozotocin or vehicle at 6 weeks of age. Urinary albumin excretion, glomerular size, and podometrics were assessed following 18 weeks of hyperglycemia. LPD offspring were growth restricted and had lower nephron and podocyte number at P21. However, by 24 weeks the podocyte deficit was no longer evident and despite low nephron endowment neither albuminuria nor glomerulosclerosis were observed. Podocyte number was unaffected by 18 weeks of hyperglycemia in NPD and LPD offspring. Diabetes increased glomerular volume reducing podocyte density, with more pronounced effects in LPD offspring. LPD and NPD diabetic offspring developed mild albuminuria with LPD demonstrating an earlier onset. LPD offspring also developed glomerular pathology. These findings indicate that growth-restricted LPD offspring with low nephron number and normalized podocyte endowment were more susceptible to alterations in glomerular volume and podocyte density leading to more rapid onset of albuminuria and renal injury than NPD offspring.


Assuntos
Diabetes Mellitus , Hiperglicemia , Podócitos , Insuficiência Renal Crônica , Camundongos , Animais , Masculino , Feminino , Albuminúria , Camundongos Endogâmicos C57BL
13.
J Am Coll Cardiol ; 81(3): 270-282, 2023 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-36653095

RESUMO

Although chronic kidney disease is characterized by low glomerular filtration rate (GFR) or albuminuria, estimated GFR (eGFR) is more widely utilized as a marker of risk profile in cardiovascular diseases, including heart failure (HF). The presence and magnitude of albuminuria confers a strong prognostic association in forecasting risk of incident HF as well as its progression, irrespective of eGFR. Despite the high prevalence of albuminuria in HF, whether it adds incremental prognostic information in clinical practice and serves as an independent risk marker, and whether there are any therapeutic implications of assessing albuminuria in patients with HF is less well-established. In this narrative review, we assess the potential role of albuminuria in risk profiling for development and progression of HF, strengths and limitations of utilizing albuminuria as a risk marker, its ability to serve in HF risk prediction models, and the implications of adopting albuminuria as an effective parameter in cardiovascular trials and practice.


Assuntos
Doenças Cardiovasculares , Insuficiência Cardíaca , Insuficiência Renal Crônica , Humanos , Albuminúria/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Insuficiência Cardíaca/epidemiologia , Taxa de Filtração Glomerular , Fatores de Risco
16.
Clin Exp Hypertens ; 45(1): 2150204, 2023 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-36540929

RESUMO

BACKGROUND: Previous studies have demonstrated that the triglyceride-glucose (TyG) index is significantly associated with vascular damage. Albuminuria is a marker of hypertension-mediated organ damage (HMOD) and has been linked to a greater risk of cardiovascular disease (CVD). However, the association between the TyG index and albuminuria in patients with hypertension is not clear. This population research focused on subjects with hypertension to investigate the association between an elevated TyG index and albuminuria. METHODS: From September 2019 to November 2019, 789 hypertensive participants were involved in our research. Logistic regression models were performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for albuminuria according to the quartiles of the TyG index. RESULTS: Multivariate logistic regression analysis revealed that the TyG index was significantly associated with albuminuria. Using the lowest TyG index quartile as the reference, the fully adjusted ORs (95% CIs) for albuminuria for TyG index quartile II, quartile III, and quartile IV were 1.90 (1.17-3.12), 1.81 (1.07-3.07), and 3.46 (2.06-5.91), respectively. The results in the subgroup analysis were similar to the main analyses except for the smokers. Restricted cubic spline curves based on logistic regression models evaluated the linear association between the TyG index and albuminuria (P for nonlinear = 0.831). CONCLUSION: The TyG index was positively associated with albuminuria among hypertensive participants.


