Microalbumin Creatinine Ratio Research Articles

Analysis of gastric electrical rhythm in patients with type 2 diabetes mellitus

Abstract Aim To analysis the change of electrogastrogram (EGG) in patients with type 2 diabetes mellitus (T2DM), and evaluate the prevalence of abnormal gastric electrical rhythm (AGER) and its relative influencing factors. Methods A total of 65 patients with T2DM hospitalized at the Second Affiliated Hospital of Soochow University from Dec. 2020 to Dec. 2021 were included in the cross-sectional study. General information, clinical data, and medical history data of all study subjects, including name, gender, body mass index (BMI), duration of diabetes, anti-diabetic therapies, high blood pressure (HBP) history, smoking history, and medication history, were completely collected. The results of laboratory tests, including biochemical parameters, glycosylated hemoglobin (HbA1c), fasting C-peptide, 2 h postprandial C-peptide, 24 h urine total protein (24 hUTP), urine microalbumin creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) were recorded. EGG, Gastroparesis Cardinal Symptom Index (GCSI), gastric emptying ultrasound, fundus examination, carotid artery ultrasonography, cardiac autonomic function test, heart rate variability (HRV) were all examined and recorded as well. According to the results of EGG, the subjects were divided into normal gastric electrical rhythm (NGER) group and abnormal gastric electrical rhythm (AGER) group. Results (1) Fasting blood glucose (FBG), HbA1c, the presence of diabetic peripheral neuropathy (DPN) and diabetic cardiac autonomic neuropathy (DCAN) were significantly higher in the AGER group (p < 0.05). Low frequency (LF) and high frequency (HF), the indicators of HRV, were significantly lower in the AGER group (p < 0.05). In addition, the prevalence of feeling excessively full after meals, loss of appetite, and stomach or belly visibly larger after meals of gastrointestinal symptoms of gastroparesis were significantly higher in the AGER group (p < 0.05). Multiple logistic regression analysis showed that FBG and the prevalence of DCAN were the independent risk factors. Conclusion AGER was associated with high FBG and the presence of DCAN. EGG examination is recommended for patients with gastrointestinal symptoms and clues of DCAN.

Predictors of High Cardiovascular Risk Among Nonobese Patients with Type 2 Diabetes and Non-Alcoholic Fatty Liver Disease in a Chinese Population.

This study aims to investigate cardiovascular risk factors in nonobese patients with type 2 diabetes (T2DM) and non-alcoholic fatty liver disease (NAFLD) and to determine whether they might be used to predict high-risk individuals effectively. This cross-sectional study included 245 nonobese patients with T2DM who underwent FibroTouch in the National Metabolic Management Center of the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University from January 2021 to December 2022. All individuals were divided into NAFLD and non-NAFLD groups. Patients with NAFLD were further grouped by UAP tertiles (T1, T2 and T3). We created a Cardiovascular Score (total scale: 0-5 points; ≥3 points was defined as high-risk individual) based on baPWV, carotid ultrasound, and urinary microalbumin creatinine ratio (UA/CR) to assess the risk of cardiovascular disease in non-obese T2DM patients with NAFLD. Risk factors were evaluated using univariate and multivariate analysis. The performance of risk factors was compared according to the area under the receiver operating characteristic (ROC) curve. Atherogenic index of plasma (AIP), atherosclerosis index (AI), prevalence of hypertension, body mass index (BMI) and homeostatic model assessment of insulin resistance (HOMA-IR) were higher in the NAFLD group compared to the non-NAFLD group. In T3 group, AIP, AI, BMI and HOMA-IR were higher than those of T1 group. Multivariate logistic regression showed that age, systolic blood pressure, low-density lipoprotein-cholesterol (LDL-C) and AIP were risk factors for cardiovascular disease among nonobese patients with T2DM and NAFLD. The area under the ROC curve for age, systolic blood pressure, LDL-C and AIP were 0.705, 0.688, 0.738 and 0.642, respectively. The area under the ROC curve was 0.895 when combining them. Age, systolic blood pressure, AIP and LDL-C are all independent risk factors for cardiovascular disease in non-obese individuals with T2DM and NAFLD, which can be combined to identify high-risk populations and carry out intervention.

