Urine Collection Research Articles

Evaluation of the relationship between serum uric acid level and proteinuria in patients with type 2 diabetes

Introduction: Diabetes mellitus and diabetic nephropathy are the most common causes of end-stage renal disease (ESRD) in developed countries, accounting for about 30% of these cases. Up to 40% of patients with type 2 diabetes with micro albumin uria progress to overt nephropathy and develop ESRD after one to two decades. Albumin uria is the most important indicator of diabetic nephropathy and its progression. Also, hyperuricemia has been suggested as a risk factor for kidney damage, this study was designed to determine the relationship between serum uric acid level and proteinuria in patients with type 2 diabetes. Materials and methods: In this descriptive-analytical and cross-sectional study, data collection was performed among patients with type 2 diabetes referred to the diabetic Center in Gorgan from the years 2015 to 2018. The data collection tool was a two-part questionnaire including demographic and anthropometric characteristics and information about the disease. Serum levels of Uric Acid, Blood Urea Nitrogen (BUN), Creatinine (Cr), Fasting Blood Sugar (FBS) and Hemoglobin A1C (HbA1C) were measured in all patients. 24-hour urine collection was performed for proteinuria, albuminuria, urinary volume, and Cr volume. Patients’ GFR was also calculated using the CKD-EPI formula. Patients were re-evaluated 1 year after the initial evaluation in terms of measured factors and the relationship between serum uric acid and albuminuria, proteinuria, kidney function, and other serum factors were evaluated. Results: Among 823 diabetic patients that were referred to the nephrology center in this study, 90 patients were included. 34 (37.8%) of these patients were men. The age range of patients was between 32 years to 70 years with a mean of 56.31 and a standard deviation of 7.84 years. According to the Pearson correlation coefficient, a direct correlation was observed between uric acid with proteinuria and creatinine levels, and an inverse correlation was observed between uric acid and GFR. But we didn’t find any correlation between uric acid and microalbuminuria. Conclusion: According to the results of this study, the relationship between uric acid level and the severity of nephropathy (based on proteinuria) is proven. It seems that maintaining serum uric acid levels in patients with type 2 diabetes within the normal range and treatment with serum uric acid-lowering drugs may be possible to reduce the progression of diabetic nephropathy and proteinuria.

Chemical composition, energy content and apparent total tract digestibility of extruded full fat soybean from different sources fed to non-gestating, gestating and lactating sows.

This experiment was conducted to determine the chemical composition, digestible energy (DE), metabolizable energy (ME) and the apparent total tract (ATTD) of nutrients in six extruded full fat soybean (EFSB) samples from different sources fed to non-gestating, gestating and lactating sows. Forty-two non-gestating sows (Landrace × Yorkshire; parity 3 to 5), 42 gestating sows (Landrace × Yorkshire; parity 3 to 5; day 90 of gestation) and 42 lactating sows (Landrace × Yorkshire; parity 3 to 5; day 6 of lactation) were assigned to seven dietary treatments including a corn-based diet and six diets containing 30.24% EFSB from different sources in a completely randomized design with six replicate sows per dietary treatment. Total fecal and urine collection method was used during non-gestation and gestation, and the index method was used during lactation (0.3% chromic oxide). Differences in the chemical composition of the six EFSB samples from different sources were mainly reflected in ether extract, ash, crude fiber, neutral detergent fiber (NDF), acid detergent fiber, total dietary fiber, insoluble dietary fiber, soluble dietary fiber, and vitamin and micro minerals content, with a coefficient of variation ≥8.37%. The potassium hydroxide solubility of the six EFSB samples varied from 66.60% to 85.55%. There were no differences in ATTD of NDF between different EFSB samples. Additionally, there were no differences in ME values and ME/DE ratios between different physiological stages, but ATTD of NDF were higher for non-gestating and gestating sows than lactating sows (P < 0.01). In conclusion, EFSB can be used as a high-quality energy ingredient with high DE and ME values when fed to sows. DE values of EFSB in non-gestating, gestating, and lactating sows were 20.50, 20.70, and 20.02 MJ/kg, respectively, while ME values of EFSB was 19.76 MJ/kg in both non-gestating and gestating sows.

