Occurrence Of Microalbuminuria Research Articles

P-026: FACTORS ASSOCIATED WITH RENAL DYSFUNCTION AMONG CHILDREN WITH SICKLE CELL DISEASE

Purpose: Sickle cell nephropathy is a major complication of sickle cell disease and microalbuminuria is an early predictor of renal damage. Hence it is important to study the prevalence of renal dysfunction and its associated clinical, biochemical, and nutritional factors, benefitting patients in early identification and appropriate intervention thus, preventing the renal complications and associated morbidity. Materials and methods: A cross sectional study was conducted considering a total of 163 patients between 5-20 years, with SCD (homozygous) of either sex, diagnosed using HPLC attending outpatient clinic in their steady state for routine clinical care at a tertiary care hospital. Patients with history of blood transfusion within 2 weeks or in acute crisis or febrile illness were excluded from the study. Random spot urine sample was used for estimation of microalbuminuria by immunoturbidimetry method. Demographic details, clinical, biochemical, and nutritional parameters of each were recorded, analysed and compared. Microalbuminuria was said to be present if urine albumin creatinine ratio was between 30-300 mg/gm urine creatinine and value more than 300 mg/gm of urine creatinine was labelled as macroalbuminuria. A positive screening test was repeated twice with an early morning urine sample before labelling patient as having microalbuminuria. eGFR estimation was done using modified schwartz formula. Results: Out of total 163 patients (5-20 years), majority (32.52%) were in the age group of 6.1-9 years followed by 5-6 years (31.29%). Male female ratio was 1.3:1. Mean BMI was 14.67 ± 2.32. Mean VOC episodes and mean number of blood transfusions were 3.25 ± 2.91 and 3.23 ± 4.39 respectively. 3 patients had macroalbuminuria (1.84%), microalbuminuria was found in 24 patients (14.72%) while 83.44% patients were normal. 71.8% patients had normal eGFR, 18.4% had hyperfiltration while 9.8% had mild decrease in eGFR. The mean age was significantly higher in children with microalbuminuria than in those without microalbuminuria (11.69 ± 3.86 vs 8.55 ± 3.59 years; P=0.001), youngest patient being 6-year-old. Amongst positive patients, 66.67% were males and 33.33% were females. However, no significant correlation was found between gender and microalbuminuria (P= 0.293). 70.8% of positive patients had ≥3 episodes of vaso-occlusive crisis during their lifetime (P= 0.028) which was found to be statistically significant. Blood pressure taken at first visit were within normal limits for all the patients. 75% patients were already on hydroxyurea at the time of enrolment. 16.67% patients with microalbuminuria had hyperfiltration, 12.5% had mild decrease in eGFR while 70.83% had normal eGFR. No significant correlation was found between patient’s eGFR, nutritional status, blood transfusion frequencies, acute febrile illness episodes or any laboratory parameters with microalbuminuria. Conclusion: Age and frequent episodes of vaso-occlusive crises were found to be major factors associated with occurrence of microalbuminuria. These results confirm the need for early screening of microalbuminuria in patients with sickle cell disease and will be helpful in designing target strategy for early identification and introduction of appropriate timely intervention (drugs like ACE inhibitors) so that long term renal complications can be prevented. The authors do not declare any conflict of interest

The association between serum interleukin-1 beta and heparin sulphate in diabetic nephropathy patients

