Morning Urine Samples Research Articles

Microalbuminuria in Non-diabetic Hypertensive Individuals: A Cross Sectional Observation in Dhaka Medical College Hospital

The study was conducted to assess the prevalence of microalbuminuria in non-diabetic hypertensive individuals with or without antihypertensive medication(s), attending medicine outpatient department of Dhaka Medical College Hospital. Non-diabetic hypertensive individuals without a history of pre-existing kidney diseases participated in this cross-sectional study. A questionnaire was used for collecting information on demographics, life style and family history of cardiovascular and kidney disease. Spot morning urine samples were collected for albumin estimation. Albuminuria thresholds were evaluated and defined using albumin-creatinine ratio (ACR). A total of 500 non-diabetic hypertensive individuals (310 males, 190 females) aged 52.25+/-7.99 years were enrolled in this study. After excluding 08 persons with macroalbuminuria, microalbuminuria was found in 51 cases (10.37%) [7.68%-13.06%].The prevalence was higher in females than males, ie 11.89% [7.23%- 16.55%] and 9.45% [6.18%-12.72%] respectively. There was no statistical significant difference between the sex groups. Duration of blood pressure showed statistical significant association with the occurrence of microalbuminuria. This suggests that, in Bangladeshi hypertensive individuals microalbuminuria is not uncommon. Further prospective studies with large sample size in different areas of the country are needed to confirm the prevalence of microalbuminuria in such individuals. The causative factors as well as prognostic value of the occurrence of microalbuminuria in this population remain to be determined in prospective cohort studies.

Post-collection acidification of spot urine sample is not needed before measurement of electrolytes

IntroductionKidney stone formers can have higher oxalate and phosphate salt amounts in their urine than healthy people and we hypothesized that its acidification may be useful. The study aims to compare results of urine concentrations of calcium, magnesium, and inorganic phosphorus in the midstream portion of first voided morning urine samples without (FMU) and with post-collection acidification (FMUa) in kidney stone patients.Materials and methodsThis is a prospective single center study. A total of 138 kidney stone patients with spot urine samples were included in the study. Urine concentrations of calcium, magnesium and inorganic phosphorus were measured with and without post-collection acidification. Acidification was performed by adding 5 µL of 6 mol/L HCl to 1 mL of urine.ResultsThe median age (range) of all participants was 56 (18-87) years. The median paired differences between FMU and FMUa concentrations of calcium, magnesium, and inorganic phosphorus were: - 0.040 mmol/L, 0.035 mmol/L, and 0.060 mmol/L, respectively. They were statistically different: P < 0.001, P < 0.001, P = 0.004, respectively. These differences are not clinically significant because biological variations of these markers are much higher.ConclusionsNo clinically significant differences in urinary calcium, magnesium, and inorganic phosphorus concentrations between FMU and FMUa in patients with kidney stones were found.

Альбумінурія та ВІЛ-інфекція в педіатричних пацієнтів

HIV infection increases the risk of developing chronic kidney disease (CKD). Diagnosis at an early stage of HIV associated kidney disease in children is of particular importance, given its prevalence. Determination of the concentration of albumin and creatinine in a single portion of urine, followed by the calculation of the albumin/creatinine ratio (ACR) is used for early diagnosis and assessment of the progression of CKD. Purpose - to study the frequency and risk factors of albuminuria in children with HIV infection, depending on the stage of the disease, immunosuppression, and viral load. Materials and methods. 73 children with HIV infection were examined. Albumin was analyzed in the morning urine sample twice (during the first and third months of observation) using a Beckman Coulter AU 480 series analyzer. Albuminuria was assessed by ACR. The criterion for a moderately elevated level of albuminuria was considered as ACR ≥3 mg/mmol in both measurements and was interpreted as the presence of microalbuminuria (MAU). Results. A steady increase in ACR was noted in 19 (26.0%) patients. The influence of the stage of HIV-infection on the level of albuminuria has not been established. Non-significant immunosuppression (IS) sharply reduced the chances of MAU - OR=0.019 (CI: 0.002-0.159), the presence of a very severe stage of IS significantly increased them - OR=18.89 (CI: 4.33-82.32). There was a pronounced inverse correlation between the ACR and the CD4+ count, both absolute (ρ=-0.51; p&lt;0.001) and relative (ρ=-0.53; p&lt;0.001). It was found that against the background of viral load, the average ACR was twice as high, and the percentage of MAU was nine times higher. In the case of normal viral overload, the chances of moderately elevated albuminuria were significantly reduced - OR=0.048 (CI: 0.012-0.194). The highest rates of ACR were observed in children with a viral load of more than 100,000 copies of RNA/ml, among these patients, MAU was stated in ¾ of cases. A high viral load increased the risks of MAU by one and a half orders of magnitude - OR=15.30 (CI: 3.51-66.68). Elevated ACR was recorded 3.6 times more often in children with progressive HIV-infection than in other patients (OR=14.13; CI: 1.47-136.12; p&lt;0.02). Conclusions. More than a quarter of children with HIV-infection have moderately elevated albuminuria. Renal dysfunction in children with HIV infection has been most closely associated with very severe immunosuppression, RNA HIV viral load &gt;100,000 copies/ml, and progressive course of HIV-infection, as evidenced by albuminuria studies. The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was adopted by the Local Ethics Committee of the institution specified in the work. The informed consent of the parents or guardians of the children was obtained for the study. The authors declare no conflict of interest. Key words: HIV infection, children, albuminuria, risk factors.

