Abnormal Albumin Research Articles

Dysglycemia but not lipids is associated with abnormal urinary albumin excretion in diabetic kidney disease: a report from the Kidney Early Evaluation Program (KEEP)

BackgroundThe relationship between glycemic control and lipid abnormalities with urinary albumin-creatinine ratio (ACR) in chronic kidney disease (CKD) patients with diabetes mellitus (DM) is unknown. We sought to investigate the association of dyslipidemia and glycemic control with levels of albuminuria in the National Kidney Foundation (NKF) Kidney Early Evaluation Program (KEEP) participants with DM and CKD stage 3 or higher.MethodsWe performed a cross-sectional study of 6639 eligible KEEP patients with DM and CKD Stage 3 to 5 from June 2008 to December 2009. Multivariate logistic regression was used to evaluate the association of lipid parameters (per 10 mg/dl change in serum level) and glycosylated hemoglobin (HbA1c) values with three degrees of albuminuria normo (<30 mg⁄g), micro (30 to 300 mg⁄g) and macro (>300 mg⁄g).Results2141 KEEP participants were included. HbA1c levels were strongly associated with micro-albuminuria (compared to normo-albuminuria) and macro-albuminuria (compared to normo-albuminuria and micro-albuminuria). Each 1.0% increase in HbA1c increased the odds of micro-albuminuria by 32% (OR 1.32, 95% CI 1.23-1.42) and the odds of macro-albuminuria (vs. microalbuminuria) by 16% (OR 1.16, 95% CI 1.05-1.28). Only increases in serum HDL were associated with decreased odds of micro-albuminuria; otherwise, the association between other components of the serum lipid profile with urinary ACR did not reach statistical significance.ConclusionIn this cross-sectional study of 2141 KEEP participants with DM and CKD stages 3–5, overall glycemic control but not lipids were associated with abnormal urinary albumin excretion, a marker of increased risk for progressive disease.

Hypertension and antihypertensive treatment in HIV-infected individuals. A longitudinal cohort study

Objectives. Hypertension is a significant contributor to cardiovascular disease in HIV-infected individuals. The purposes of this study were to assess the development of new-onset hypertension and the use of antihypertensive treatment and blood pressure (BP) control. Methods. In a longitudinal study of 434 HIV-infected individuals (43±11 years, 72% males, follow-up 3.4±0.8 years), standardized BP recordings were undertaken at three clinical visits both at baseline and at follow-up, and cardiovascular risk factors were monitored. Adjusted odds ratio (OR) for new-onset hypertension (systolic BP≥140 and/or diastolic BP≥90 mmHg or initiation of antihypertensive treatment) was calculated using multiple logistic regression analyses. Results. New-onset hypertension occurred with an incidence of 29.8 per 1000 person-years (95% CI 20.3–42.2). HIV duration (OR=1.10, 95% CI 1.01−1.20), mean BP (1.24, 95% CI 1.13−1.35) and abnormal urinary albumin excretion (OR=5.47, 95% CI 1.07−27.85) were independent predictors for new-onset hypertension after adjustment. Use of antihypertensive treatment increased threefold from 17% to 49% in hypertensive patients. Adequate BP control was obtained in 22% of patients on antihypertensive therapy. Conclusions. HIV duration predicted new-onset hypertension, which could suggest involvement of low-grade inflammation; this hypothesis needs to be further explored. Despite increased use of antihypertensive treatment, enhanced awareness and adequate treatment of hypertension are still warranted in HIV-infected individuals.

Delirium in cardiac patients: A clinical review

Delirium is a common but preventable clinical syndrome that is distressing for patients, relatives and staff. It occurs frequently on cardiac wards and is associated with important adverse health consequences. In cardiac surgery patients, important preoperative risk factors are presence of cognitive impairment, depressive symptoms, previous stroke or transient ischaemic attack and abnormal albumin. Nursing staff are particularly well placed to facilitate the diagnosis of delirium, which should be suspected if a patient has a rapid onset of fluctuating confusion. The Delirium Observation Screening (DOS) tool has been developed for use by nursing staff during routine ward care to identify delirium. The initial management of delirium involves identification and treatment of the potential cause, or combination of causes. People with delirium may have impaired capacity to consent and health-care professionals who care for people with delirium should therefore be familiar with the assessment of mental capacity.