Estimation of Microalbuminuria in Children with Beta Thalassaemia Major: A Cross-sectional Study

Introduction: Improvement in the standard of care of Thalassaemia by regular blood transfusion increases life expectancy. Multiple transfusions with concurrent iron overload and chronic anaemia, leading to tissue-level hypoxemia, cause significant renal dysfunction. Microalbuminuria is a sensitive marker of glomerular damage, and studies in thalassemic children have demonstrated variable prevalence rates of microalbuminuria. Aim: To study the prevalence of microalbuminuria and its association with clinical and laboratory parameters in children with Beta Thalassaemia Major (BTM). Materials and Methods: A cross-sectional study was conducted from January 2018 to June 2019 at Indira Gandhi Institute of Child Health, Bangaluru, Karnataka,India. A total of 155 children with Beta Thalassaemia Major (BTM) aged 2-18 years, attending the Thalassaemia Day Care Centre, were included in the study. Their demographic details such as age, gender, clinical parameters like frequency of transfusions, type of chelation therapy, height, weight, Body Mass Index (BMI), organomegaly, and laboratory parameters like serum creatinine, ferritin, pretransfusion Hb%, and Urinary Microalbumin Creatinine Ratio (UMCR) were studied as per a predesigned proforma. The association between microalbuminuria with clinical and laboratory parameters was evaluated using the independent sample T-test or Mann-Whitney U test and Chi-square/Fischer’s-exact test. Results: A total of 155 children with BTM were studied. In the present study, out of a total of 155 patients, microalbuminuria was found in 66 (42.6%). A significant increase in the prevalence of microalbuminuria was observed as the age advanced, as the frequency of blood transfusions increased, with low pretranfusion haemoglobin (g%), and with elevated serum ferritin. Conclusion: In the present study, the prevalence of microalbuminuria was found to be 42.6%. Screening for microalbuminuria is recommended in all children with beta thalassaemia major for the early detection of renal dysfunction, prevention of disease progression, and improvement in the quality of their lives.

CT features of pulmonary embolism in patients with COVID-19 pneumonia.

The aim of this study was to describe the Computed Tomography (CT) features of pulmonary embolism in patients hospitalized for acute COVID-19 pneumonia and to evaluate the prognostic significance of these features. This retrospective study included 110 consecutive patients who were hospitalized for acute COVID-19 pneumonia and underwent pulmonary computed tomography angiography (BTPA) on the basis of clinical suspicion. The diagnosis of COVID-19 infection was determined by CT findings typical of COVID-19 pneumonia and/or a positive result of a reverse transcriptase-polymerase chain reaction test. Of the 110 patients, 30 (27.3%) had acute pulmonary embolism and 71 (64.5%) had CT features of chronic pulmonary embolism. Of the 14 (12.7%) patients who died despite receiving therapeutic doses of heparin, 13 (92.9%) had CT features of chronic pulmonary embolism and 1 (7.1%) of acute pulmonary embolism. CT features of chronic pulmonary embolism were more common in deceased patients than in surviving patients (92.9% vs. 60.4%, p=0.01, respectively). Low oxygen saturation and high urine microalbumin creatinine ratio at admission in COVID-19 patients are important determinants of mortality after adjusting for sex and age in logistic procedures. CT features of chronic pulmonary embolism are common in COVID-19 patients undergoing Computed Tomography Pulmonary Angiography (CTPA) in the hospital. The coexistence of albuminuria, low oxygen saturation and CT features of chronic pulmonary embolism at admission in COVID-19 patients may herald fatal outcomes.

To screen for obstructive sleep apnea in patients with type 2 diabetes mellitus and its association with microvascular complications

Objectives: The objectives of this study were to find the association between obstructive sleep apnea (OSA) and microvascualr complications in patients with type 2 diabetes mellitus (T2DM). Material and Methods: This study was conducted at Bangalore Medical College. One hundred patients fulfilling the inclusion criteria were enrolled for the study. The study group included outpatients and inpatients with T2DM in Victoria Hospital and Bowring and Lady Curzon Hospital. The data were collected according to the pro forma in terms of history, clinical examination, and the necessary investigations (HbA1c and urine microalbumincreatinine ratio). To screen for OSA, STOP-BANG questionnaire was used. To assess microvascular complications, patients were subjected to fundoscopy, urine microalbumin-creatinine ratio, and Toronto clinical neuropathy scoring system. Based on STOP-BANG score, patients were divided into three groups: Low risk (0–2), intermediate risk (3–4), and high risk (5–8) for OSA. Mean values for the duration of diabetes, HbA1c, urine microalbumincreatinine ratio, and Toronto neuropathy score were compared in each group using ANOVA variance analysis. To find the association between OSA and diabetic retinopathy, Kruskal–Wallis test was used. Results: Based on STOP-BANG score, 16% of patients were in the low-risk group, 68% in the intermediate-risk group, and 16% in the high-risk group. There was a significant difference in Toronto neuropathy scores, urine microalbumin-creatinine ratio, and diabetic retinopathy between low-, intermediate-, and high-risk OSA groups indicating higher neuropathy scores, higher values of UMCR, and more advanced diabetic retinopathy among the high-risk group as compared to other two groups. The association between STOP-BANG scores and UMCR, Toronto neuropathy score, and diabetic retinopathy was statistically significant with P values of 0.002, 0.029, and 0.03, respectively. Conclusion: All diabetic patients should be screened for OSA which is simple and inexpensive. Those who fall in intermediate-risk and high-risk categories showed more advanced microvascular complications. They should be subjected to polysomnography and treated for OSA for better glycemic control and to delay the progression of microvascular complications.