Exercise and Interorgan Communication: Short-Term Exercise Training Blunts Differences in Consecutive Daily Urine 1H-NMR Metabolomic Signatures between Physically Active and Inactive Individuals.

Physical inactivity is a worldwide health problem, an important risk for global mortality and is associated with chronic noncommunicable diseases. The aim of this study was to explore the differences in systemic urine 1H-NMR metabolomes between physically active and inactive healthy young males enrolled in the X-Adapt project in response to controlled exercise (before and after the 3-day exercise testing and 10-day training protocol) in normoxic (21% O2), normobaric (~1000 hPa) and normal-temperature (23 °C) conditions at 1 h of 50% maximal pedaling power output (Wpeak) per day. Interrogation of the exercise database established from past X-Adapt results showed that significant multivariate differences existed in physiological traits between trained and untrained groups before and after training sessions and were mirrored in significant differences in urine pH, salinity, total dissolved solids and conductivity. Cholate, tartrate, cadaverine, lysine and N6-acetyllisine were the most important metabolites distinguishing trained and untrained groups. The relatively little effort of 1 h 50% Wpeak per day invested by the untrained effectively modified their resting urine metabolome into one indistinguishable from the trained group, which hence provides a good basis for the planning of future recommendations for health maintenance in adults, irrespective of the starting fitness value. Finally, the 3-day sessions of morning urine samples represent a good candidate biological matrix for future delineations of active and inactive lifestyles detecting differences unobservable by single-day sampling due to day-to-day variability.

Urinary concentrations of amphenicol antibiotics in relation to biomarkers of oxidative DNA and RNA damage in school children

Previous studies implied that elevated exposure to amphenicol antibiotics may induce increased oxidative stress. However, the effects of amphenicol antibiotics exposure on oxidative stress damage in human have not been well studied. This study examined the associations between amphenicol antibiotics exposure and oxidative damage biomarkers in school children. Three major amphenicols including chloramphenicol (CAP), thiamphenicol (TAP), florfenicol (FF) and two biomarkers of 8-hydroxydeoxyguanosine (8-OHdG) for oxidative DNA damage and 8-oxo-7,8- dihydroguanosine (8-OHG) for oxidative RNA damage were measured in 414 morning urine samples collected from 70 school children in Shanghai, China. School children were exposed to CAP, TAP, and FF with median concentrations of 1.37, 0.36, and 0.06 μg/g Cre, respectively. Linear mixed models revealed that an interquartile range (IQR) increase of urinary TAP was positively associated with 7.75%(95% CI: 4.40%, 11.1%) increase of 8-OHdG and 7.48%(95% CI: 2.49%, 15.6%) increase of 8-OHG, respectively; in addition, CAP was associated with elevated 8-OHdG. Although FF was not found to be significantly associated with either 8-OHdG or 8-OHG, it is warranted to further investigate FF and its metabolites levels in relation to oxidative stress in future study. Our findings provide new evidence for the effects of exposure to TAP and CAP on nucleic acid oxidative damage in Children.

A Presurgical-Window Intervention Trial of Isothiocyanate-Rich Broccoli Sprout Extract in Patients with Breast Cancer.