Risk Factors of Delirium after Cardiac Surgery: A Systematic Review

Delirium or acute confusion is a temporary mental disorder that occurs frequently among hospitalized elderly patients, but also in younger patients a delirium can develop. Patients who undergo cardiac surgery have an increased risk of developing delirium that is associated with many negative consequences. Therefore, prevention of delirium is essential. Despite the high incidence of delirium, a paucity of data on risk factors for delirium exists. The aim of this study was to summarize the available information concerning these risk factors. A literature research was performed using the PubMed, Cinahl, and Cochrane Library databases and was limited to the last 10 years. Our review revealed 27 risk factors; 12 predisposing and 15 precipitating factors for delirium after cardiac surgery. The most established predisposing risk factors were atrial fibrillation, cognitive impairment, depression, history of stroke, older age, and peripheral vascular disease. The most established precipitating risk factor was a red blood cell transfusion. An abnormal albumin level was reported as the most established precipitating risk factor among blood values tested. A low cardiac output and the use of an Intra Aortic Balloon Pump or inotropic medication seem to be the most relevant risk factors associated with a postoperative delirium. A multifactorial risk model should be applied to identify patients at an increased risk of developing delirium following elective cardiac surgery. In these patients, if possible, preventative interventions can be taken and early recognition of delirium can be realized. This could potentially decrease the incidence of delirium and negative consequences caused by a postoperative delirium.

Gastrointestinal symptoms, electrogastrography, inflammatory markers, and PG-SGA in patients with advanced cancer

Electrogastrography (EGG) is a technique used to record gastric myoelectrical activity (GMA). Our aim is to investigate the (1) prevalent patterns of GMA, (2) most frequent gastrointestinal (GI) symptoms reported on the Dyspepsia Symptom Severity Index (DSSI), and (3) EGG diagnosis and correlations with GI symptoms, ghrelin, and inflammatory markers. An EGG was performed 10 min preprandial and 30 min postprandial after ingestion of 500 ml water. EGG measurements were recorded by electrodes positioned externally on the abdominal wall. C-reactive protein (CRP), ghrelin, and albumin were included at baseline. There were 53 patients enrolled, with a median age of 60 years (range, 18-82 years) and EGG diagnoses of mixed dysrhythmia (n = 25), tachygastria (n = 15), bradygastria (n = 6), gastric outlet obstruction (n = 1), and normal (n = 6). Forty-seven patients with an abnormal EGG had high median CRP, low median albumin, and high median ghrelin levels when compared to 6 patients with a normal EGG, with CRP [12 (8-22) vs. 6 (5-8)]; albumin [35 (26-40) vs. 38.5 (34-42)]; ghrelin [4 (2-10) vs. 2.5 (2-9)]. According to the DSSI, the most frequent dysmotility-like symptoms were (1) frequent burping and belching [73.6%], (2) bloating [60.4%], (3) feeling full after meals [69.8%], (4) inability to finish normal-sized meal [66%], (5) abdominal distention [51%], and (6) nausea after meals [50.9%]. The most frequent reflux- and ulcer-like symptoms were (1) regurgitation of bitter fluid [43.4%] and abdominal pain before meals [39.6%]. The most frequent nutrition impact symptoms as recorded on the Patient-Generated Subjective Global Assessment in patients with an abnormal EGG diagnosis were no appetite or did not feel like eating, nausea, vomiting, and feeling full quickly. Abnormal EGG diagnosis, ghrelin, albumin, and CRP levels are found in the majority of patients with advanced cancer. Further studies are needed to better understand the correlation of these abnormal serum levels and their interaction with the pathogenesis of abnormal electrogastrographic rhythms.

