Association Of Albuminuria Research Articles

The multidimensional nature of renal disease: Rates and associations of albuminuria in an Australian Aboriginal community

An epidemic of end-stage renal disease (ESRD) is accompanying the rising rates of hypertension, type 2 diabetes and cardiovascular disease among Aborigines in the Northern Territory of Australia. Incidence rates are now 21 times those of nonAboriginal Australians and are doubling every four years. We describe the rates and associations of renal disease in one remote community, which has a current ESRD incidence of 2700 per million, and cardiovascular mortality among the highest in Australia. Between 1992 and 1995 a community-wide screening program was conducted, in which the urinary albumin/creatinine ratio (ACR) was used as the chief renal disease marker. More than 90% of the population ages five and older participated. Albuminuria was evident in early childhood and increased dramatically with age; 26% of adults had microalbuminuria and 24% had overt albuminuria. All renal failure developed out of a background of overt albuminuria. ACR was significantly correlated with the presence of scabies at screening, with a history of poststreptococcal glomerulonephritis, which is epidemic and endemic in the community, with increasing body wt, blood pressure, glucose, insulin and lipid levels, and with evidence of heavy drinking. ACR was also significantly and inversely correlated with birth weight. As a result of its association with deteriorating hemodynamic and metabolic profiles, increasing ACR was also correlated with increasing cardiovascular risk score. Direct observations showed, and multivariate models predicted, progressive amplification of ACR when multiple risk factors were present simultaneously. Albuminuria also clustered in families. Renal disease in this population is multifactorial, with risk factors related to whole-of-life nutrition, metabolic and hemodynamic profiles, infections, health behaviors, and possibly a family predisposition. Its relationship to low birth weight, and its associations with deteriorating metabolic and hemodynamic profiles, suggest that renal disease is, in part, a component of Syndrome X, which explains the simultaneous increase in metabolic, cardiovascular and renal disease in Aboriginal people. The family clustering might have both environmental and genetic causes, and is under further investigation. Most of the identified risk factors arise out of poverty, disadvantage and accelerated lifestyle change, and the current epidemic can be explained by the confluence of many risk factors in the last few decades. The introduction of effective and sustained programs to address social, economic and educational inequities in all Aboriginal communities, and of screening and renal- and cardiovascular-protective treatment programs for those already afflicted are matters of great urgency.

Towards an epidemiologic definition of renal disease: Rates and associations of albuminuria in a high‐risk Australian Aboriginal community

Summary: An epidemic of renal failure is accompanying the rising rates of hypertension, type 2 diabetes and cardiovascular disease among Aborigines in the Northern Territory of Australia. the rates and associations of the underlying renal disease were studied in a remote Aboriginal community whose renal failure rates are among the highest reported in the world. More than 90% of school‐age children and adults participated in a health screen, in which the urinary albumin/creatinine ratio (ACR) was used as the primary renal disease marker. Albuminuria was evident in early childhood and increased dramatically with age; 26% of adults had microalbuminuria and 24% had overt albuminuria. Most hypertension segregated in persons with albuminuria and all renal failure developed out of a background of overt albuminuria. ACR levels correlated with the presence of scabies at screening, with a history of post‐streptococcal glomerulonephritis, with increasing bodyweight or its surrogates, with increasing blood pressure, glucose, insulin and lipid levels, and with evidence of heavy drinking. ACR also correlated inversely with birthweight. Finally, increasing ACR correlated with an increasing cardiovascular risk factor score. Thus many factors contribute to renal disease in this community; most are the features and consequences of lifestyle change, poverty and disadvantage. Renal disease shares risk factors, including low birthweight, with Syndrome X, which supports the inclusion of renal disease in that syndrome, and explains the excess cardiovascular morbidity in people with chronic renal disease. There is an urgent need for effective programs to modify recognized risk factors, and to identify and treat people with established renal disease to retard the progression of renal insufficiency.