Dietary isothiocyanates (ITCs) from cruciferous vegetables have shown potent anti-breast cancer activities in preclinical models, but their anticancer effects in vivo in breast cancer patients remain elusive. A proof-of-principle, presurgical window of opportunity trial is conducted to assess the anticancer effects of dietary ITCs in breast cancer patients. Thirty postmenopausal breast cancer patients are randomly assigned to receive ITC-rich broccoli sprout extract (BSE) (200µmol ITC per day) or a placebo for 2 weeks. Expression of biomarkers related to ITCs functions are measured in breast cancer tissue specimens at pre- and post-interventions using immunohistochemistry staining. First morning urine samples are collected at both timepoints for proteomic analysis. Overall, the study shows high compliance (100%) and low toxicity (no grade 4 adverse event). Trends of increase in cleaved caspase 3 and tumor-infiltrating lymphocytes (TILs) and trends of decrease in Ki-67 and nuclear to cytoplasm ratio of estrogen receptor (ER)-α are observed in the BSE arm only, consistent with the significantly altered signaling pathways identified in urinary proteomic analysis. Anticancer activities of ITCs are observed in breast cancer patients, supporting the potential beneficial roles of ITC-containing cruciferous vegetables in breast cancer prognosis.

Proteomic analysis of urinary exosomes from patients with lithium‐induced nephrogenic diabetes insipidus

Lithium (Li)‐induced Nephrogenic Diabetes Insipidus (NDI) is a large healthcare problem, which affect around 40% of patients with bipolar disorder undergoing Li treatment. NDI is characterized by the inability in the kidney to concentrate urine in response to vasopressin in the kidney collecting duct (CD). In animals, Li causes a downregulation of aquaporin‐2 and a cellular remodeling of the CD in rats resulting in a reduced fraction of principal cells relative to intercalated cells. Whether Li has similar effects in the human kidney is, however, not known. Urinary exosomes are extracellular nanovesicles derived from intracellular multivesicular bodies fused with the plasma membrane of epithelial cells lining the kidney tubular system and the urinary tract. The purpose of the first part of this study is to analyze whether the urinary rat proteome reflects the Li‐induced changes in the kidney. This is followed by proteomic analyses of urinary exosomes isolated from Li‐NDI patients.Rats were divided in three groups; controls (n=8), 2‐week Li treatment (40 mmol/kg/food, n=8) and 4‐week Li treatment (40 mmol/kg/food, n=8). Treatment with Li showed a significant increase in urine output after 2‐weeks (P&lt;0.01) and 4‐weeks (P&lt;0.05). Additionally, the rats developed severe polydipsia, with water intake significantly increased after 2‐weeks Li treatment (P&lt;0.001) and 4‐weeks Li treatment (P&lt;0.0001).Early morning urine samples from the placebo group in a previous published 12‐week placebo‐controlled pilot trial (Fotso Soh et al, 2021. A double‐blind, randomized, placebo‐controlled pilot trial of atorvastatin for nephrogenic diabetes insipidus in lithium users. Bipolar Disorders 23, 66–75) involving Li‐NDI patients (n=9) were collected. The Li‐NDI participants have been on a stable dose of Li (˃2 months) and determined to have a urinary osmolality &lt;600 mOsm/kg at baseline. In addition, urine from random healthy controls (n=6) were collected. Urine samples from the rodent study and human study were subjected to ultracentrifugation for exosome isolation and will be further processed for mass spectrometry analysis (MS/MS).

Association of Salt-Reduction Knowledge and Behaviors and Salt Intake in Chinese Population.

ObjectiveExcessive salt intake is causally associated with an increased risk of cardiovascular disease. Salt-reduction strategies have been rapidly deployed across China since 2017. This study aimed to investigate the association of salt-reduction knowledge and behaviors and salt intake in Chinese population.Study DesignThis study was a national cross-sectional study in China.MethodsThis cross-sectional study was based on data collected during a Chinese adult chronic disease and nutrition surveillance program in 2018 with 7,665 study participants. Salt intake was assessed by calculating 24 h urine sodium from morning urine samples. Logistic regression and mean impact value (MIV) based on the back propagation (BP) artificial neural network were used to screen the potential influencing factors.ResultsA total of 7,665 participants were included in the analysis, with an average age of 54.64 ± 13.26 years, and with men accounting for 42.6%. Only 19.3% of the participants were aware of the Chinese Dietary Guidelines, and only 7.3% of them could accurately identify the level of salt intake recommended in the Chinese Dietary Guidelines. Approximately 41% of the participants adopted salt-reduction behaviors, among whom the number of participants who used less salt when cooking was the highest, and the number of participants who used low sodium salt was the lowest. In the logistic regression, only “No extra salt was added at the table” group showed the effect of salt-reduction, the odds ratio (OR) being 0.78 (95% confidence interval [CI]: 0.64–0.95). The MIV result based on the BP neural network showed that the most important salt-reduction behavior was using less salt when cooking, while reducing eating-out behavior and using salt-limiting tools were the least important.ConclusionThe research shows that the popularization of salt-reduction knowledge and behaviors can reduce the population's salt intake. However, there is still considerable scope for promoting salt-reduction knowledge and behaviors, while the promotion of salt-reduction tools and low-sodium salt still needs to be strengthened.