Assuntos
Doenças Cardiovasculares , Hipertensão , Humanos , Albuminúria , Hipertensão/complicações , Glucose , Triglicerídeos , Glicemia , Fatores de Risco , Biomarcadores
17.
Clin Nutr ; 42(2): 83-92, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36516702

RESUMO

BACKGROUND & AIMS: Population-based studies have suggested a protective effect of coffee against development of chronic kidney disease (CKD), possibly through coffee's anti-inflammatory and antioxidant compounds. Studies on coffee and kidney function decline in the general population are scarce. We studied associations of habitual coffee consumption with repeated assessments of estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR). METHODS: We used data from 7,914 participants of the population-based Rotterdam Study. Baseline coffee consumption data (cups/day) were obtained from home interviews and validated food frequency questionnaires (1997-2008). Repeated assessments of eGFR (ml/min per 1.73 m2, 1997-2014) were calculated according to the creatinine-based CKD Epidemiology Collaboration equation of 2012. Repeated assessments of urinary albumin and creatinine were used to estimate ACR (mg/g, 2006-2014). Data were analyzed by applying linear mixed models, adjusted for sociodemographic, lifestyle and dietary factors, and cardiovascular disease risk factors. Predefined subgroup analyses were performed stratified by CKD risk factors. RESULTS: Participants' mean (SD) baseline age was 66 (10) years, 57% were women and median [IQR] coffee consumption was 3.0 [2.0, 5.0] cups/day. Those drinking more coffee were more likely to smoke, and to have type 2 diabetes (T2D) and obesity. Mean eGFR was 79 (15) ml/min per 1.73 m2. In the total study population, coffee was not associated with longitudinal eGFR during a median of 5.4 years of follow-up (ß = 0.04 ml/min per 1.73 m2 per one cup/day [95% CI: -0.10,0.18]). However, among those aged >70 years, one additional coffee cup/day was associated with on average 0.84 (0.51,1.18) ml/min per 1.73 m2 higher longitudinal eGFR. Among obese participants this estimate was 0.32 (0.01,0.63). A protective trend was also observed among former smokers (0.17 [-0.03,0.39]) and those with T2D (0.42 [-0.05,0.88]). Coffee was not associated with longitudinal ACR (0.01 mg/ml [-0.01,0.02]). CONCLUSION: While coffee was not associated with eGFR and ACR in the total population, more coffee consumption was associated with higher longitudinal eGFR among those at higher risk for CKD, i.e., among those aged 70+ and obese participants. These findings require confirmation in other prospective cohort studies.


Assuntos
Diabetes Mellitus Tipo 2 , Insuficiência Renal Crônica , Humanos , Feminino , Masculino , Estudos Prospectivos , Creatinina/urina , Diabetes Mellitus Tipo 2/complicações , Taxa de Filtração Glomerular , Fatores de Risco , Rim , Obesidade/complicações , Albuminas , Albuminúria/epidemiologia
18.
Environ Pollut ; 318: 120851, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36509352

RESUMO

The nephrotoxicity of low-chronic metal exposures is unclear, especially considering several metals simultaneously. We assessed the individual and joint association of metals with longitudinal change in renal endpoints in Aragon Workers Health Study participants with available measures of essential (cobalt [Co], copper [Cu], molybdenum [Mo] and zinc [Zn]) and non-essential (As, barium [Ba], Cd, chromium [Cr], antimony [Sb], titanium [Ti], uranium [U], vanadium [V] and tungsten [W]) urine metals and albumin-to-creatinine ratio (ACR) (N = 707) and estimated glomerular filtration rate (eGFR) (N = 1493) change. Median levels were 0.24, 7.0, 18.6, 295, 3.1, 1.9, 0.28, 1.16, 9.7, 0.66, 0.22 µg/g for Co, Cu, Mo, Zn, As, Ba, Cd, Cr, Sb, Ti, V and W, respectively, and 52.5 and 27.2 ng/g for Sb and U, respectively. In single metal analysis, higher As, Cr and W concentrations were associated with increasing ACR annual change. Higher Zn, As and Cr concentrations were associated with decreasing eGFR annual change. The shape of the longitudinal dose-responses, however, was compatible with a nephrotoxic role for all metals, both in ACR and eGFR models. In joint metal analysis, both higher mixtures of Cu-Zn-As-Ba-Ti-U-V-W and Co-Cd-Cr-Sb-V-W showed associations with increasing ACR and decreasing eGFR annual change. As and Cr were main drivers of the ACR change joint metal association. For the eGFR change joint metal association, while Zn and Cr were main drivers, other metals also contributed substantially. We identified potential interactions for As, Zn and W by other metals with ACR change, but not with eGFR change. Our findings support that Zn, As, Cr and W and suggestively other metals, are nephrotoxic at relatively low exposure levels. Metal exposure reduction and mitigation interventions may improve prevention and decrease the burden of renal disease in the population.