Correlation between Insulin Resistance and Microalbuminuria Creatinine Ratio in Postmenopausal Women.

Objective To study the relationship between insulin resistance and urinary microalbumin creatinine ratio in postmenopausal women. Methods The selected research group comprised 104 postmenopausal women with type 2 diabetes who were admitted to the Department of Endocrinology in the green card center at the First Affiliated Hospital of Hainan Medical University between 2017 and 2019 inclusive. Ninety-eight postmenopausal women with the normal blood glucose metabolism hospitalized in the same period were used as the control group. The age, body mass index, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, fasting blood glucose, fasting insulin (FINS), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), and urinary albumin-creatinine ratio (UACR) were analyzed. The insulin resistance index (HOMR-IR) was calculated, and the correlation between IR and UACR was analyzed. Results Levels of HOMA-IR, SBP, HbA1c, HDL-C, LDL-C, TC, TG, FPG, FINS, and UACR in the study group were higher than those in the control group, and a significant difference was found between the groups (P < 0.05). The level of DBP in the study group was lower than that in the control group, and the difference was statistically significant (P < 0.05). Pearson correlation analysis showed that UACR was positively correlated with HOMA-IR and HbA1c (r = 0.254, r = 0.565, P < 0.01). Multiple linear stepwise regression analysis further showed that HOMA-IR and age were positively correlated with UACR (P < 0.05). Conclusion There is a correlation between IR and UACR in postmenopausal women. IR is an independent risk factor for UACR.

Genomic DNA Methylation in Diabetic Chronic Complications in Patients With Type 2 Diabetes Mellitus.

AimTo explore the relationship between genomic DNA methylation and diabetic chronic complications.Methods299 patients with type 2 diabetes mellitus (T2DM) hospitalized in the Second Affiliated Hospital of Soochow University were enrolled. We divided the patients into different complications groups and corresponding non-complication groups. Clinical and biochemical parameters were compared between the two groups. The level of genomic DNA methylation in leukocytes was determined by high-performance liquid chromatography-tandem mass spectrometry.Results(1) Age, duration of diabetes, creatinine (Cr), blood urea nitrogen (BUN), genomic DNA methylation, 24- hour urine total protein (24-hUTP), and intima-media thickness (IMT) were significantly higher in the carotid plaque (CP) group. Waist-to-hip ratio (WHR), body mass index (BMI), estimated glomerular- filtration rate (eGFR), and albumin (Alb) were significantly lower in the CP group. Gender, age and BMI were the influencing factors of CP. (2) Age, duration, Cr, BUN, urinary microalbumin creatinine ratio (UACR), systolic blood pressure (SBP), TCSS, and 24- hUTP were significantly higher in the diabetic retinopathy (DR) group. eGFR, 2h postprandial C- peptide, and Alb were lower in the DR group. Age, duration, Cr, Alb, SBP, and the presence of DN were the influencing factors of DR. (3) Age, duration, HbA1c, BUN, TCSS, SBP, and IMT(R) were significantly higher in the diabetic nephropathy (DN) group. 2h postprandial C-peptide, and Alb were lower in the DN group. HbA1c, BUN, DR, and HBP were the influencing factors of DN. (4) Age, duration, total cholesterol (TC), low-density lipoprotein (LDL-C), triglyceride (TG), Cr, BUN, uric acid (UA), and SBP were significantly higher in the diabetic peripheral neuropathy (DPN) group. The level of genomic DNA methylation and eGFR were significantly lower in the DPN group. Age, duration, LDL-C, UA, the presence of DR, and the genomic DNA methylation level were the influencing factors for DPN. Incorporating the level of genomic DNA methylation into the prediction model could improve the ability to predict DPN on the basis of conventional risk factors.ConclusionLow level of genomic DNA methylation is a relatively specific risk factor for DPN in patients with T2DM and not a contributing factor to the other chronic complications.