Long-Term Effects of Kidney Donation on Renal Function and Blood Pressure in African Americans

African Americans (AAs) have four times higher prevalence of ESRD than Caucasians. Therefore, long-term effects of kidney donation are of considerable importance in this patient population. GFR was measured by (125)I-iothalamate clearance, 24-hour urine albumin excretion, and 24-hour BP monitoring in 33 AAs and 11 CAs who donated kidneys for transplantation 5 to 23 years previously. Mean GFRs were 76 ± 13 and 78 ± 11 ml/min per 1.73 m(2) for AA and CA donors, respectively. Nine percent of the AA donors and none of the CA donors had GFRs below 60 ml/min per 1.73 m(2). AA donors had a tendency for lower prevalence of microalbuminuria compared with CA donors (18.1% versus 36.3%) and a tendency for higher prevalence of macroalbuminuria compared with CAs (12.1% versus 0.0%). Twenty-four percent of the AAs, and 45% of the CAs were hypertensive with mean daytime BP ≥135/85 mmHg. Only 6% of AAs had a decrease in mean nocturnal systolic BP of 10% or more as compared with daytime readings. Older age at time of donation was associated (P = 0.046) with lower GFR values compared with younger ages. Carefully selected AA kidney donors have well preserved renal function and a low prevalence of hypertension many years after kidney donation. Abnormal albumin excretion and loss of physiologic decrease in nocturnal BP is more prevalent in AA donors than the general AA population. Older age at donation may predict lower GFR after donation.

High Rate of Regression From Micro-Macroalbuminuria to Normoalbuminuria in Children and Adolescents With Type 1 Diabetes Treated or Not With Enalapril

OBJECTIVETo evaluate the frequency of normalization, the persistence of remission, and the impact on normalization of glycemic control and lipid profile, we analyzed data from a retrospective observational cohort study of type 1 diabetic children and adolescents with abnormal urinary albumin excretion (UAE).RESEARCH DESIGN AND METHODSAll diabetic children and adolescents (n = 41) who had persistent abnormal UAE in the period of 1984 to 2008 and followed up until 2009 (follow-up duration = 13.1 ± 6.2 years) were included in the study. Nine patients progressed to macroalbuminuria; 24 patients were administered ACE inhibitor treatment.RESULTSThe cumulative prevalence of abnormal UAE was 9%. During follow-up, 14 of 17 untreated and 19 of 24 treated patients reverted to normoalbuminuria. In the remission group compared with the nonremission group, A1C levels during follow-up decreased (7.5 ± 1.0 vs. 9.4 ± 1.2%, P < 0.0001) and serum HDL cholesterol increased (52.7 ± 11.3 vs. 42.7 ± 8.6 mg/dL, P < 0.05). The micro-macroalbuminuric patients had lower HDL cholesterol (51.0 ± 11.4 vs. 62.4 ± 13.6 mg/dL, P < 0.0001) than 134 normoalbuminuric diabetic patients.CONCLUSIONSMicroalbuminuria and macroalbuminuria were not permanent in most of our diabetic children and adolescents. If abnormal UAE values are high and persist for >1 year, only long-lasting treatment with ACE inhibitors seems able to induce persistent remission, especially when associated with good metabolic control and high HDL cholesterol levels.

The Use of Biochemical Parameters as Nutritional Screening Tools in Surgical Patients