Inflammation is considered an important mechanism in the development of diabetes mellitus (DM) and persists for a long time before the occurrence of diabetic nephropathy (DN). Many studies have demonstrated that a decrease in the endothelial glycocalyx (EG) is negatively correlated with proteinuria. To elucidate whether EG damage induced by inflammasomes in DM patients leads to the occurrence of microalbuminuria (MA) and accelerates the progression of DN, this study screened 300 diagnosed DM patients. Finally, 70 type 2 diabetes patients were invited to participate in this study and were divided into two groups: the T2DM group (patients with normal MA and without diabetic retinopathy, n = 35) and the T2DN group (patients with increased MA and diabetic retinopathy, n = 35). Circulating heparin sulphate (HS, EG biomarkers) and interleukin-1 beta (IL-1β, inflammasome biomarkers) of the patients were measured by ELISA. Laboratory data were measured using routine laboratory methods. Patients in the T2DN group had increased serum HS, increased IL-1β, increased CRP, decreased haemoglobin, and increased neutrophils compared to patients in the T2DM group (all P < 0.05). Increased HS and decreased haemoglobin were independently associated with T2DN patients. ROC curves showed that the AUC of HS for the prediction of T2DN was 0.67 (P < 0.05). The combination of HS and haemoglobin yielded a significant increasement in the AUC (0.75, P < 0.001) with optimal sensitivity (71.2%) and specificity (79%). Furthermore, serum IL-1β was positively correlated with HS and was an independent associated factor of HS in the T2DN group. The relationship between HS and IL-1β was not significant in the T2DM group. Our findings surgessed the inflammasome may be associated with and promote damage to the EG during the disease course of DN that manifests as increased MA.

MO639THE ASSOCICATION BETWEEN SERUM INTERLEUKIN 1 BETA AND HEPARAN SULFATE IN DIABETIC NEPHROPATHY PATIENTS

Abstract Background and Aims The global diabetes mellitus (DM) prevalence in 2019 is estimated to be 9.3%. Approximately 20% to 40% of patients with DM develop diabetic nephropathy (DN). DN is the leading cause of end stage renal disease (ESRD). Inflammation is considered to be an important mechanism in the development of DM and persists for a long time before the occurrence of DN. Many studies demonstrated that decrease of endothelium glycocalyx (EG) was negatively correlated with proteinuria. Whether EG damage induced by inflammasome in DM patients leads to the occurrence of micro albuminuria (MA) and accelerating the progress of DKD is rarely studied. Method: This prospective, observational cohort study screened 300 diagnosed diabetic patients from departments of nephrology and endocrinology of our hospital. The exclusion criteria were: type 1 diabetes; acute infections; usage antibiotics within 3 months; kidney disease before; heart failure; malignancy. Finally 70 patients were invited to this study and were divided into type 2 DM (T2DM) group and type 2 diabetic nephropathy (T2DN) group. T2DM group were defined as patients with normal MA and without diabetic retinopathy (n=35). T2DN group were defined as patients with increased MA and diabetic retinopathy (n=35). Laboratory data were measured via routine laboratory methods. Heparan sulfate (HS) and interleukin 1 beta (IL-1β) were noted as EG biomarker and inflammasome biomarker respectively. Serum samples of patients were collected, and serum IL-1β and HS were measured by ELISA. SPSS 18.0 was used for all statistical analyses. Results: T2DN patients had higher serum IL-1β (27.85 vs. 21.35 pg/ml), higher HS (2.17 vs. 1.47 ng/ml), higher urea nitrogen (6.30 vs. 5.33 umol/L), higher CRP (2.03 vs. 0.81 mg/L), higher hemoglobin (128 vs. 141 g/L), higher neutrophil (4.1 vs. 3.4 × 109/L) and higher neutrophilic granulocyte percentage (63% vs. 56%) compared with T2DM patients (all P&amp;lt;0.05). Logistic regression analyses demonstrated serum HS was independently associated with T2DN. Furthermore in T2DN patients, serum IL-1β was positively correlated with HS (r = 0.6, P&amp;lt;0.01) and was and independent associated factor. The relationship of HS and IL-1β was not significant in T2DM patients. Conclusion T2DN patients had higher serum IL-1β and HS than T2DM patients in our study. In T2DN patients IL-1β was an independent associated factor of HS. The results suggested that the inflammasome may damage the EG in diabetic patients, which induced the occurrence of MA and accelerating the progress of DN.