Serum and urine albumin: a progress report on their measurement and clinical significance

For about 25 years, bromcresol green and bromcresol purple have been the basis for most of the measurements of serum albumin in the US and perhaps in the world. The longevity of the methods is due to their being simple, sensitive, specific, inexpensive and relatively free from interferences. The lack of change in the serum albumin methodology is balanced by two important developments. First, the recognition of the importance of serum albumin in the maintenance of good health, and the association of decreased concentrations with increased risk of morbidity and mortality. Second, the association of albuminuria with diabetic nephropathy, which without medical intervention could lead to end-stage renal disease. The development of accurate and precise methods for urinary albumin has provided a tool to physicians to extend the length and improve the quality of life of many diabetic individuals.

Regional differences in albuminuria among American Indians: An epidemic of renal disease

Albuminuria is a risk factor for renal and cardiovascular disease. We conducted a cross sectional survey of 4549 older American Indians in Arizona, Oklahoma and North and South Dakota of (micro)albuminuria. A range of 20.1 to 48.3% of all participants had either micro- (> or = 30 to < 300 mg albumin/g creatinine) or macroalbuminuria (> or = 300 mg albumin/g creatinine). A total of 53% of the participants were diabetic, and the prevalence in Arizona (65 to 70%) was significantly greater than the other two sites. Prevalence of micro- and macroalbuminuria were significantly higher among those who were older, diabetic or hypertensive, and participants from Arizona. Even normotensive, nondiabetic Arizona Indians had higher prevalence rates than similar participants elsewhere. Higher prevalence rates of micro- and macroalbuminuria were also found among Arizona participants than participants with similar degrees of glucose intolerance from the other two sites. Indians reporting the greatest degree of Indian blood were more likely to have abnormal albuminuria (P < 0.0001). The duration of diabetes, fasting plasma glucose, systolic blood pressure, fibrinogen and Indian heritage were independently associated with micro- or macroalbuminuria. The association of albuminuria with subsequent ESRD, cardiovascular morbidity and overall mortality suggests that these American Indians will face a large disease burden. The correlation with reported Indian blood implies a strong component of genetic susceptibility, possibly independent of diabetes.

Incipient and Overt Diabetic Nephropathy in African Americans With NIDDM

OBJECTIVE--To determine the prevalence of incipient and overt nephropathy in African-American subjects with non-insulin-dependent diabetes mellitus (NIDDM) attending a hospital clinic. Contributory factors, such as blood pressure (BP), duration and age at onset of diabetes, hyperglycemia, hyperlipidemia, and body mass index (BMI) also were evaluated. RESEARCH DESIGN AND METHODS--We recruited 116 African-American subjects with NIDDM for this cross-sectional, descriptive, and analytical study. BP, BMI, 24-h urine albumin excretion, creatinine clearance, serum creatinine, lipids, and GHb levels were measured. Albumin excretion rate (AER) was calculated, and subjects were divided into three groups: no nephropathy (AER < 20 micrograms/min), incipient nephropathy (AER 20-200 micrograms/min), and overt nephropathy (AER > 200 micrograms/min). Frequency of hypertension and nephropathy was analyzed by chi 2 testing, group means were compared using analysis of variance, and linear correlations were performed between AER and other variables. Multiple regression analysis was used to examine the association of these variables while controlling for the effects of other variables. RESULTS--Increased AER was present in 50% of our subjects; 31% had incipient and 19% had overt nephropathy. Hypertension was present in 72.4%; nephropathy, particularly overt nephropathy, was significantly more prevalent in the hypertensive group. Mean BP and diastolic blood pressure (dBP) were higher in the groups with incipient and overt nephropathy, and systolic blood pressure (sBP) was increased in overt nephropathy. Men with either form of nephropathy had higher sBP, dBP, and mean BP, whereas only women with overt nephropathy had increased sBP and mean BP. Subjects with incipient or overt nephropathy had a longer duration of diabetes, and those with overt nephropathy had a younger age at onset of diabetes. By multiple regression analysis, AER correlated with younger age at diabetes onset, but not with diabetes duration. No correlation with age, lipid levels, or GHb was noted. BMI correlated with AER. CONCLUSIONS--Incipient and overt nephropathy were observed frequently in these African-American subjects with NIDDM. Albuminuria correlated with BP, younger age at diabetes onset, and BMI. Association of albuminuria and increased cardiovascular mortality may place 50% of inner-city African-American patients with NIDDM at risk for developing cardiovascular complications.