Aerobic exercise training improves nocturnal blood pressure dipping in medicated hypertensive individuals.

The absence of nocturnal blood pressure (BP) reduction at night in hypertensive individuals is associated with an increased cardiovascular risk. The main purpose of the present study was to investigate the effects of an aerobic training intervention on nocturnal BP dipping in medicated hypertensive individuals. At baseline, hypertensive individuals under pharmacological treatment underwent 24-h ambulatory BP monitoring and a morning urine sample to analyze albumin creatinine ratio (UACR). Then, participants were divided into nocturnal dippers ( N = 15; 59 ± 6 years) and nondippers ( N = 20; 58 ± 5 years) according to a day-to-night BP reduction of >10% or <10%, respectively. Next, participants underwent a 3-weekly, 4-month aerobic interval training intervention. Follow-up measurements revealed a reduction in daytime diastolic BP in dippers and nondippers ( Ptime < 0.001), whereas nighttime systolic BP was reduced only in nondippers ( P = 0.004). Regarding dipping pattern, nocturnal systolic BP dipping increased after training in nondippers (5 ± 3 to 9 ± 7%; P = 0.018), whereas in dippers, there was a decrease in nocturnal dipping after training (14 ± 4 to 10 ± 7%, P = 0.016). Nocturnal diastolic BP dipping did not change in nondippers (8 ± 5 to 10 ± 7%; P = 0.273) but decreased in dippers (17 ± 6 to 12 ± 8%; P = 0.004). In addition, UACR was significantly reduced in both groups after training ( Ptime = 0.020). Aerobic exercise training is associated with nocturnal BP dipping as nighttime BP was lower than before the program in medicated hypertensive individuals with an initial nondipping phenotype. The lack of improvement in individuals with a dipping phenotype warrants further investigation to discern whether dipping phenotypes influence BP responses to exercise training.

Prevalence of Chlamydia trachomatis in Women Who Are Candidates for In Vitro Fertilization in a Private Reference Service in Southern Brazil: A Cross-Sectional Study.

IntroductionChlamydia trachomatis (CT) has been related to fallopian tube damage and infertility. Its prevalence in the population that attend public services is known; however, there is scant data on this factor in private infertility clinics. The objective of this study is to verify the prevalence of CT among women attending a private in vitro fertilization (IVF) reference clinic in southern Brazil.MethodsThis is a cross-sectional study carried out between January 1, 2019, and August 30, 2021, at an IVF private clinic in southern Brazil. Infertile women between 18 and 50 years old, who provided a morning urinary sample for reverse transcription-polymerase chain reaction (RT-PCR) test for CT analysis, were included in the study. The variables studied included the patient's age, body mass index (BMI), duration of infertility, type of infertility, indication for IVF, and detection or not of CT in the urine.ResultsThe prevalence of CT was 10.84% (22 out of 203; 95% CI: 7.27-15.87). Patients with secondary infertility were older and had more ovarian and tubal factors compared to cases of primary infertility. The tubal factor was the most prevalent (27.3% in women with primary infertility and 35.8% in those with secondary). Time of infertility and BMI were similar between groups. Our results are derived from a single private IVF clinic which reduces the external validity.ConclusionThe prevalence of 10.84% of CT in this population raises the importance of screening for sexually transmitted infections for proper treatment and to achieve better IVF outcomes.

Diagnostic Accuracy of Urine Lipoarabinomannan Testing in Early Morning Urine versus Spot Urine for Diagnosis of Tuberculosis among People with HIV.