Relationship between ACR and other determinants of microalbuminuria in T2DM patients

Introduction: The occurrence of microalbuminuria in type 2 diabetes mellitus (T2DM) patients is regarded as an early clinical sign of incipient kidney damage. Microalbuminuria is often evaluated as urinary albumin to urinary creatinine ratio (ACR). Aim: To assess determinants of microalbuminuria in T2DM patients without prior diagnosis of nephropathy using ACR cut-off values. Materials and Methods: ACR was measured in a total of 90 T2DM patients, during two months in three non-consecutive days, and routine biochemical analyses were performed, including glycated hemoglobin (HbA1c), serum uric acid (SUA), and atherogenic index of plasma (AIP). The cut-off values of ACR were ≤ 2.5 mg/mmol in males, and ≤ 3.5 mg/mmol in females. Duration of T2DM, history of hypertension, HbA1c, estimated glomerular filtration rate (eGFR), AIP, and SUA were investigated for association with microalbuminuria. Results: According to ACR patients were considered as non-albuminuric (n= 57) and microalbuminuric (n = 33). Compared to non-albuminuric group, microalbuminuric group had increased urinary creatinine, urinary albumin, HbA1c, triglycerides and SUA, whilst decreased HDL-cholesterol levels. Although eGFR was generally reduced, the correlation between LogACR and eGFR was not significant (p &gt; 0.05). However, the correlation between LogACR and LogHbA1c was significant. The multiple logistic regression analysis revealed HbA1c (t = 3.42; p = 0.012) and SUA (t = 2.44; p = 0.040) as independent predictors of microalbuminuria in T2DM patients. Conclusion: At ACR cut-off values, concentrations of HbA1c and SUA were independent predictors of microalbuminuria in T2DM patients not yet diagnosed with nephropathy.

A15570 Micro-albuminuria in Stage 2 Hypertensive patients with Left Ventricular Hypertrophy

Objectives: Microalbuminuria (MA, albuminuria: 20–200 μg min-1) is associated with several cardiovascular risk factors including left ventricular hypertrophy (LVH). The relationship, usually assumed to reflect an increased blood pressure (BP) load on the heart and the kidney. To evaluate this relation between MA and LVH, left ventricular mass index (LVMI) was deter-mined in stage 2 hypertensive patients with LVH. Methods: Hundred cases of non diabetic patients with stage 2 hypertension and left ventricular hypertrophy visiting outdoor and indoor patients of Mayo Hospital Lahore were registered. Microalbuminuria was detected using standardized dipstick technique (MICRAL, Roche, USA) and recorded in mg/dL. Left ventricular hypertrophy was deter-mined by measuring LVMI in gram/m2 using GE Logic pro 500 echocardiography with color Doppler. All this information was collected through a specially designed proforma Results: Microalbuminuria was present in 65% of the hypertensive individuals with LVH. When the occurrence of microalbuminuria was analyzed according to the different clinical parameters like age and gender and duration of hypertension, a significant correlation was found with age and duration of hypertension, but no significant relation was found with either gender Conclusion: There is high frequency of microalbuminuria in hypertensive individuals with left ventricular hypertrophy. This is associated with advanced age, duration of hypertension and degree of left ventricular hypertrophy. So microalbuminuria is an important predictor of cardiovascular morbidity and mortality in hypertensive patients with left ventricular hypertrophy and should be checked routinely in all hypertensive patients, regardless of the presence of diabetes.

A15574 Micro-albuminuria in Stage 2 Hypertensive patients with Left Ventricular Hypertrophy

Objectives: Microalbuminuria (MA, albuminuria: 20–200 μg min-1) is associated with several cardiovascular risk factors including left ventricular hypertrophy (LVH). The relationship, usually assumed to reflect an increased blood pressure (BP) load on the heart and the kidney. To evaluate this relation between MA and LVH, left ventricular mass index (LVMI) was deter-mined in stage 2 hypertensive patients with LVH. Methods: Hundred cases of non diabetic patients with stage 2 hypertension and left ventricular hypertrophy visiting outdoor and indoor patients of Mayo Hospital Lahore were registered. Microalbuminuria was detected using standardized dipstick technique (MICRAL, Roche, USA) and recorded in mg/dL. Left ventricular hypertrophy was deter-mined by measuring LVMI in gram/m2 using GE Logic pro 500 echocardiography with color Doppler. All this information was collected through a specially designed proforma Results: Microalbuminuria was present in 65% of the hypertensive individuals with LVH. When the occurrence of microalbuminuria was analyzed according to the different clinical parameters like age and gender and duration of hypertension, a significant correlation was found with age and duration of hypertension, but no significant relation was found with either gender Conclusion: There is high frequency of microalbuminuria in hypertensive individuals with left ventricular hypertrophy. This is associated with advanced age, duration of hypertension and degree of left ventricular hypertrophy. So microalbuminuria is an important predictor of cardiovascular morbidity and mortality in hypertensive patients with left ventricular hypertrophy and should be checked routinely in all hypertensive patients, regardless of the presence of diabetes.