Quantifying the daily intake of water from morning and spot urine samples; retrospective analysis of a clinical trial in volunteers

BackgroundThe hydration status can be indicated by biomarkers in the urine. However, the sensitivity and specificity of single measurements of biomarkers in morning urine and spot urine samples to quantify previous and current daily water ingestion is unclear.MethodsThe water content of food and liquid consumed by 20 volunteers (mean age 42 years) was calculated daily for two weeks. The volunteers increased their consumption of water by approximately 30% during the second week. They measured their excreted urine volume and sampled the morning urine and 24-h collections of urine for analysis of osmolality and creatinine during the first four days of both weeks (N = 157). The same biomarkers of hydration were measured in spot samples taken at every voiding on the other days (N = 762). Receiver operating characteristic (ROC) curves were used to study the ability of pre-specified ranges of biomarkers to quantify the water intake.ResultsThe biomarkers in the morning urine obtained during normal fluid intake quantified the water consumption with an average area under the ROC curve (AUC) of 0.72 for osmolality and 0.66 for creatinine. Spot urine yielded an AUC of 0.74 for osmolality and 0.70 for creatinine. The AUCs obtained for days of increased fluid intake were approximately 10% lower. Large intakes (3–4 L daily) were identified with a sensitivity of 50–80% and low intakes (< 1.5–2 L) with a sensitivity of 20–50%, while false positives occurred in approximately 10%.ConclusionBiomarkers in morning urine and spot urine samples distinguished between large and small daily water intakes. Osmolality was slightly superior to creatinine. The indications were less useful during days of increased fluid intake.

Comparison between 24-hour diet recall and 24-hour urine collection for estimating sodium and potassium intakes and their ratio among Korean adults.

This study aimed to compare 24-h diet recall (DR) and 24-h urine collection (UC) for estimating sodium and potassium intakes and their ratio (Na/K), identifying factors associated with sodium and potassium intakes and Na/K, and identifying those who were likely to underestimate sodium and potassium intakes by DR. A total of 640 healthy adults aged 19-69 yrs completed a questionnaire survey, salty taste assessment, anthropometric measurement, two 24-h DRs, and two 24-h UCs. The mean sodium and potassium intakes and Na/K were 3,755 mg/d, 2,737 mg/d, and 1.45 according to DR, and 4,145 mg/d, 2,812 mg/d, and 1.57 according to UC, with percentage differences of -9.4%, -2.7%, and -7.6% in the values between the two methods, respectively. Men, older adults, smokers, obese individuals, those who consumed all the liquid in the soup, and those who were found to be salty in the salty taste assessment consumed significantly more sodium; older adults, the heavy- activity group, and obese individuals consumed more potassium; and men, younger adults, smokers, and obese individuals had a significantly higher Na/K, according to UC. Compared with UC, DR was more likely to underestimate sodium intake in older adults, smokers, obese individuals, those who consumed all the liquid in the soup, and those who consumed eating-out/delivery food at least once a day, and potassium intake in older adults, the heavy-activity group, and obese individuals. The mean sodium and potassium intakes and Na/K estimated by DR were comparable to those measured by UC. However, the association of sodium and potassium intakes with sociodemographic and health-related factors showed inconsistent results when estimated by DR and UC. Factors influencing the underestimation of sodium intake by DR compared to UC should be further investigated.

К традиционной технологии выделки кожи у народов Сибири: использование танинов при дублении и окрашивании шкуры

Tanning is the final stage of turning the animal skin into tanned leather. In the distant past, tanners known exclusively the vegetable tanning substances, the main of which was tannin. In different quantities it is found in almost all plants and trees. A century and a half ago, chemists invented a method of tanning using chromium, which quickly displaced tannin tanning from the production process due to cheapness and short time frame of its implementation. The use of urine and deer droppings in the skin dressing of Chukchi and Koryak only seems exotic among the many ways to soften the dermis among Siberian aborigines. Back in ancient Rome, there was a tax on the collection of urine by tanners for this purpose, and manure treatment (the use of rotten dog excrement and bird droppings) was widely practiced in the manufacture of soft and thin morocco in the East. The relevance of the traditional method of leather tanning is beyond doubt. The method of tanning with chromium and its derivatives used in modern production facilities is highly toxic, and the production of such leather is accompanied by pollution of the environment and waste of water. Leather products, produced by traditional methods are becoming more and more popular. The article is written based on field materials collected during the expeditionary work among the Chukchi and Koryaks in the village Achayvayam (Olyutorsky District of the Kamchatka Krai) at the end of the last century