ABSTRACTThe Fujifilm SILVAMP TB LAM (FujiLAM) assay offers improved sensitivity compared to Determine TB LAM Ag (AlereLAM) for detecting tuberculosis (TB) among people with HIV. Here, we examined the diagnostic value of FujiLAM testing on early morning urine versus spot urine and the added value of a two-sample strategy. We assessed the diagnostic accuracy of FujiLAM on cryopreserved urine samples collected and stored as part of a prospective cohort of adults with HIV presenting for antiretroviral treatment in Ghana. We compared FujiLAM sensitivity and specificity in spontaneously voided urine samples collected at inclusion (spot urine) versus in the first voided early morning urine (morning urine) and for a one (spot urine) versus two samples (spot and morning urine) strategy. Diagnostic accuracy was determined against both microbiological (using sputum culture and Xpert MTB/RIF testing of sputum and urine to confirm TB) and composite reference standards (including microbiologically confirmed and probable TB cases). Paired urine samples of spot and morning urine were available for 389 patients. Patients had a median CD4 cell count of 176 cells/μL (interquartile range [IQR], 52 to 361). Forty-three (11.0%) had confirmed TB, and 19 (4.9%) had probable TB. Overall agreement for spot versus morning urine test results was 94.6% (kappa, 0.81). Compared to a microbiological reference standard, the FujiLAM sensitivity (95% confidence interval [CI]) was 67.4% (51.5 to 80.9) for spot and 69.8% (53.9 to 82.8) for morning urine, an absolute difference (95% CI) of 2.4% (−10.2 to 14.8). Specificity was 90.2% (86.5 to 93.1) versus 89.0% (85.2 to 92.1) for spot and morning urine, respectively, a difference of 1.2% (−3.7 to 1.4). A two-sample strategy increased FujiLAM sensitivity from 67.4% (51.5 to 80.9) to 74.4% (58.8 to 86.5), a difference of 7.0% (−3.0 to 16.9), while specificity decreased from 90.2% (86.5 to 93.1) to 87.3% (83.3 to 90.6), a difference of −2.9% (−4.9 to −0.8). This study indicates that FujiLAM testing performs equivalently on spot and early morning urine samples. Sensitivity could be increased with a two-sample strategy but at the risk of lower specificity. These data can inform future guidelines and clinical practice.IMPORTANCE This study indicates that FujiLAM testing performs equivalently on spot and early morning urine samples for detecting tuberculosis among people with HIV. Sensitivity could be increased with a two-sample strategy but at the risk of lower specificity. These data can inform future guidelines and clinical practice around FujiLAM.

Pregnancy diagnosis in goats (Capra hircus) using barium chloride and progesterone-based kit in Bangladesh

The study was conducted to develop a technique for early diagnosis of pregnancy in goats from July 2016 to June 2017. About 100 goats of different age groups were randomly selected for the trial and goats were categorized under four groups according to their gestation lengths (0.5 to 1 month, &gt;1 to 1.5 months, &gt;1.5 to 2 months and &gt;2 to 2.5 months). Blood from jugular vein and morning urine samples were collected from four groups and brought to the laboratory, and serum was separated from the clotted blood. Then 1%, 1.5% and 2% barium chloride solution were prepared and test was done by using 1 ml barium chloride of each concentration mixing with 1 ml of urine sample, and allowed for 5 and 10 minutes for interpretation. Presence of precipitation was interpreted as negative for pregnancy and absence of precipitation was interpreted as positive for pregnancy. For each blood sample, 3-5 drops of serum was added in each sample insertion hole of the Bovipreg kit and 5 minutes was allowed to observe the presence of one or two red line in the kit. One red line was interpreted as negative pregnancy and two red lines were interpreted as positive pregnancy. In our study 1% barium chloride, showed 93.5% accuracy, whereas 1.5% barium chloride provided 92% accuracy for the goats having 0.5 to 1 month of gestation. In case of 2% barium chloride, the highest accuracy was 91.5% for the goats having &gt;1 to 1.5 month of gestation. Conversely, the accuracy for progesterone-based early pregnancy diagnostic kit was 96.5%. Therefore, 1% barium chloride can be utilized for the diagnosis of pregnancy in goats. Asian J. Med. Biol. Res. 2022, 8 (1), 42-46

The relation between urinary sodium and potassium excretion and risk of cardiovascular events and mortality in patients with cardiovascular disease.