Assuntos
Cádmio , Urânio , Pessoa de Meia-Idade , Adulto , Humanos , Albuminúria , Espanha/epidemiologia , Cromo , Zinco , Cobalto , Molibdênio , Titânio , Bário
19.
J Diabetes Complications ; 37(1): 108382, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36535110

RESUMO

AIM: To investigate the relationship of the lipoprotein(a), albuminuria, myostatin with sarcopenia in elderly patients with type 2 diabetes (T2D). METHODS: A total of 461 elderly patients with T2D who were admitted to our hospital were selected as the research subjects. There were 34 cases in line with Asian sarcopenia diagnosis (group A), and 427 patients had no such symptoms as the control group (group C). The levels of lipoprotein(a), albuminuria, myostatin in each group were compared, and the effect factors of muscle loss in elderly patients with T2D were analyzed by univariate/multivariate logistic regression. RESULTS: The incidence of sarcopenia in 461 elderly patients with T2D in this study was 7.37 % (34/461). However, the levels of appendicular skeletal muscle mass index (ASMI, kg/m2), albumin and epidermal growth factor receptor (eGFR) in group A were lower than those in group C (P < 0.05). The levels of lipoprotein(a), albuminuria, myostatin in group A were higher those in group C (P < 0.05). Additionally, group A had a higher morbidity in diabetic retinopathy and neuropathy. Univariate logistic regression analysis revealed that the risk factors of muscle loss are ASMI, lipoprotein(a), albuminuria, myostatin, diabetic retinopathy and neuropathy. Multivariate Logistic regression analysis showed that the risk factors of muscle loss in elderly patients with T2D were lipoprotein(a), albuminuria, myostatin and diabetic neuropathy. CONCLUSION: The lipoprotein(a), albuminuria, myostatin and diabetic neuropathy are closely related to the occurrence and development of muscle loss in elderly patients with T2D.


Assuntos
Diabetes Mellitus Tipo 2 , Neuropatias Diabéticas , Retinopatia Diabética , Sarcopenia , Humanos , Idoso , Sarcopenia/complicações , Sarcopenia/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/metabolismo , Miostatina , Retinopatia Diabética/patologia , Albuminúria/etiologia , Albuminúria/complicações , Neuropatias Diabéticas/complicações , Lipoproteína(a) , Músculo Esquelético/metabolismo
20.
Pediatr Nephrol ; 37(4): 881-890, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34545446

RESUMO

BACKGROUND: AKI is an important complication post cardiac surgery in children. An early diagnosis can help in mitigating complications and allow for prognostication. Urinary albumin:creatinine ratio (ACR) as a biomarker can provide a cheaper and more accessible AKI risk assessment and prediction. There is a paucity of paediatric literature regarding its utility. METHODS: This was a prospective observational study, enrolling all children aged 1 month to 18 years, who underwent cardiac surgery, with use of cardiopulmonary bypass. Cohort was divided into groups < 2 years and ≥ 2 years for analyses to account for differences in physiological albumin excretion with age. RESULTS: Of 143 children enrolled in the study, 36 developed AKI. In both age groups, the post-operative ACR was higher than pre-operative ACR among patients with and without AKI. In the group aged ≥ 2 years, the highest first post-operative ACR tertile (> 75.8 mg/g) predicted post-operative AKI after adjusting for clinical variables (adjusted RR, 11.71; 1.85-16.59). In the group aged < 2 years, the highest first post-operative ACR tertile (> 141.3 mg/g) predicted post-operative AKI in unadjusted analysis but not after adjusting for clinical variables (RR, 2.78; 0.70-6.65). For AKI risk prediction, AUC (95% CI) was highest after combining clinical model and pre-operative ACR for groups aged < 2 years [0.805 (0.713-0.896)] and ≥ 2 years [0.872 (0.772-0.973)]. CONCLUSIONS: This study provides evidence for use of albuminuria as a feasible biomarker in AKI prediction in children post cardiac surgery, especially when added to a clinical model. A higher resolution version of the Graphical abstract is available as Supplementary information.


Assuntos
Injúria Renal Aguda , Procedimentos Cirúrgicos Cardíacos , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/urina , Albuminas , Albuminúria/complicações , Albuminúria/etiologia , Biomarcadores/urina , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criança , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/urina
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