Nutritional status influences surgical outcome and complication rates. The National Institute of Clinical Excellence (NICE) recommends screening patients on admission; yet traditional nutritional screening tools are underutilised. This retrospective case-control study investigates the association between biochemical factors and adverse outcomes in orthopaedic patients to ascertain whether they could provide more suitable alternatives to traditional screening tools. 66 patients with fractured neck of femur were investigated. Adverse outcomes including Length of Stay (LOS), and deaths were recorded. Total Lymphocyte Counts (TLC), Serum Albumin Levels and Haemoglobin levels, were recorded pre-operatively (pre-op) and post-operatively (post-op). Adverse outcomes in those with normal and abnormal biochemical values were compared using Chi Squared and T Testing. Linear associations were tested for using Pearson rank correlation. Automated Nutrition Scores Beta (ANSB) were calculated and their relationship to adverse outcomes investigated. Protein energy malnutrition was common on admission. However, only 2 patients were nutritionally screened during admission. Those patients with abnormal pre-op TLC had an increased LOS in hospital. Those with abnormal albumin and/or TLC had increased mortality rates. Abnormal albumin levels were associated with a significant 3 fold increase in mortality (p = 0.009) and post-operative TLC were found to be negatively correlated with LOS (r = –0.3, p = 0.038). ANSB were also found to correlate with increased adverse outcomes although this was not significant. This study demonstrates that nutritional status is poorly assessed on admission in orthopaedic patients and consequently that provision of nutritional supplements is suboptimal. This study also demonstrates a highly significant relationship between abnormal albumin and adverse outcomes and identifies a new correlation between post-operative TLC and LOS. This study confirms that individual biochemical parameters and biochemical scores can be used to identify orthopaedic patients at particular risk of adverse post-op outcomes. These biochemical screening methods may be a more efficient and reliable way of stratifying malnutrition associated risk on admission.

Tubular toxicity of proteinuria

Proteinuria is a prognostic indicator of progressive kidney disease and poor cardiovascular outcomes. Abnormally filtered bioactive macromolecules interact with proximal tubular epithelial cells (PTECs), which results in the development of proteinuric nephropathy. This condition is characterized by alterations in PTEC growth, apoptosis, gene transcription and inflammatory cytokine production as a consequence of dysregulated signaling pathways that are stimulated by proteinuric tubular fluid. The megalin-cubilin complex mediates the uptake of several proteins, including albumin, into PTECs. Megalin might also possess intrinsic signaling properties and the ability to regulate cell signaling pathways and gene transcription after processing regulated intramembrane proteolysis. Megalin could, therefore, link abnormal PTEC albumin exposure with altered growth factor receptor activation, proinflammatory and profibrotic signaling, and gene transcription. Evidence now suggests that other PTEC pathways for protein reabsorption of (patho)physiological importance might be mediated by the neonatal Fc receptor and CD36.

The prevalence of albuminuria in dogs and cats in an ICU or recovering from anesthesia

To evaluate the prevalence of albuminuria in dogs and cats admitted to the ICU or recovering from an anesthetic event. Prospective clinical study over a 10-week period in 2003. Veterinary teaching hospital. One hundred and five dogs and 22 cats. Urine was collected from dogs and cats admitted to the ICU or recovering from an anesthetic event. When possible, a second urine sample was collected approximately 48 hours later from those animals that had albuminuria during the initial screening. All dog samples and most cat samples were screened for albumin using a commercial point-of-care immunoassay. Aliquots of samples that tested positive were stored at -20 °C until subsequent albumin quantification via antigen capture ELISA. Albuminuria was detected in 63 of 105 (60.0%) dogs and in 14 of 22 (63.6%) cats; the prevalence was higher in animals admitted to ICU than in those recovering from anesthesia. In subsequent samples from 26 dogs, urine albumin decreased in 20 (76.9%) when compared with the first sample; urine albumin was undetectable in 5 (19.2%). In subsequent samples from 6 cats, 4 (66.7%) had decreases in urine albumin when compared with the first sample; 1 (16.7%) was negative for urine albumin. Eleven of 12 dogs (91.7%) and 3 of 4 cats (75%) that died within 3 days of admission to the ICU had abnormal urine albumin; whereas 52 of 93 (55.9%) and 11 of 18 (61.1%) dogs and cats, respectively, who survived more than 3 days had abnormal urine albumin. Dogs with albuminuria were at increased risk of death. The prevalence of albuminuria in animals admitted to the ICU or recovering from anesthesia is higher than reported previously and transient in some patients. The presence of albuminuria may be a negative prognostic indicator in this population.