Choriocapillaris microvasculature dysfunction in systemic hypertension

We examined the choriocapillaris microvasculature using a non-invasive swept-source optical coherence tomography angiography (SS-OCTA) in 41 healthy controls and 71 hypertensive patients and determined possible correlations with BP and renal parameters. BP levels, serum creatinine and urine microalbumin/creatinine ratio (MCR) specimens were collected. The estimated glomerular filtration rate (eGFR) was calculated based on CKD-EPI Creatinine Equation. The main outcome was choriocapillaris flow deficits (CFD) metrics (density, size and numbers). The CFD occupied a larger area and were fewer in number in the hypertensive patients with poor BP control (407 ± 10 µm2; 3260 ± 61) compared to the hypertensives with good BP control (369 ± 5 µm2; 3551 ± 41) and healthy controls (365 ± 11 µm2; 3581 ± 84). Higher systolic BP (β = 9.90, 95% CI, 2.86–16.93), lower eGFR (β = − 0.85; 95% CI, − 1.58 to − 0.13) and higher urine MCR (β = 1.53, 95% CI, 0.32–2.78) were associated with larger areas of CFD. Similar significant associations with systolic BP, eGFR and urine MCR were found with number of CFD. These findings highlight the potential role of choriocapillaris imaging using SS-OCTA as an indicator of systemic microvascular abnormalities secondary to hypertensive disease.

The Risk Factors for Diabetic Retinopathy in a Chinese Population: A Cross-Sectional Study.

Aims Epidemiological data on diabetic retinopathy (DR) in Chinese population is still rather scarce, and risk factors for diabetic retinopathy are inconsistent because of study designs, grading standards, and population samples. Materials and Methods This hospital-based retrospective study included 1052 type 2 diabetes patients. Diabetic retinopathy was diagnosed by nonmydriatic fundus photography and/or fundus examination apparatus. Logistic regression analysis was performed to evaluate the risk of diabetic retinopathy. Results A total of 352 (33.5% prevalence) subjects were diagnosed with diabetic retinopathy based on our population. The patients in the DR group not only had significantly higher hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), urinary microalbumin-creatinine ratio (ACR), and systolic blood pressure but also had higher follicle-stimulating hormone (FSH), luteinizing hormone (LH), and sex hormone-binding globulin (SHBG) levels compared to those in the non-DR group. Moreover, we confirmed that diabetes duration and HbA1c are strongly associated with DR risk. We also found that serum LH was an independent risk factor in male diabetic retinopathy patients (OR = 1.086, 95% CI 1.024–1.152), and the levels of LH were significantly associated with diabetic retinopathy prevalence (P = 0.018). Conclusions Our study strengthens the argument that diabetes duration and HbA1c are risk factors for patients with DR. Additionally; we firstly confirmed that serum LH was an independent risk factor in male diabetic retinopathy patients.

“A STUDY OF MICROALBUMINURIA IN NON DIABETIC HYPERTENSIVE PATIENTS”

Hypertension is a major public health problem all over the world. The incidence of hypertension is increasing year after year and the prevalence of hypertension is increasing day by day due to increased life expectancy and aging population and their sedentary lifestyle. Hypertension is known to cause microvascular changes and increased cardiovascular risk from it. Microalbuminuria possibly reflects a state of increased renal endothelial permeability and is an easily measured marker of rather diffuse endothelial dysfunction, low grade inflammation and vascular disease burden2. Microalbuminuria has been determined as an important prognostic indicator and has been reported to be associated with increased cardiovascular risk and progressive renal damage. Reliable data on the prevalence of microalbuminuria in the general population and its association with cardiovascular risk factors is limited. Till now, there is little data available regarding screening and early treatment of hypertensive patients with microalbuminuria, as in the case of microalbuminuric non diabetic subjects. With these perspective this cross sectional study of microalbuminuria in non-diabetic hypertensive patients was undertaken to study prevalence of microalbuminuria in Non Diabetic hypertensive patients. Objectives: To determine the prevalence of microalbuminuria in non-diabetic hypertensive patients and to correlate the presence of microalbuminuria with the patients of different clinical profiles. Materials and Methods: This was observational, cross sectional study of Patients diagnosed with hypertension either admitted in ward or attending OPD of Medical College and Tertiary Care Centre. Urine microalbumin creatinine ratio was used for estimation of microalbuminuria. Conclusion: It was proved that microalbuminuria prevalence was directly proportional to the duration of hypertension, the stage of hypertension. Prevalence of microalbuminria was low in ACE inhibitor and ARB treated hypertensive patients.

Sleeve Gastrectomy Attenuates Diabetic Nephropathy by Upregulating Nephrin Expressions in Diabetic Obese Rats.