PS-P14-2: ARTERIAL HYPERTENSION AND SALT CONSUMPTION IN LITHUANIA

Objective: Though it is an easily modifiable factor, high salt consumption remains the major contributor of the development of arterial hypertension and cardiovascular mortality. The World Health Organization recommends to consume less than 5 g salt per day. We aimed to evaluate the associations of 24-hour urinary sodium excretion and arterial blood pressure in Lithuanian adult population. Design and method: 1082 randomly selected individuals (18–69 years) were invited to participate in the study. We obtained 1035 samples of 24-hour urine collections, but 147 participants were excluded due to incomplete or inaccurate urine collection and/or 24 h urinary creatinine excretion outside 2 standard deviations of the sex-specific distribution. Three blood pressure (BP) readings were measured, separated by at least 1 min. Arterial hypertension was defined as systolic or diastolic BP &gt; 140/90 mmHg and/or antihypertensive treatment and/or previously diagnosed hypertension. 9 individuals were excluded due to missing blood pressure measurements. Results: In a final analysis 879 individuals were enrolled, 52.67% was female. Mean age of all participants was 47.49 (±12.05) years old. Mean 24-hour urinary sodium excretion was 162.5mmol/24 hours and calculated mean salt consumption was 9.97 g (±5.29). Males had higher mean salt consumption than females (11.76 ± 5.8 g vs. 8.36 ± 4.2, p &lt; 0.001). 35.7% of participants were identified to have arterial hypertension, a quarter were treated with antihypertensive medication. Hypertensive individuals had significantly higher salt consumption than normotensive participants of this study (11.1 ± 6.3 g vs. 9.35 ± 4.5 g, p &lt; 0.01). Correlation coefficient between arterial hypertension and salt consumption was 0.25 (p &lt; 0.001). Conclusions: Mean salt consumption in Lithuania twofold exceeds recommended amount. Male individuals use more salt than female. Hypertensive individuals have higher salt consumption.

Development of a kit for urine collection on filter paper as an alternative for Pompe disease screening and monitoring by LC-HRMS.

Pompe disease (PD) is an inborn error of metabolism caused by α-glucosidase acid enzyme deficiency. It significantly impacts patients' health and life quality and may lead to death in the first few years of life. Among the well-established diagnostic methods, urinary glucose tetrasaccharide (Glc4) screening by high performance-liquid chromatography has been helpful in monitoring Glc4 levels in patients on enzyme replacement therapy, demonstrating therapy efficacy. However, the specimen shipping process from a sample collecting location to a specialized laboratory for monitoring the Glc4 is costly and presents preanalytical challenges. In this work, we developed a filter paper based-urine collection kit to facilitate specimen shipment, and liquid chromatography coupled with high-resolution mass spectrometry (LC-HRMS) analysis to determine Glc4 and creatinine in dried urine on filter paper. The LC-HRMS was based on a combination of targeted and untargeted screening on the same specimen injection and was successfully developed and validated. Bland-Altman statistics revealed a good relationship between dried and liquid urine samples and Glc4 and creatinine. Glc4 and other metabolites in dried urine showed stability for at least 7 days at 4 and 22 °C, and 3 days at 50 °C. The stability of the analytes and the efficiency of the kit were tested simulating real conditions by sending it by post. After two days in transit without refrigeration, the stability of compounds was maintained, showing the reliability of the urine collection kit and analysis method to determine the PD biomarker Glc4.

PS-BPB05-3: SERINE PROTEASE INHIBITION EXERTS AQUARETIC EFFECT AND DECREASES URINARY EXOSOMAL AQP2 LEVELS

Objective: Serine proteases (SPs) play pivotal roles in various physiological processes. In the kidney, it is reported that the epithelial sodium channel (ENaC) is activated via the proteolytic cleavage of α and γ subunits by SPs. We previously reported that a synthetic SP inhibitor camostat mesilate (CM) suppressed the cleavage of γENaC, thereby decreasing sodium reabsorption and blood pressure in aldosterone-infused rats. These results suggest the important roles of SPs within the kidney in the regulation of sodium homeostasis and blood pressure. Here, we aimed to identify novel physiological roles of SPs in the renal tubule and understand the mechanism of actions of SP inhibitors by administering CM into healthy rats. Design and method: Six-week-old male Sprague-Dawley rats were divided into control and CM groups. CM group rats were subcutaneously implanted with sustained-release pellets of CM (14 mg/day). After 24 h urine collection was performed, rats were sacrificed at day 7 to obtain blood and kidney samples. Urine volume was measured during the experimental period, and blood and urinary electrolytes, blood vasopressin, and renal tissue osmolality were measured. Protein expression of SPs and aquaporin-2 (AQP2) was analyzed by Western blotting. Results: CM significantly increased urine volume by approximately two-fold throughout the experimental period [urine volume (mL/day): control, 15.5 ± 2.4; CM, 30.6 ± 5.8], in a urinary sodium and osmolyte excretion-independent manner, which indicated that free water excretion had occurred. The vasopressin, potassium, and calcium levels in the blood and osmolality in the inner medulla, which affect free water reabsorption in the renal tubule, remained unchanged after CM administration. CM decreased urinary exosomal AQP2 excretion, suggesting that the AQP2 activity was suppressed in the collecting duct. These changes were reversed by the infusion of desmopressin. Such water diuretic action caused by CM was independent of its action on prostasin and TMPRSS4, which are serine proteases associated with sodium and water homeostasis, respectively. Conclusion: Our results revealed the association of SP inhibition with free water diuresis in the kidney and demonstrated that CM administration resulted in the downregulation of AQP2. The current findings suggest that SP inhibitors could become a new class of aquaretic drugs.