Most evidence on the relationship between sodium and potassium intake and cardiovascular disease originated from general population studies. This study aimed to evaluate the relation between estimated 24-hour sodium and potassium urinary excretion and the risk of recurrent vascular events and mortality in patients with vascular disease. 7561 patients with vascular disease enrolled in the UCC-SMART cohort (1996-2015) were included. Twenty-four hour sodium and potassium urinary excretion were estimated (Kawasaki formulae) from morning urine samples. Cox proportional hazard models with restricted cubic splines were used to evaluate the relation between estimated urinary salt excretion and major adverse cardiovascular events (MACE; including myocardial infarction, stroke, cardiovascular mortality) and all-cause mortality. After a median follow-up of 7.4 years (interquartile range: 4.1-11.0), the relations between estimated 24-hour sodium urinary excretion and outcomes were J-shaped with nadirs of 4.59 gram/day for recurrent MACE and 4.97 gram/day for all-cause mortality. The relation between sodium-to-potassium excretion ratio and outcomes were also J-shaped with nadirs of 2.71 for recurrent MACE and 2.60 for all-cause mortality. Higher potassium urinary excretion was related to an increased risk of both recurrent MACE (HR 1.25 per gram potassium excretion per day; 95%CI 1.13-1.39) and all cause-mortality (HR 1.13 per gram potassium excretion per day; 95%CI 1.03-1.25). In patients with established vascular disease, lower and higher sodium intake were associated with higher risk of recurrent MACE and all-cause mortality. Higher estimated 24-hour potassium urinary excretion was associated with a higher risk of recurrent MACE and all-cause mortality.

Abstract 39: Exosomal long non-coding RNA help differentiate diabetic kidney disease from non-diabetic kidney disease

Aims and Objective: To analyze the difference in expression of different exosomal long non-coding RNA in subjects with DKD vs NDKD.Methodology: Second morning urine sample was collected from histologically confirmed 33 DKD and 30 NDKD patients. Exosomes were isolated using precipitation method and characterised by Nanoparticle Tracker Analysis (Nanosight NS 300) and Atomic Force Microscopy (Pico Plus 5500 ILM). RNA was isolated using trizole method. Expression of long Noncoding RNA (PVT1, MALAT1, NEAT1, HOTAIR, GAS5) were analysed by Real time PCR with respect to endogenous control (18s and B actin).Result: Expression of long non-coding RNA MALAT1 was 1.9 fold higher (p<0.005), NEAT (0.7 times) and PVT (0.9 times) in DKD and there was reduced expression of GAS5 and HOTAIR compared to NDKD.Conclusion: Exosomal long non-coding RNA MALAT1 expression is significantly higher and can serve as future target of research to differentiate DKD from NDKD.

Abstract 16: Urinary metabolic signatures for differential diagnosis of diabetic and non-diabetic kidney disease

Background:Renal involvement in T2DM can be due to diabetes per se (Diabetic Kidney Disease) or causes other than diabetes (Non-diabetic kidney disease). Currently available clinical, biochemical and radiological markers fail to differentiate DKD from NDKD and renal biopsy remains gold standard for correct diagnosis. While urinary signatures may provide a non-invasive alternative to that end, no study has been reported on urinary metabolomics of biopsy-confirmed DKD and NDKD subjects.Aims:To identify the expression of urinary metabolic signatures as putative marker for differentiation of biopsy-confirmed DKD and NDKD subjects.Methods:Consecutive patient with renal involvement were subjected to biopsy and classified as per ISN/RPS Classification. Morning urine sample were collected for analysis by Gas Chromatography and mass spectrometry. Features were extracted and analysed using appropriate statistical method.Results:Urinary metabolites (M1, M2, M3, M4) were found to be depleted in patients with kidney disease (P < 0.004, <0.006, and < 0.01, <0.03 respectively). M5 was exclusively depleted in NDKD (n=16). The level of M6 (<0.01), M7 (<0.03) increased and M8 (<0.05), M9 (0.03), M10 (0.02) were decreased in DKD subjects (n=34) .Conclusion:Our pilot study suggests that urinary metabolomics analysis may help to distinguish DKD and NDKD subjects. Our results warrant validation in another cohort.Table 1The summary of all the above four casesPatient 1Patient 2Patient 3Patient 4Age79614167SexFemaleFemaleFemaleFemalePresentationBlackouts, loss of consciousnessSweating, loss of consciousnessPalpitations, sweating Loss of consciousnessGiddiness, palpitations, shortness of breathComorbid conditionsHTN, coronary artery diseaseDiabetes, HTN-Hypothyroidism HTNAt diagnosis Rbs34344923 Insulin levels394403000248924000 C peptide level87.54.3519.1916.2 Insulin antibody Highly sensitive insulin antibodies1070 units/ml (normal <12) >100 u/ml (ref range <1) Insulin free <2.5 uu/ml (ref range 4.0-20.0)36 nmol/L, N (0-0.02 nmol/L)300 units/ml (normal <12)87.2units/ml (normal <12)TreatmentDiet and steroidsDiet and steroidsDiet and steroidsDiet, steroids, rituximabAfter treatment Insulin levels2000 uiu/ml-45 uiu/ml203miu/ml Insulin antibodyNormalised20 units/ml (<12)1.63 units/ml (<12)HTN: Hypertension

External Exposure to BTEX, Internal Biomarker Response, and Health Risk Assessment of Nonoccupational Populations near a Coking Plant in Southwest China.