Administration of Olanzapine to Prevent Postoperative Delirium in Elderly Joint-Replacement Patients: A Randomized, Controlled Trial

Delirium is a serious postoperative condition for which few pharmacologic prevention trials have been conducted. The authors tested the efficacy of perioperative olanzapine administration to prevent postoperative delirium in elderly patients after jointreplacement surgery. The authors conducted a randomized, double-blind, placebocontrolled, prophylaxis trial at an orthopedic teaching hospital, enrolling 495 elderly patients age ≥65 years, who were undergoing elective knee- or hip-replacement surgery; 400 patients received either 5 mg of orally-disintegrating olanzapine or placebo just before and after surgery. The primary efficacy outcome was the incidence of (DSM-III-R) delirium. The incidence of delirium was significantly lower in the olanzapine group than in the placebo group; this held true for both knee- and hip-replacement surgery. However, delirium lasted longer and was more severe in the olanzapine group. Advanced age, a high level of medical comorbidity, an abnormal albumin level, and having knee-replacement surgery were independent risk factors for postoperative delirium (Clinicaltrials.gov Identifier: NCT000699946). Administration of 10 mg of oral olanzapine perioperatively, versus placebo, was associated with a significantly lower incidence of delirium. These findings suggest that olanzapine prophylaxis of postoperative delirium may be an effective strategy.

Administration of Olanzapine to Prevent Postoperative Delirium in Elderly Joint-Replacement Patients: A Randomized, Controlled Trial

Delirium is a serious postoperative condition for which few pharmacologic prevention trials have been conducted. The authors tested the efficacy of perioperative olanzapine administration to prevent postoperative delirium in elderly patients after joint-replacement surgery. The authors conducted a randomized, double-blind, placebo-controlled, prophylaxis trial at an orthopedic teaching hospital, enrolling 495 elderly patients age ≥65 years, who were undergoing elective knee- or hip-replacement surgery; 400 patients received either 5 mg of orally-disintegrating olanzapine or placebo just before and after surgery. The primary efficacy outcome was the incidence of (DSM-III-R) delirium. The incidence of delirium was significantly lower in the olanzapine group than in the placebo group; this held true for both knee- and hip-replacement surgery. However, delirium lasted longer and was more severe in the olanzapine group. Advanced age, a high level of medical comorbidity, an abnormal albumin level, and having knee-replacement surgery were independent risk factors for postoperative delirium (Clinicaltrials.gov Identifier: NCT000699946). Administration of 10 mg of oral olanzapine perioperatively, versus placebo, was associated with a significantly lower incidence of delirium. These findings suggest that olanzapine prophylaxis of postoperative delirium may be an effective strategy.

Ischemia-modified albumin and cardiovascular risk markers in polycystic ovary syndrome with or without insulin resistance

The aim of this study was to evaluate ischemia-modified albumin levels (IMA) in polycystic ovary syndrome (PCOS) cases with and without insulin resistance and the correlation of IMA with carotid intima media thickness, homocysteine, and high-sensitivity C-reactive protein levels. Significantly higher levels of IMA in young lean PCOS cases, more relevant in insulin resistant cases, indicates chronic hypoxia and oxidative stress which might play a role in the metabolic consequences in PCOS.

Alpha-thalassemia is associated with a decreased occurrence and a delayed age-at-onset of albuminuria in sickle cell anemia patients

The aim of this study was to identify possible risk factors for albuminuria, an early marker of sickle cell anemia (SCA) glomerulopathy, in a cohort of 189 SCA adult patients followed at the Sickle Cell Center of Guadeloupe, a French Caribbean island. Biological parameters obtained at baseline, α-globin gene status, and β S haplotypes were compared in patients stratified accordingly to graded albuminuria. Abnormal albumin excretion rate was detected in half of the studied adult patients and macroalbuminuria occurred in 21.6%. Graded albuminuria was associated with advanced age ( p = 0.006), systolic blood pressure ( p = 0.031), and worsened anemia, i.e. low hemoglobin rate ( p < 0.0001) and red blood cell count ( p < 0.0001). Alpha-thalassemia frequency was lower in microalbuminuric and macroalbuminuric patients than in normoalbuminuric patients, 12.5%, 13.75% and 26%, respectively ( p = 0.0057). Comparison of albuminuria-free survival curves in SCA patients without and with α-thalassemia showed that the median time of albuminuria onset was delayed in the later ones ( p = 0.021). In contrast, no association of albuminuria was detected with the Bantou β S haplotype. Our results strongly suggest a protective effect of α-thalassemia against glomerulopathy in SCA adult patients which could be related to a decreased hemolytic rate.