Predictive Value of Gradual Change in Renal Function on Vasculopathy Related Complications and Mortality in Patients with Sickle Cell Disease

▪Introduction:For a long time sickle cell disease (SCD) was mainly prevalent in children and young adults, but due to improved prevention of (fatal) complication in early life, SCD patients become older. However, with the rising age of these patients more complications are observed including cumulating organ damage, which plays an important role in the limited life expectancy of adult sickle cell patients. In the general population, change in renal function over time is related to cardiovascular mortality and is considered to be a reflection of general microvascular damage. By the use reciprocal serum creatinine values over time the subclinical decline in renal function is linear in time. Given the fact that most forms of organ damage in SCD are related to vasculopathy, the gradual change in renal function in the SCD population may have a predictive value for developing organ damage. In this study, we assessed the relation between the slope in renal deterioration (plotted by linear regression) with organ damage and several laboratory values in a cohort of sickle cell patients in a single tertiary hospital.Methods:All SCD patients (HbSS, HbSC and HbSβ-thalassemia) at the out-patient clinicin the period from 2006 until 2016 were included and their gradual change in renal function over this period was determined and the slope of renal deterioration was plotted. Only creatinine values assessed in steady state conditions were included in the analysis. Patients with less than 3 creatinine measurements over this period or missed their regular outpatient appointments in the last three years were excluded. Patients were divided into three tertiles according to the slope of renal decline and the development of organ damage (i.e., microalbuminuria, chronic kidney disease (CKD; eGFR<60 ml/min/1.73m2), retinopathy, avascular necrosis (AVN), CVA and elevated tricuspid regurgitation velocity (TRV)), mortality rate, various laboratory values (i.e., Hb, LDH, reticulocyte count, leukocyte count, HbF, NT-proBNP, creatinine and eGFR) and patient characteristics (i.e., age, gender, genotype groups) were related to these tertiles.Results:In total 167 patients were included in the study and divided in tertiles according to the slope of renal function (ie. Tertile 1 representing the fastets detertioration in renal function over time and tertile 3 the slowest decline in renal function). Patients with the more severe genotype (HbSS/HbSβ0) were significantly more present in tertile 1 as compared to the other tertiles (83.9%, 55.4% and 52.7%, respectively (p=0.001)) indicating that the decline in renal function was significantly faster in patients with HbSS/HbSβ0. The slope of renal function decline was also significantly associated with occurrence of microalbuminuria (59.3% , 32.1% and 15.1% for tertile 1-3, respectively (p<0.001)). Mortality (10.7%, 3.6% and 1.8% , respectively) and CKD (7.1%, 1.8% and 0.0%, respectively) showed the same trend but did not reach statistical significance. Other forms of organ damage, i.e., retinopathy, AVN, CVA and increased TRV were not associated with the slope in renal deterioration. (Table 1) Hemolysis (LDH, Hb, reticulocytes) was significantly more prevalent in tertile 1 as compared to the other tertiles whereas leukocyte count, HbF or NT-proBNP were not related to the decline in renal function.Conclusion:This study demonstrates that long-term subclinical renal deterioration determined in a population of patients with SCD is faster in patients with the severe genotype (HbSS/HbSβ0) and is associated with microalbuminuria while a trend towards correlation with mortality and renal failure was observed. The slope in renal decline appeared to be related with hemolytic rate while no association with other forms of organ damage or laboratory values was found. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