Benzene, toluene, ethylbenzene and xylene isomers (BTEX) have raised increasing concern due to their adverse effects on human health. In this study, a coking factory and four communities nearby were selected as the research area. Atmospheric BTEX samples were collected and determined by a preconcentrator GC–MS method. Four biomarkers in the morning urine samples of 174 participants from the communities were measured by LC–MS. The health risks of BTEX exposure via inhalation were estimated. This study aimed to investigate the influence of external BTEX exposure on the internal biomarker levels and quantitatively evaluate the health risk of populations near the coking industry. The results showed that the average total BTEX concentration in residential area was 7.17 ± 7.24 μg m−3. Trans,trans-muconic acid (T,T-MA) was the urinary biomarker with the greatest average level (127 ± 285 μg g−1 crt). Similar spatial trends can be observed between atmospheric benzene concentration and internal biomarker levels. The mean values of the LCR for male and female residents were 2.15 × 10−5 and 2.05 × 10−5, respectively. The results of the risk assessment indicated that special attention was required for the non-occupational residents around the area.

Impaired fasting blood glucose is associated with incident albuminuria: Data from a Chinese community-based cohort

ObjectiveGrowing evidence links hyperglycemia in the diabetic range to albuminuria, while the association between impaired fasting glucose (IFG) and albuminuria is not well established. The study intends to explore whether IFG is longitudinally associated with incident albuminuria in a non-diabetic Chinese community-based cohort. MethodsParticipants with urine albumin creatinine ratio (UACR) both in 2014 and 2018 from the atherosclerotic cohort were included. A total of 1649 non-diabetic subjects were ultimately included in the analysis after ruling out participants with UACR≥30 mg/g and self-reported history of renal diseases at baseline. Fasting blood glucose (FBG) was assessed by Roche C8000 Automatic Analyzer and UACR was measured with Unicel DxC 800 Synchron biochemistry analyzer using spot morning urine sample. Incident albuminuria was defined as an advance from normal to microalbuminuria or macroalbuminuria. Multivariable logistic regression model was used to investigate the relationship between FBG and incident albuminuria. ResultsDuring a mean follow-up of 4.38 years, 82 (4.97%) participants developed incident albuminuria. Logistic regression analysis showed that after adjustment, the risk of incident albuminuria increased by 71% (OR = 1.71, 95%CI: 1.11–2.62, P = 0.014) for every 18 mg/dl (1 mmol/l) increase of FBG level. Besides, FBG level was independently and gradably associated with incident albuminuria. Compared with the FBG < 100 mg/dl (5.6 mmol/l) group, the risk increased 1.63-fold for incident albuminuria (OR = 2.63, 95%CI:1.42–4.87, P = 0.002) in the FBG 110-126 mg/dl (6.1–7.0 mmol/l) group while the association between FBG 100-110 mg/dl (5.6–6.1 mmol/l) group and the outcome was not significant. Subgroup and interaction analyses were performed and no significant modification effect was found. ConclusionIFG was independently associated with incident albuminuria in Chinese community-based population. The higher the FBG level, the higher the risk of incident albuminuria, which may suggest that screening for albuminuria should be emphasized in population with IFG so as to prevent and treat it in an early stage.

A STUDY ON COMPARISON BETWEEN MICROALBUMINURIAAND MACROALBUMINURIA IN TYPE 2 DIABETICS ON SEVERITY OF DIABETIC RETINOPATHY

Aim: The Aim of study is to measure the prevalence of albuminuria (both microalbuminuria and macroalbuminuria) among type 2 diabetic patients and to estimate its role on severity of diabetic retinopathy in type 2 diabetics. Materials and Methods: A cross sectional study conducted at ophthalmology department,Dr SN Medical College, Jodhpur, Rajasthan in 300 type 2 diabetic patients in one year of study period. All the patients had done ocular examination. The ETDRS scale used for grading Diabetic retinopathy. A morning urine sample used for detecting albuminuria. Urine albumin excretion values 30-300 mg in 24 hrs considered as microalbuminuria and values &gt;300 mg in 24 hrs considered as macroalbuminuria.The analysis was done using SPSS 16.0. Results: The prevalence of microalbuminuria is 31.80% and prevalence of macroalbuminuria is 20.60%. Patients with macroalbuminuria has a greater prevalence of diabetic retinopathy as compare to patients who has normo or microalbuminuria which is statistically signicant, p value&lt; 0.001. Conclusion:In type 2 diabetics patients Microalbuminuria is a very useful in estimating the severity of diabetic retinopathy. Patients who have microalbuminuria is on higher risk for the development and progression of diabetic retinopathy.