Malignant hypertension. Current modes of therapy.

The story of human hypertension research really begins in 1836 as a by-product of Richard Bright's 1 investigations into the association of albuminuria and dropsy, which developed the broad concept of systemic vascular disease. In 1872, Gull and Sutton 2 formulated the concept that a vascular disease, which they called "arterio-capillary fibrosis," was present as the "primary and essential condition in the morbid state called chronic Bright's disease with contracted kidneys." A new era in the study of hypertension began in 1879 with Frederick Horatio Akbar Mahomed's 3,4 report on the first systematic investigation of blood pressure during life. He observed that elevation in blood pressure may either precede or follow renal disease, and he proposed the concept that "what is the cause in one case may be the result in another." That hypertension may occur independent of renal disease and may pursue a variable course was reported by three

Malignant Hypertension

The story of human hypertension research really begins in 1836 as a by-product of Richard Bright's1investigations into the association of albuminuria and dropsy, which developed the broad concept of systemic vascular disease. In 1872, Gull and Sutton2formulated the concept that a vascular disease, which they called arterio-capillary fibrosis, was present as the primary and essential condition in the morbid state called chronic Bright's disease with contracted kidneys. A new era in the study of hypertension began in 1879 with Frederick Horatio Akbar Mahomed's3,4report on the first systematic investigation of blood pressure during life. He observed that elevation in blood pressure may either precede or follow renal disease, and he proposed the concept that what is the cause in one case may be the result in another. That hypertension may occur independent of renal disease and may pursue a variable course was reported by three

ALBUMINURIA IN ASSOCIATION WITH SCABIES

The association of albuminuria with scabies was discussed frequently in the French and the German literature several years ago. Some authors claimed that it was common, while others denied its existence. As I have failed to find any recent articles on this subject, although it is mentioned in several of the standard textbooks of dermatology, I consider an attempt to settle this question indicated. REVIEW OF THE LITERATURE In a series of 1,300 Japanese patients (the author did not state how many had scabies) Scheube 1 found 17 instances of albuminuria which, according to his belief, were due to scabies. Boyer 2 described 5 cases in which albuminuria appeared at the onset of scabies, before any treatment was started, and disappeared when the scabies was cured. There are many reports of albuminuria caused by various drugs used in the treatment of scabies. Nine of 124 patients with scabies who were

STUDIES ON ALBUMINURIA AND EOSINOPHILIA IN SCABIES

The association of albuminuria with scabies has been a matter of interest, speculation and investigation for over a hundred years. Although it would seem that so simple a matter could be easily and finally settled, yet the results of investigation by different authors vary greatly, not only as to its frequency and severity, but even to its actual occurrence. LITERARY REVIEW Posner 1 found albumin in the urine of all scabies patients with his reagent. Spiegler, quoted by Hubner, also came to the same conclusion; but Hubner 2 showed that these observers had used a reagent that gave a positive reaction from dilutions of 1: 50,000 at least, and for which, as even Spiegler himself remarked, it was difficult to find albumin free controls. The reagent was also positive with peptone albuminoses and nucleo-albumins. Hubner found albumin in the urine of forty-seven out of fifty scabetic patients with Spiegler's reagent,

POSTURAL OR ORTHOSTATIC ALBUMINURIA

Following Richard Bright's observation, in 1827, of the direct association of albuminuria with pathological changes in the kidneys, the medical profession showed a natural tendency to regard the presence of albumin in the urine as a positive sign of nephritis. It was not long after Bright's discovery, however, that cases began to appear in which examination of the urine showed albumin to be present without any evidences of ill health in the patient and without the fatal outcome commonly associated with nephritis. Such observations have steadily increased in number, so that for some time past there has been an increasing tendency toward the belief that albumin in the urine is not necessarily an indication of serious pathological change in the kidney. This tendency to regard the presence of albumin as of not very serious moment has led to the adoption of numerous terms to define the