S-27-2: RENAL WATER LOSS-INDUCED SKIN WATER CONSERVATION LEADS TO HIGH BLOOD PRESSURE IN SPONTANEOUSLY HYPERTENSIVE RATS

Objective: Although previous studies have demonstrated the pathophysiological basis of hypertension in basic and clinical sciences, the decisive mechanism of essential hypertension remains to be clarified. We recently reported that 5/6 nephrectomized rats exhibited renal water loss due to impaired renal concentration ability and that the renal water loss triggered suppression of transepidermal water loss (TEWL). This skin water conservation was achieved by skin vasoconstriction-mediated reduction in skin vascular mass, which increased blood pressure in 5/6 nephrectomized rats. In this study, we examined the effect of renal and skin water handling on high blood pressure in spontaneously hypertensive rats (SHR). Design and method: We used male 9 weeks old SHR and its control normotensive Wistar Kyoto rats (WKY) in this study. The rats were kept in metabolic cages to collect urine for 24 hours. We also collected urine under water deprivation. After the urine collection, the rats were sacrificed and their plasma and tissues were collected. Skin sodium and potassium content were measured by the ashing-flame photometer method. In a separate experiment, we compared blood pressure and TEWL in anesthetized SHR and WKY. Body temperature was raised by elevating room temperature. Results: Compared with WKY, SHR exhibited a significant increase in urine volume and a decrease in urine osmolality. There were no significant differences in plasma osmole concentrations, urinary sodium, potassium, and urea excretion between the groups. SHR showed significantly higher urine volume and lower urine osmolarity than WKY even in water deprivation, suggesting that SHR has renal water loss. SHR exhibited significantly lower TEWL and higher blood pressure and skin sodium and potassium content compared with WKY. Skin vasodilation induced by elevating body temperature significantly reduced blood pressure in SHR but not WKY. Conclusions: These findings suggest that renal water loss due to the impaired renal concentration ability induces suppression of TEWL and skin osmole accumulation in SHR. This skin water conservation leads to high blood pressure via skin vasoconstriction to reduce skin vascular mass and TEWL. Skin water conservation as a compensatory mechanism for renal water loss may be a key mechanism and novel therapeutic target for essential hypertension.

The Paper-Based Biosensor for Early Detection of Oral Cancer

The significance of paper-based biosensors for the early stage detection of oral cancer and their compatibility with affordable and low-cost diagnostics have been discussed in this article. Oral cancer is a major public health concern in India, and early-stage detection can be a great boon to the public. Among all the available methods for diagnosis, paper-based biosensors have proven to be very efficient in all aspects. It requires a very small volume of sample and very little time, and the process of detection is very simple. The diagnostic platform described here employs a hydrophobic material (wax) to pattern microfluidic channels on a hydrophilic substrate (paper) to detect the desired biomarker in saliva as biological fluid. Biomarker detection in saliva is advantageous because it is a noninvasive and potentially diagnostic sample. One of the primary benefits of using saliva in diagnosis is that sample collection is simple and noninvasive, significantly reducing the discomfort associated with blood collection and the privacy concerns associated with urine collection. The presence of biomarkers such as salivary cotinine and nitrite can be detected on a single paper-based analytical device, allowing for parallel quantification of the biomarkers. Calorimetric assays are used to analyze the biomarkers qualitatively, and ImageJ software is used to analyze the biomarkers quantitatively

PS-C35-8: ESTIMATING A MODEL FOR 24-HOUR URINARY SODIUM EXCRETION FROM SPOT URINE SODIUM AND CREATININE OF BANGLADESHI POPULATION