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease, and sleeve gastrectomy (SG) is considered to be an effective strategy to improve pre-existing DN. However, the mechanism remains unknown. Animal model of DN was induced by high-fat diet (HFD) and streptozotocin (STZ). SG or sham surgery was performed and rats were sacrificed at 4, 8, and 12weeks after surgery. The basic parameters (blood glucose, body weight, kidney weight), indicators of renal function including serum creatinine (Scr), blood urea nitrogen (BUN), urine microalbumin, urine creatinine (Ucr), microalbumin creatinine ratio (UACR), ultrastructural changes of glomerulus, and the expression of nephrin gene and protein in glomerular podocytes were compared among groups. Blood glucose and body weight of SG rats were significantly lower than those of the sham-operated rats, and renal function of SG groups were also significantly improved within the postoperative period of 12weeks. The results of periodic acid-Schiff staining (PAS) and transmission electron microscopy (TEM) showed that glomerular hypertrophy and accumulation of extracellular matrix proteins were significantly alleviated after SG, and the thickness of basement membrane and the fusion or effacement of foot processes were also significantly improved. The mRNA and protein expression of nephrin in SG groups was significantly higher than that in the sham group. These results suggest that SG attenuates DN by upregulating the expression of nephrin and improving the ultrastructure of glomerular filtration membrane. This study indicates that SG can be used as an available therapeutic intervention for DN.

Inferior Vena Cava Diameter Predicts Nephropathy in Patients Late After Fontan Palliation

Single ventricle congenital heart defect patients have improved survival with Fontan palliation. However, they remain at risk for nephropathy, as indicated by pathologic microalbuminuria. We sought to investigate whether echocardiographic measures of the inferior vena cava diameter (a surrogate for elevated CVP) indexed to the body surface area (iIVC) or cardiac index (CI) can predict the presence of nephropathy in Fontan patients. We performed a single-center case-control study, including 39 asymptomatic Fontan (age 14.8 ± 7.9years) and 29 healthy controls (age 12.7 ± 2.7years). The primary outcome was abnormal microalbumin-creatinine ratio (MCR) from the first-morning void urine in Fontan patients. Measurements of iIVC and CI were derived using transthoracic echocardiography by two investigators with a high intra-class correlation coefficient (ICC = 0.97). Group comparison between Fontan and controls as well as between Fontan with normal and abnormal MCR was performed using Fisher's exact and t tests. Pearson and Spearman's correlations and multivariate regressions were performed to analyze the relations between the MCR, iIVC, and CI. Abnormal MCR was noted in 13/39(33%) of Fontan patients. The mean iIVC was larger in the Fontan compared to controls (p < 0.0001) and in Fontan with abnormal MCR compared to those with normal MCR (p = 0.0006). A positive correlation (r = 0.62; p < 0.001) was noted between MCR and iIVC. All patients with abnormal MCR had the iIVC > 1cm/m2. There were no significant relations between the CI and MCR. Significant prevalence of nephropathy late after Fontan palliation warrents screening. Echocardiographic measurement of iIVC could serve as one of the screening measures. The finding of the iIVC diameter > 1cm/m2 should prompt further renal evaluation.

Assessment of biomarkers of endothelial dysfunction in patients with angiographically proven coronary artery disease

Introduction: The endothelium plays an important role in vascular homeostasis. Endothelial dysfunction leads to vasospasm, vasoconstriction, excessive thrombosis, and abnormal vascular proliferation. Endothelial dysfunction may be present in asymptomatic individuals, those could later develop hypertension, diabetes mellitus, and heart-related problems, which is one of the major causes of morbidity and mortality in India. The markers of endothelial dysfunction studied in this work are high-sensitivity C-reactive protein (hs-CRP), urine microalbumin creatinine ratio, and associated other markers such as lipid profile and fasting plasma sugar. Aims and Objective: The primary aim of this study was to assess biomarkers of endothelial dysfunction in patients with angiographically proven coronary artery disease (CAD). The secondary aim of this study was to estimate the levels of serum hs-CRP, urine microalbumin creatinine ratio, lipid profile, and fasting plasma sugar level in patients with angiographically proven CAD. Materials and Methods: This cross-sectional descriptive study was carried out from May 1, 2017 to April 30, 2019, at MGM Medical College, Aurangabad on approval of the Institutional Ethics Committee. A total of 231 patients with CAD of both sexes aged 21–80 years were included in the study. Serum hs-CRP was estimated by immunoturbidimetry, lipid profile by microslide method on VITROS 5600 (Ortho Clinical Diagnostics, Raritan, NJ, USA), urine microalbumin by immunoturbidimetry, urine creatinine by enzymatic reaction, and urine microalbumin creatinine ratio is calculated. Results and Discussion: hs-CRP was elevated in smokers, especially in triple vessels as compared to single and double vessels in patients with CAD, whereas the difference was nonsignificant between two- and three-vessel disease groups. In this study, we found an increased association between patients with microalbuminuria and abnormalities in serum lipoproteins. These lipid abnormalities include a lower high-density lipoprotein (HDL) level as well as higher values for low-density lipoprotein (LDL) and total triglycerides. Conclusion: This study showed that hs-CRP and urine microalbumin creatinine ratio levels were higher especially in smoker patients with CAD. There was an increase in levels of serum triglycerides, hs-CRP, LDL, and reduced HDL cholesterol levels in patients with CAD.