Racial Differences in Kidney Function Among Individuals With Obesity and Metabolic Syndrome: Results From the Kidney Early Evaluation Program (KEEP)

Obesity and metabolic syndrome may differ by race. For participants in the National Kidney Foundation's Kidney Early Evaluation Program (KEEP), we examined whether African American and white participants with obesity and metabolic syndrome differ regarding albuminuria, estimated glomerular filtration rate (eGFR), anemia, and bone/mineral metabolism derangements in chronic kidney disease (CKD). 3 study cohorts were assembled: (1) eligible African American and white KEEP participants with body mass index > or = 30 kg/m(2), (2) a subgroup meeting criteria for metabolic syndrome, and (3) a subgroup with eGFR < 60 mL/min/1.73 m(2) and laboratory measurements for hemoglobin, parathyroid hormone, calcium, and phosphorus. Patient characteristics and kidney function assessments were compared and tested using chi(2) (categorical variables) and t test (continuous variables). Univariate and multivariate logistic regression analyses were performed to evaluate associations of race with kidney disease measures. Of 37,107 obese participants, 48% were African American and 52% were white. Whites were more likely to have metabolic syndrome components (hypertension, 87.1% vs 84.8%; dyslipidemia, 81.6% vs 66.7%; diabetes, 42.7% vs 34.9%) and more profoundly decreased eGFR than African Americans (CKD stages 3-5 prevalence, 23.6% vs 13.0%; P < 0.001). African Americans were more likely to have abnormal urinary albumin excretion (microalbuminuria, 12.5% vs 10.2%; OR, 1.60 [95% CI, 1.45-1.76]; macroalbuminuria, 1.3% vs 1.2%; OR, 1.61 [95% CI, 1.23-2.12]) and CKD stages 1-2 (10.3% vs 7.1%; OR, 1.54 [95% CI, 1.38-1.72]). For participants with CKD stages 3-5, anemia prevalence was 32.4% in African Americans and 14.1% in whites; corresponding values for secondary hyperparathyroidism were 66.2% and 46.6%, respectively. Obesity and metabolic syndrome may be heterogeneous disease states in African Americans and whites, possibly explaining differences in long-term kidney and cardiovascular outcomes.

Breast Cancer in Association with Radial Scar/Complex Sclerosing Lesion (rs/csl): Long Term Follow Up and Risk of Subsequent Breast Cancer

Breast Cancer in Association with Radial Scar/Complex Sclerosing Lesion (rs/csl): Long Term Follow Up and Risk of Subsequent Breast Cancer

Importance of serum albumin level in the preoperative tests conducted in elderly patients with hip fracture

Background Preoperative testing is commonly performed in patients undergoing surgery for hip fractures. The purpose of this study was to determine the appropriate preoperative tests after implementation of the case-payment reimbursement system and clinical pathway. Methods We analysed 242 patients admitted to a regional hospital for hip fracture. Preoperative comorbidities and laboratory test results were measured and evaluated for their association with the occurrence of postoperative adverse outcomes. Results Univariate analysis showed that abnormal chest X-ray, haemoglobin, albumin, and total protein were associated with concomitant pulmonary diseases. Abnormal electrocardiogram (ECG), Na, creatinine, and aspirate aminotransferase (AST) levels were associated with heart disease. On the base of the univariate analysis, the significant preoperative variables for increased postoperative complications at 30 days included abnormal chest X-ray (odds ratio, 4.45; 95% confidence interval (CI), 2.24–8.84), ECG (odds ratio, 3.95; 95% CI, 1.96–7.95), Hct (odds ratio, 2.22; 95% CI, 0.96–5.16), Hb (odds ratio, 2.68; 1.29–5.58), blood urine nitrogen (odds ratio, 2.69; 95% CI, 1.34–5.42), creatinine (odds ratio, 4.49; 2.31–8.75), albumin (odds ratio, 9.68; 95% CI, 3.16–29.65), and AST (odds ratio, 2.36; 95% CI, 1.12–4.98). After adjustment for age, sex, and comorbidities, the risk factors that improved the predictability of postoperative complications were found to be abnormal chest X-ray (odds ratio, 6.03; 95% CI, 1.84–19.82) and albumin level (odds ratio, 6.23; 95% CI, 1.90–20.42). Conclusion Serum albumin level and preoperative chest X-rays should be included in the preoperative routine tests recommended for elderly patient with hip fracture.