Background: The best estimate of population distribution and the average level of dietary salt intake is provided by measuring 24hour urinary sodium (Na) excretion in a representative sample. Collection of 24hour urine is difficult for community living people, and therefore, use of the spot urine Na concentration for estimation of daily salt intake was proposed as an alternative to 24hour urine collection. Purpose: To develop and validate equations to estimate the population mean levels of 24hour urinary Na excretion from spot urine Na for a Bangladeshi population. Methods: We utilized a dataset in which estimates of urinary Na levels were available from urine samples from 24hour urine collection and from spot urine of 217 participants, aged 40 to 59 years. We developed formulas to estimate 24hour urinary Na (24HUNa) by using 24hour urinary Creatinine (24HUCr), spot urine Na (SUNa), and spot urine creatinine (SUCr). For the reliability and validity tests of developed formulas, we use another dataset of 517 participants, aged 30 to 59 years, that also contains Na levels from urine samples from 24hour urine collection and from spot urine collection. Results: The obtained formulas were as follows: (i) PRCr (mg/day) = − 6.68 × age (year) + 14.68 × weight (kg) + 23.89 × height (cm) − 3198.18; (ii) estimated 24HUNa (mmol/day) = 42.40 × XNa0.270; where PRCr = predicted value of 24HUCr, XNa = SUNa (mmol/L)/SUCr (mg/L) × PRCr (mg/day). The correlation coefficients of Na (mmol/day) between estimated and measured from 24hour urine sample were 0.477, which was statistically highly significant (p &lt; 0.001). The mean difference (bias) between estimated and measured Na (mmol/day) was 2.9, which was not statistically significant (p &gt; 0.05). Intraclass correlation coefficient (ICC) between estimated and measured 24HUNa was 0.502. Conclusions: These formulas are useful for estimating population mean levels of 24hour urinary Na excretion, though this method is not suitable for estimating individual Na excretion.

A GC-FID validated method for detection and quantification of ethylene oxide in urine bags

The urine bag is a thermo-labile medical-hospital device used in clinical/surgical procedures in urine drainage and collection. As it is a thermolabile material, it is commonly sterilized by ethylene oxide, a highly toxic, mutagenic and carcinogenic cyclic ether gas. Currently, several countries require, through documents and standards, the quantification of ethylene oxide in medical and hospital devices. Thus, this work describes the development and validation of a method employed for the quantification of ethylene oxide (ETO) in urine bags. The method was developed based on the guidelines of ISO 10993-7, ANVISA and INMETRO. The work range, linearity, limits of detection and quantification, repeatability, intermediate precision and selectivity were evaluated. Statistical tools such as Levene's test, Grubbs, residual analysis, F-test of two variances, paired sample T test and ANOVA table, were also applied to evaluate the method. The linearity of the work range (10 – 400 mg.L-1) showed an adequate correlation coefficient (r > 0.9993), with a homoscedastic profile with absence of outliers while the limit of detection and quantification were 1,95 and 6,5 mg.L-1 respectively. After validation, 45 samples of urine bags of different batches were evaluated, which demonstrated levels of ETO below the limit of detection (1,95 mg.L-1). The results highlight a simple method that meets several regulations with a wide working range, high sensitivity and capability to quantify ETO not only in urine bags but also in other medical devices.

PS-C30-1: URINARY ANGIOTENSINOGEN-MELATONIN RATIO IN GESTATIONAL DIABETES AND PREECLAMPSIA

Objective: A large research portfolio indicates that an activated renal renin-angiotensin system or a deficit on melatonin is associated with several cardiovascular pathologies. In this observational clinical study, we hypothesized that alterations in urinary melatonin or angiotensinogen levels may be altered in two common conditions, preeclampsia and gestational diabetes. Our primary objective was to assess melatonin and angiotensinogen as novel disease biomarkers detectable and quantifiable in the urine of pregnant women with or without pregnancy complications. Design and Methods: This was a concurrent cohort study of pregnant women with selected obstetric pathologies (gestational diabetes, preeclampsia, hypertension and obesity with hypertension). A group of healthy controls was also included. Urinary 6-sulfatoxymelatonin and angiotensinogen were measured by sensitive and specific ELISAs in first morning void urine samples. The patients were included in the cohort consecutively, and the diagnosis was blinded at the level of urine collection. Urinary 6-sulfatoxymelatonin and angiotensinogen levels were investigated in the patients included in the cohort. Results: Urinary levels of angiotensinogen were significantly higher in the gestational diabetes [angiotensinogen/creatinine ratio median (25th, 75th): 0.11 (0.07, 0.18)] and preeclampsia [0.08 (0.06, 0.18)] groups than in those with healthy pregnancy [0.05(0.04, 0.06]; 6-sulfatoxymelatonin levels were significantly lower in the gestational diabetes [ug/h: median (25th, 75th): 0.12(0.08, 0.17)] and preeclampsia [0.12 (0.09, 0.15)] groups than in those with healthy pregnancy [0.20 (0.15, 0.27]. Neither morning void protein/creatinine ratio nor 24-h urine protein estimate were significantly different between the study groups. Conclusion: These results suggest that urinary angiotensinogen levels may indicate an intrarenal RAS activation while melatonin production appears to be defective in gestational diabetes or hypertension. An angiotensinogen/melatonin ratio is suggested as an early biomarker for identification of gestational diabetes or hypertension. This report provides a basis for the potential use of melatonin for the treatment of preeclampsia. A prospective study in a larger number of patients to determine the operative characteristics of these markers as potential diagnostic tests is justified.