Impact of systemic hypertension on retinal and choroidal microvasculature using OCT Angiography

AbstractIn this cross‐sectional study, we measured the retinal and choroidal microvasculature using the optical coherence tomographic angiography (OCTA) in 77 adults (n = 153 eyes) with systemic hypertension (mean [SD] age, 58 [9] years; 49% women; 23% poorly controlled BP) who are without ocular diseases and determined correlations with systemic vascular risk factors. Data on 24‐hr ambulatory blood pressure (BP) monitoring, serum creatinine, and urine microalbumin/creatinine ratio (MCR) were collected. Estimated glomerular filtration rate (eGFR) was calculated based on CKD‐EPI Creatinine Equation. OCTA imaging (6 × 6 mm macular scans; AngioVue) with quantitative retinal capillary densities (superficial and deep vascular plexuses; SVP and DVP) and choriocapillaris flow voids (area, size and number) were obtained. Linear regression was used to investigate the association of risk factors with microvascular analysis. Higher systolic BP was correlated with sparser retinal capillary density (β = −0.23, −0.44 to −0.02) and smaller areas of flow voids (β = −0.13, −0.24 to −0.02). Also, higher diastolic BP was correlated with flow voids that were smaller in individual size (β = −0.18, −0.34 to −0.02) but more numerous (β = 13.89, 0.61–27.17). Lower eGFR was correlated with sparser retinal capillary density (β = 6.42, 1.25–11.60) whereas renal parameters were not associated with flow voids. In patients with hypertension, higher BP appeared to cause retinal capillary dropout but increase blood flow in the choriocapillaris, which needs to be further investigated. Changes in the retinal microvasculature may reflect kidney function, which highlights the potential of using the OCTA to study early systemic microvascular changes.

Effect of acupressure at Sanyinjiao on albuminuria in patients with early diabetic nephropathy: A single-blind, randomized, controlled preliminary study

BackgroundElevated urinary albumin excretion is a clinical manifestation of early-stage diabetic nephropathy (DN). PurposeTo investigate effect of acupressure at Sanyinjiao on albuminuria in patients with early DN. MethodsTotal included 53 patients with DN and albuminuria; 21 were assigned to the sham group without acupressure, and 32 were assigned to the experimental group with acupressure at Sanyinjiao (SP6) for 8weeks. The experimental group was divided into experiment A (acupressure <45 days) and experiment B (acupressure ≥45 days). The primary outcome measure was the urine albuminuria/creatinine ratio (UACR) or logarithmic transformed urine microalbumin creatinine ratio (log-UACR) changes, and the secondary outcome measures were the estimated glomerular filtration rate and hemoglobin A1c. ResultsThe difference in UACR and log-UACR before and after the study was higher in the experiment B group than in the experiment A and sham groups. ConclusionAcupressure at Sanyinjiao for 8 weeks may reduce albuminuria in patients with DN. However, this study was a preliminary design.

Impact of systemic vascular risk factors on the choriocapillaris using optical coherence tomography angiography in patients with systemic hypertension