Up-regulation of protease-activated receptor-1 in diabetic glomerulosclerosis

Patients with diabetes are under a hypercoagulable state leading to generation of thrombin. It is not known whether thrombin plays a role in the progression of diabetic nephropathy. We analyzed gene expression of two thrombin receptors, protease-activated receptor-1 (PAR-1) and PAR-4 in the kidney of diabetic db/db mice. Mice developed hyperglycemia from 7 to 10 weeks of age and showed renal abnormalities such as mesangial expansion and urinary albumin excretion at 10 weeks of age. PAR-1 mRNA was up-regulated in isolated glomeruli in db/db mice compared with age-matched db/m littermates, but PAR-4 mRNA was not. In situ hybridization studies showed that PAR-1 mRNA was detected mainly at the glomerulus, and that intensive signals were observed in mesangial cells and podocytes. The up-regulation of PAR-1 in glomeruli in diabetic mice may play a role in the progression of glomerulosclerosis and abnormal urinary albumin excretion in diabetic nephropathy.

Dietetic habits and quality of semen in Indian subjects.

Dietetic habits revealed significant effect on seminal plasma vitamin B12 levels. The mean values for seminal plasma vitamin B12 activity in lactovegetarians from normozoospermic, oligozoospermic and azoospermic groups are significantly lower than the corresponding mean values observed in the nonvegetarian subjects. The mean vitamin B12 content of seminal plasma in azoospermic group was distinctly lower than the mean values in normozoospermic and oligozoospermic groups. However, seminal plasma vitamin B12 values showed no correlation with the sperm content of the corresponding semen in both normozoospermic and oligozoospermic subjects. Studies on sperm morphology and on biochemical parameters revealed no significant effect of the type of diet on sperm count, sperm motility, percentage abnormal sperms, seminal plasma total proteins, albumin, fructose, citric acid, acid and alkaline phosphatase activity in normozoospermic group.

High Rate of Deficiency in the Amino Acids Tryptophan and Histidine in People with Wounds

Malnutrition resulting from inadequate protein, energy, or micronutrient intake has been identified as an independent risk factor for the development of pressure ulcers in older adult patients and is associated with increased morbidity and death. To assess the relationship between albumin, the standard biochemical marker of nutritional adequacy, and amino acid status in people with wounds. The authors performed tests for serum albumin, prealbumin, and amino acid profiles on 18 consecutive hospital patients with wounds and 7 patients without wounds. A low level of the essential amino acids tryptophan and histidine was a common finding in older people with wounds. Of the 18 consecutive wound cases, 16 (88.9%) were found to be deficient in tryptophan, histidine, or both. Moreover, levels were generally found to be lower than those in the group without wounds. The levels of all other amino acids were essentially normal for all patients. Finally, although serum albumin is often used as a surrogate marker of amino acid adequacy or nutritional status, clinically abnormal albumin had poor specificity (63.2%), poor sensitivity (60.7%), and low positive predictive value (70.8%) for the identification of a low tryptophan or histidine level. People with wounds are a relatively at-risk group and are likely to be overlooked in terms of micronutrient deficiencies, and these findings have important implications in terms of potential specific targeting of nutrient supplementation.