PS-R07-5: A CASE OF PRIMARY ALDOSTERONISM WITH DECLINED GLOMERULAR FILTRATION RATE AFTER ADRENALECTOMY

Background: Primary aldosteronism (PA) has been known to cause organ damage, such as renal and cardiovascular disorders more frequently than essential hypertension (EH), independently of blood pressure. Among renal disorders, albuminuria is more prevalent in patients with PA than EH, while GFR tends to be higher in PA due to glomerular hyperfiltration. Surgical and medical treatments for PA correct these effects of excess aldosterone, which sometimes uncover preexisting chronic kidney disease (CKD). Here we present a case of PA with CKD who manifested decline of glomerular filtration rate (GFR) and overt renal failure following resection of aldosterone-producing adenoma. Case report: A 53-year-old woman was diagnosed with hypertension at the age of 40. Her primary care physician started treatment with a calcium channel blocker (CCB). At the age of 49, she was diagnosed with Sjogren's syndrome (SS). Blood tests revealed severe hypokalemia and eGFR of 50 mL/min/1.73m2, while 24-hr urine collection showed urinary protein of 0.5 g per day. SS was suspected to underlie her renal disease. A renal biopsy was performed, and suggested nephrosclerosis and IgA nephropathy. On the other hand, a 11mm-sized tumor in the left adrenal gland was discovered during the investigation of secondary hypertension. PA was confirmed based on active renin concentration (ARC) of 4.3 pg/mL, plasma aldosterone concentration (PAC) of 342 pg/mL, an aldosterone-to-renin ratio of 79.5 (&gt; 40), and 24-hr urinary aldosterone levels of 15.9 μg per day under the adequate salt-loaded condition. Adrenal venous sampling yielded aldosterone hypersecretion from the left adrenal vein, which indicated aldosterone-producing adenoma. Laparoscopic partial left adrenalectomy was performed and fully normalized ARC, PAC, and urinary aldosterone levels, which indicated biochemical cure of PA. Consequently, blood pressure had been well controlled with a single CCB. However, while her preoperative serum creatine level ranged from 0.9 to 1.1 mg/dL and eGFR was around 40–50 mL/min/1.73m2, her postoperative serum creatine level increased to 1.4 to 1.9 mg/dL and eGFR decreased to 25 to 35 mL/min/1.73m2 on average. In contrast, urinary protein level improved to less than 0.1 g/day, suggesting that post-treatment increase in creatine level indicated unveiling CKD rather than deterioration of renal function. Conclusion: PA treatment may unmask CKD through improving glomerular hyperfiltration from aldosterone excess.

UMA HISTÓRIA INCONSISTENTE DE EXCREÇÃO DE CÁLCULOS NUM ADOLESCENTE: UM CASO CLÍNICO DE TRANSTORNOS AUTOINDUZIDOS

Introduction: Urolithiasis is uncommon in children. Suspicion should be raised in the presence of exaggerated clinical manifestations. Case Report: An eleven-year old uncircumcised adolescent male was referred to a pediatric nephrology consultation complaining of recurrent episodes of dysuria with emission of black calculus. He had no lumbar or abdominal pain, nor gross hematuria. On physical examination, Giordano sign was negative bilaterally. His laboratory evaluation, urinalysis and ultrasound were unremarkable. A 24-hour urine collection had no noteworthy alterations. Stone analysis was unconclusive. No metabolic or infectious cause for a calculus was identified. The calculus was sent to an outside laboratory and rubber elastomer was detected. After determining the stones were self-induced, the adolescent was referred to Pedopsychiatry appointment. No further signs or symptoms of nephrolithiasis were reported. Discussion: Although Factitious Disorders caused by proxy have been increasingly recognized, there is a significant less awareness that children and adolescents can intentionally falsify symptoms.