We investigated the characteristics of the choriocapillaris flow voids using optical coherence tomography angiography (OCTA) in 85 patients (164 eyes) with hypertension (mean ± SD age, 56 ± 11 years; 45% women; 20% poorly controlled BP; 16% diabetes) who are without ocular diseases and determined possible correlations with systemic vascular risk factors. Data on 24-hour ambulatory blood pressure (BP), serum creatinine, and urine microalbumin/creatinine ratio (MCR) were collected. Estimated glomerular filtration rate (eGFR) was calculated based on CKD-EPI Creatinine Equation. OCTA imaging (6 × 6 mm scans; AngioVue) with quantitative microvascular analysis of the choriocapillaris was performed. Linear regression was used to investigate the association of systemic risk factors with area (percentage), size (pixels) and number of choriocapillaris flow voids. Diabetes (β = 0.33; 95% CI, 0.02 to 0.63) and daytime systolic BP (β = −0.13; 95% CI, −0.24 to −0.02) were associated with areas of flow voids. Age (β = 0.21; 95% CI, 0.06 to 0.36) and daytime diastolic BP (β = −0.18; 95% CI, −0.34 to −0.02) were associated with size of flow voids. Age (β = −21.21; 95% CI, −31.79 to −10.63) and nighttime diastolic BP (β = 13.89; 95% CI, 0.61 to 27.17) were associated with number of flow voids. Kidney parameters were not associated with any features of flow voids. In patients with hypertension, a higher BP appeared to increase blood flow in the choriocapillaris which needs to be considered when using the OCTA to study eye diseases in hypertensives.

IgA nephropathy associated acute kidney injury with ankylosing spondylitis and HLA-B27 positive: a case report

We are reporting a rare case with ankylosing spondylitis (AS), renal impairment with IgA nephropathy. Here, we discuss the course of diagnosis. A 32 year-old man with bilateral pain of the sacroiliac joints for 5 years and leg swelling for 10 days. A Diagnosis of AS by HLA-B27 and pelvic X-ray tests, pathological diagnosis and IgA nephropathy based on renal biopsy. We administered methylprednisolone 500 mg/d for 3 consecutive days, followed by methylprednisolone 40 mg oral QD for a month. The patient was followed up once a month. In the sixth month, the patient's serum creatinine had decreased to 0.96 mg/dL, urine microalbumin creatinine ratio decreased to 173.3 mg/g, and albumin had risen to 33.1 g/L. Pain and morning stiffness were relieved. Although the causal relationship between AS and IgA nephropathy in this patient still needs to be established. In clinical practice, patients with AS need to be screened for renal complications.&#x0D; CBMJ 2019 January: vol. 08 no. 01 P: 39-43

Impact of hypertension on retinal capillary microvasculature using optical coherence tomographic angiography

Objective:Reduction in capillary density or rarefaction is a hallmark of essential hypertension. We measured the retinal capillary density using noninvasive optical coherence tomographic angiography (OCT-A) in adults with treated systemic hypertension and determined possible correlations with ambulatory blood pressure (BP) and renal parameters.Methods:This observational cross-sectional study consisted of 153 normal eyes from 77 nondiabetic hypertensive adults [mean (SD) age, 58 (9) years; 49% women; 23% poorly controlled BP]. Data on 24-h ambulatory BP monitoring, serum creatinine, and urine microalbumin/creatinine ratio (MCR) were collected. Estimated glomerular filtration rate (eGFR) was calculated based on CKD-EPI Creatinine Equation. Retinal capillary density measured with the OCT-A (AngioVue) at superficial (SVP) and deep vascular plexuses (DVP). Linear regression was used to investigate the association of risk factors with capillary density.Results:Retinal capillary density (percentage) at DVP was reduced in patients with poorly controlled BP (SBP = 148 ± 8 mmHg; 27.2 ± 13.0) compared with those with well controlled BP (SBP = 125 ± 9 mmHg; 34.7 ± 11.3). In the multivariable analysis, poorly controlled BP [β = −6.49, 95% confidence interval (CI), −12.39 to −0.59], higher SBP (β = −0.23, 95% CI −0.44 to −0.02) and lower eGFR (β = 6.42, 95% CI 1.25–11.60) were associated with sparser retinal capillary density. Systemic factors were not associated with capillary density at SVP (all P > 0.05).Conclusion:In adults with treated systemic hypertension, retinal capillary density reduced with higher BP and poorer eGFR. These findings highlight the potential role of OCT-A to study early microvascular changes because of systemic hypertension.

An observational study for assessment of point-of-care management received by diabetic patients before referral to a tertiary care hospital