Evaluation of urinary na levels as a risk factor in patients with coronary artery disease.

Restriction of salt intake is advised in the general population to reduce cardiovascular risk. Daily higher salt intake may contribute to high coronary artery disease (CAD) prevalence in the Turkish population, although there is limited data regarding salt intake and urinary sodium (Na) extraction in patients with CAD. In this study, we aimed to assess the relationship between urine Na, potassium (K), protein and creatine levels in patients with CAD. One hundred participants, aged 30-65, who underwent coronary angiography under elective conditions were enrolled in this study between May 2019 and August 2019. Patients who had known CAD before, acute coronary syndrome, hypertension, congestive heart failure, diabetes mellitus (DM), structural heart disease, malignancy, renal failure, and severe comorbid states were excluded from the study. Coronary angiograpy revealed CAD in 61 patients and normal coronary arteries in 39 patients who were classified as the control group. Morning urine samples were collected for analysis.The 24-hour urine sodium was calculated using the KAWASAKI method. Spot urinary protein extraction and spot urinary micro-protein/creatinine ratio were significantly higher in the CAD group than in the control group (p=0.035, p=0.031, respectively). Also, serum creatinine (Cr) was found to be higher while glomerular filtration rate (GFR) and Na levels were found to be lower in the CAD group than in the control group (p=0.014, p=0.012, p=0.016 respectively). The logistic regression model was statistically significant, χ2(25)=41.45, p=0.021 and GFR, Na levels, spot urinary micro-protein/creatinine, and HDL levels were assessed as predictive factors for CAD.CONCLUSİON: Urinary Na and K extraction is not affected by the presence of CAD. Also, spot urinary Na/ K ratio and 24-hour sodium extraction were similar between patients with and without CAD. However, decreased GFR and increased urinary micro-protein/creatinine ratio could be risk factors for CAD. Furter studies with large samples are needed to assess this relationship (Tab. 6, Ref. 16).

Excretion Patterns of Urinary Sediment and Supernatant Podocyte Biomarkers in Patients with CKD.

Podocyte depletion causes glomerulosclerosis, and persistent podocyte loss drives progression to ESKD. Urinary sediment podocin (u-sed Pod) mRNA excretion and urinary supernatant podocalyxin (u-sup PCX) protein have been used to monitor disease activity in glomerular diseases. However, the differences in these markers among pathologies have not been investigated. We examined the roles of these markers in kidney diseases. From January 2013 to March 2016, early morning urine samples were collected from 12 healthy controls and 172 patients with kidney disease (n=15 patients with minor glomerular abnormality with mild proteinuria and/or microscopic hematuria, n=15 with minimal change nephrotic syndrome [MCNS], n=15 with membranous nephropathy [MN], n=60 with IgA nephropathy [IgAN], n=19 with crescentic GN [Cres GN], n=10 with lupus nephritis [LN], and n=38 with other kidney diseases). We examined u-sed Pod mRNA excretion, u-sup PCX protein, and the urinary protein-creatinine ratio (u-PCR). u-sed Pod mRNA excretion was significantly correlated with u-sup PCX protein (r=0.37, P<0.001). Both u-sed Pod mRNA excretion and u-sup PCX protein were significantly correlated with u-PCR (r=0.53, P<0.001 and r=0.35, P<0.001, respectively). Interestingly, u-sed Pod mRNA excretion was significantly increased in proliferative-type GN-including IgAN with extracapillary proliferative lesions, Cres GN, and LN class IV-and significantly correlated with the rate of crescent formation, whereas u-sup PCX protein was significantly increased only in those with MN and subepithelial dense deposit-type LN compared with controls. Higher u-sed Pod mRNA excretion and u-sup PCX protein were associated with proliferative-type GN, indicating podocyte detachment and subepithelial dense deposit-type GN, respectively. The results suggest that u-sed Pod mRNA excretion and u-sup PCX protein have usefulness for the diagnosis and measurement of disease activity with regard to glomerular diseases.