The association between dietary sodium intake and obesity in adults by sodium intake assessment methods: a review of systematic reviews and re-meta-analysis.

The scientific evidence of a sodium-obesity association is limited by sodium intake assessments. Our specific aim is to synthesize the association between dietary sodium intake and obesity across the sodium intake assessments as evidenced by systematic reviews in adults. A systematic search identified systematic reviews comparing the association of dietary sodium intakes with obesity-related outcomes such as body mass index (BMI), body weight, waist circumference, and risk of (abdominal) obesity. We searched PubMed on October 24, 2022. To assess the Risk of Bias in Systematic Reviews (ROBIS), we employed the ROBIS tool. This review included 3 systematic reviews, consisting of 39 unique observational studies (35 cross-sectional studies and 4 longitudinal studies) and 15 randomized controlled trials (RCTs). We found consistently positive associations between dietary sodium intake and obesity-related outcomes in cross-sectional studies. Studies that used 24-h urine collection indicated a greater BMI for those with higher sodium intake (mean difference = 2.27 kg/m2; 95% confidence interval [CI], 1.59-2.51; P < 0.001; I2 = 77%) compared to studies that used spot urine (mean difference = 1.34 kg/m2; 95% CI, 1.13-1.55; P < 0.001; I2 = 95%) and dietary methods (mean difference = 0.85 kg/m2; 95% CI, 0.1-1.51; P < 0.05; I2 = 95%). Quantitative synthesis of the systematic reviews has shown that cross-sectional associations between dietary sodium intake and obesity outcomes were substantially different across the sodium intake assessments. We need more high-quality prospective cohort studies and RCTs using 24-h urine collection to examine the causal effects of sodium intake on obesity.

PS-C04-5: ASSOCIATIONS BETWEEN INTERARM SYSTOLIC BLOOD PRESSURE DIFFERENCE AND HYPERTENSIVE ORGAN DAMAGES IN PATIENTS WITH ESSENTIAL HYPERTENSION

Objective: Several studies and meta-analyses have reported that interarm systolic blood pressure difference (IAD) in the upper limbs is associated with risks such as all-cause mortality and cardiovascular diseases. However, few results have examined the usefulness of IAD as an index of arteriosclerosis in patients with essential hypertension (EHT). We investigated the relationship between IAD and vascular structures and evaluated the usefulness of IAD as an index of hypertensive organ damages in EHT patients. Design and method: In 71 untreated EHT patients (48 males, average age 56 ± 13 years) without chronic kidney disease (urinary albumin excretion less than 300 mg / g of creatinine and estimated glomerular filtration rate 60 mL / min / 1.73m2 or more), blood sampling, 24-hour urine collection, and 24-hour blood pressure monitoring were performed. Next, as cardiovascular structural indices, Next, as indicators of vascular structure, the intima media thickness of carotid artery (IMT) was measured by ultrasonography, and the cardio ankle vascular index (CAVI) and ankle brachial index (ABI) were measured by using the Vascular Screening System VaSera VS-1000 (Fukuda Denshi, Tokyo, Japan) device. The absolute value of the difference between the left and right blood pressure measured at the same time was defined as IAD. Results: IAD was not associated with age, BMI, or systolic and diastolic blood pressure in 24-hour blood pressure monitoring. IAD increased accompanying with a decrease in creatinine clearance (r = -0.25, p &lt; 0.05). IAD correlated positively with IMT (r = 0.24, p &lt; 0.05) and negatively with ABI (r = -0.45, p &lt; 0.01), whereas it did not associate with CAVI. Furthermore, in multiple regression analysis using any of IMT, ABI and creatinine clearance as objective variables, and conventional risk factors for atherosclerosis and IAD as explanatory variables, IAD became an independent determinant factor for IMT, ABI and creatinine clearance. Conclusions: In EHT patients, IAD was associated with decreased renal function and vascular abnormalities. IAD was considered to be a useful index as an initial screening for latent hypertensive organ damages in EHT patients.