Introduction: Quality of diabetes care is suboptimal worldwide and it varies in rural and urban areas. Indian studies assessing the quality of diabetic care are few. We conducted a study to identify the gap in diabetes management as rural patients received before referral to a tertiary care hospital. Methods: The study was conducted over 2 years in our institution. Rural patients managed previously outside our institution were included in the study. Patients were interviewed for treatment history. Prescriptions and related documents were evaluated for basic examinations, investigations, proper advices, and management processes. Results: A total of 352 diabetic patients were evaluated. Blood pressure (BP) checkup was more regular than blood sugar monitoring (91% vs. 58%). Glycosylated hemoglobin was monitored rarely (2%). Eye checkup (2%), screening of neuropathies (7%), autonomic features (3%), electrocardiography (11%), and lipid screening (9%) were infrequent. Urine microalbumin-creatinine ratio was checked rarely (1%). Advice on diet (62%), exercise (56%), smoking cessation (15%), and foot care (2%) were suboptimal. Usages of insulin, oral hypoglycemic agents (OHA), and antihypertensive agents were suboptimal. Only 86 cases (29%) out of 295 with indications of OHA got adequate dose of OHAs and only 5 cases (9%) out of 57 cases with indications of insulin got adequate dose of insulin. Among diabetic hypertensives (115 cases), only 19% got adequate dose of antihypertensives. Conclusion: Diabetic patients were managed inadequately. The study provides data for developing interventions for improving the quality of diabetes care of rural patients outside the tertiary care setup.

Albuminuria Is Associated with Endothelial Dysfunction in Sickle Cell Disease

Introduction: Albuminuria is a common and sensitive marker of glomerular injury in SCD. We and others have previously observed the association of albuminuria with echocardiographically-derived tricuspid regurgitant jet velocity, systolic blood pressure, and history of stroke, suggesting a shared vasculopathic pathophysiology. However, the pathogenesis of albuminuria in SCD remains poorly defined. The purpose of this study was to evaluate the association of albuminuria with endothelial dysfunction, assessed non-invasively using ultrasound imaging of the brachial artery in SCD patients. In addition, we evaluated the association of albuminuria assessed by spot urine collection with 24-hour urine collections for protein.Methods: Spot urine measurements for microalbumin/creatinine ratio (UACR) were obtained during the "non-crisis," steady state over 2-3 visits, with a 24-hour urine collection for assessment of protein at the final visit. We obtained routine laboratory tests, including markers of hemolysis (lactate dehydrogenase, and total and indirect bilirubin) at the baseline visit. Endothelial function was assessed non-invasively at the final visit using a brachial artery shear stress method, with measurements of flow-mediated dilation (FMD), an index of endothelium-dependent vasodilation and nitroglycerin-mediated dilation (NTMD), a measure of endothelium-independent vasodilation. Patients on renin-angiotensin-aldosterone system (RAAS) blocking agents (ACE-inhibitors, angiotensin receptor blockers, direct renin inhibitors and mineralocorticoid receptor blockers), as well as those on hydroxyurea were on a stable dose for at least 3 months prior to enrollment. We evaluated associations between measures of endothelial function and other study covariates using Spearman's correlation coefficient for continuous covariates, and the Kruskal Wallis test for categorical covariates. Linear regression analysis was used to adjust for baseline arterial diameter. Reported p-values are for individual tests, unadjusted for multiple comparisons.Results: Spot urine samples were obtained in 23 subjects with sickle cell anemia (female = 13, male = 10), mean age, 43.3 ± 12.0 years, with normoalbuminuria (UACR < 30 mg/g creatinine) in 7 subjects, microalbuminuria (UACR = 30 - 299mg/g creatinine) in 9 subjects and macroalbuminuria (UACR ³300 mg/g creatinine) in 7 subjects. Albuminuria (assessed by spot microalbumin/creatinine ratio) was significantly correlated with FMD (ρ = -0.45, p = 0.031). However, albuminuria was no longer significantly associated with FMD when controlled for baseline arterial diameter (p = 0.09). Although FMD appeared to be lowest in patients with macroalbuminuria, no significant difference was observed when FMD was evaluated in the 3 albuminuria categories (p = 0.16). No significant correlations were observed between NTMD and albuminuria (ρ = 0.35, p = 0.20). Surprisingly, no significant correlations were observed between FMD and hemoglobin, fetal hemoglobin, lactate dehydrogenase or indirect bilirubin. We observed a strong correlation between albuminuria assessed by spot microalbumin-creatinine ratio and total urinary protein assessed by 24-hour urine collection (ρ = 0.90, p < 0.0001). Furthermore, albuminuria assessed by spot microalbumin-creatinine ratio was strongly correlated with urine aliquots for microalbumin-creatinine ratio obtained from the 24-hour urine collection (ρ = 0.97, p < 0.0001).Conclusion: In this exploratory study, we found that albuminuria is significantly correlated with FMD in patients with SCD, suggesting that endothelial dysfunction may contribute to the pathogenesis of this complication in SCD. We also find a very strong correlation between spot urine assessments for microalbumin/creatinine ratio and 24-hour urine collections for protein, providing validation for the use of spot urine assessments for the evaluation of albuminuria in patients with SCD. DisclosuresArcher:Global Blood Therapeutics: Consultancy.