PS-BPC04-2: ASSOCIATION OF SHORT-TERM BLOOD PRESSURE VARIABILITY AND MICROALBUMINURIA IN ESSENTIAL HYPERTENSION: DIFFERENCES ACCORDING TO CLASSIFICATIONS OF BLOOD PRESSURE ABSOLUTE VALUE

Objective: Increased short-term blood pressure (BP) variability has been highlighted as a novel risk for cardiovascular diseases. The influence of short-term BP variability on cardiovascular mortality is also accelerated together with increase in BP. In essential hypertension, short-term BP variability is independently associated with early renal abnormalities. In this study, the associations of short-term BP variability with microalbuminuria were analyzed according to classifications of BP absolute value in essential hypertensive patients. Design and method: In 222 untreated essential hypertensive patients (127 males, average age 55 ± 11 years) without chronic kidney disease (urinary albumin excretion less than 300 mg/g of creatinine and estimated glomerular filtration rate 60 mL/min/1.73m2 or more), ambulatory BP monitoring was performed to estimate BP and the standard deviation of systolic BP (SBP-SD) during 24 hours. The 24-hour urine collection was also done to evaluate urinary albumin excretion. According to 24-hour BP level, patients were divided into 4 groups: 33 patients with BP &lt; 130/80 mmHg (N), 71 patients with BP of 130–149/80–89 mmHg (G1), 84 patients with BP of 150–169/90–99 mmHg (G2) and 34 patients with BP 170/100 mmHg (G3). Results: 24-hour systolic BP correlated positively with urinary albumin excretion in G1, G2 and G3 groups (r = 0.25 in G1 group; r = 0.22 in G2 group; r = 0.30 in G3 group, p &lt; 0.05, respectively), whereas there was no relation between them in N group. SBP-SD correlated positively with UAE in both G2 and G3 group (r = 0.20 in G2 group; r = 0.30 in G3 group, p &lt; 0.05, respectively), but did not so in either N or G1 group. Thus, the correlation between SBP-SD and urinary albumin excretion was confined to patients with 24-hour BP ≧ 150/90 mmHg. Furthermore, in patients with 24-hour BP ≧ 150/90 mmHg, multiple regression analysis revealed that SBP-SD was an independent determinant for urinary albumin excretion together with 24-hour systolic BP. Conclusions: These data indicate in essential hypertensive patients, that the risk of increased short-term BP variability for microalbuminuria could be potentiated along with the elevation in BP absolute value.

Effect of Dietary Counseling on Patients with Asymptomatic Hyperuricemia

In Japan, hyperuricemia is on the rise. The guideline for the management of hyperuricemia and gout recommends lifestyle changes before beginning drug therapy. This study aimed to evaluate the effectiveness of dietary counseling following the guideline. Thirty-three subjects (24 men and 9 women) with asymptomatic hyperuricemia underwent dietary counseling for 6 months based on the following recommendations : (1) prevent excessive purine intake, (2) prevent excessive fructose intake, (3) limit alcohol drinking, and (4) drink sufficient water. Obese subjects were counseled on adequate energy intake. Blood sampling, anthropometric measurements, dietary surveys, and 24-h urine collection were performed at baseline and at 6 months. Serum uric acid (S-UA) levels were significantly lower at 6 months compared to baseline. Water intake and urine volume were considerably higher at 6 months than at baseline. When compared to baseline, urine UA (U-UA) levels were significantly lower, and renal fractional excretion of UA (FEUA) was significantly higher at 6 months. Changes in renal function (serum creatinine, estimated glomerular filtration rate, and FEUA) were significantly associated with ?S-UA level. In this study, S-UA level was significantly decreased by dietary counseling in line with the guideline. This study illustrates the effectiveness of dietary counseling for asymptomatic hyperuricemia. J. Med. Invest. 70 : 34-40, February, 2023.

Standardisation of Dietary and Medication Restrictions for Urine 5-Hydroxyindoleacetic Acid (5-HIAA) Collection

The dietary restriction advice provided by Australian clinical laboratories to patients prior to 24-hour urine collection of 5-hydroxyindoleacetic acid (5-HIAA) has not been standardised. Variation exists between the lists of foods and medications patients are requested to avoid and in the duration for which the restrictions must be applied. Furthermore, the evidence for some of these restrictions is limited or outdated. A review of current literature identified that the main foods which significantly elevate urine 5-HIAA levels are plantain, banana, walnuts, hickory nuts, pineapple, plums, tomatoes, kiwifruits and avocados. These need to be avoided for at least two days prior to and during the collection period. Alcohol should be avoided for a minimum of one day before the collection and dietary supplements containing 5-hydroxytryptophan should be avoided for at least 14 days prior. Certain medications may cause false elevations of 5-HIAA but many are dependent on the assay used. Contrary to historical recommendations, we found insufficient information to warrant restriction of eggplant/aubergine, coffee, tea, milk chocolate and vanilla.