English

Background and Objectives: Diabetic nephropathy is a dreaded complication of Type 2 diabetes mellitus. However in the early stages also known as incipient nephropathy it can be detected by the presence of microalbuminuria. The aim of our study was to know the occurrence of microalbuminuria in patients with Type 2 diabetes mellitus and to note its associations with the duration of diabetes since diagnosis and also the various macrovascular and microvascular complications of diabetes mellitus.Methods. A total of fifty randomly selected diabetic patients s atisfying the inclusion criteria were selected for the study. All patients were evaluated in detail along with the testing for microalbuminuria with dipsticks (Micral)Results: The overall occurrence of microalbuminuria was 38%. The occurrence of microalbuminuria showed a direct relationship with increasing age (p=0.053) and increasing duration of diabetes since diagnosis. An HbA1c value above 7% is associated with 50% or higher incidence of microalbuminuria (p=0.018). Patients with a body mass index of more than 25kg/m2 have significant increase in the incidence of microalbuminuria (p=0.027). The incidence of microalbuminuria is significantly associated with the presence of retinopathy (p=0.073), peripheral neuropathy (p=0.009), ischemic heart disease (p=0.011) and hypertension (p=0.001). Microalbuminuria is inversely associated with HDL (p= 0.089).Interpretation & Conclusion: The occurrence of microalbuminuria in Type 2 diabetic patients of chidambaram was quite high. During the evaluation of diabetic patients the possibility of microalbuminuria and its correlation with various complications of diabetes mellitus should be kept in mind

Study of Association between Microalbuminuria and Microvascular Complications in Type II Diabetes Mellitus Patients in RajaRajeswari Medical College and Hospital, Karnataka

ABSTRACTIntroductionIndia is claimed to be the diabetes capital of the world. Many studies had proven that persistent hyperglycemia and associated metabolic syndrome features like hypertension, dyslipidemia, and obesity contribute to the development of vascular complications. The risk of chronic complications increases as a function of the duration of hyperglycemia; they usually become apparent in the second decade of hyperglycemia. Since type II diabetes mellitus (DM) often has a long asymptomatic period of hyperglycemia, many individuals with type II DM have complications at the time of diagnosis. The vascular complications of DM are subdivided into microvascular (retinopathy, neuropathy, nephropathy) and macrovascular (coronary artery disease, peripheral arterial disease, cerebro-vascular disease) complications. The present study aims to study the occurrence of microalbuminuria in patients with type II DM and note its association with the duration of diabetes since diagnosis and microvascular complications of DM.Study designProspective observational study.Materials and methodsThe study is a clinical, prospective, and observational study of 100 type II diabetics attending the medicine department outpatient/inpatient of RajaRajeswari Medical College &amp; Hospital, Bengaluru, Karnataka, India, who form the subjects for the study conducted from August 2015 to July 2016 (12 months) and who matched the inclusion criteria.Data were collected after obtaining informed/written consent from patient. After detailed history, detailed clinical examination, and general physical and systemic examinations, fundoscopy was carried out and relevant laboratory investigations were done.Results and conclusionThe overall occurrence of microalbuminuria was 38%. The occurrence of microalbuminuria showed a direct relationship with increasing age (p = 0.053) and increasing duration of diabetes since diagnosis. A hemoglobin (Hb)A1c value above 7% is associated with 50% or higher incidence of microalbuminuria (p = 0.018). Patients with a body mass index of more than 25kg/m2 have increased risk of developing type II DM and significant increase in microalbuminuria. The incidence of microalbuminuria is significantly associated withHow to cite this articleBhavya N, Kumar VA. A Study of Association between Microalbuminuria and Microvascular Complications in Type II Diabetes Mellitus Patients in RajaRajeswari Medical College and Hospital, Karnataka. J Med Sci 2017;3(1):6-10.

Soluble Urokinase Receptor and the Kidney Response in Diabetes Mellitus.

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease (ESRD) worldwide. DN typically manifests by glomerular hyperfiltration and microalbuminuria; then, the disease progresses to impaired glomerular filtration rate, which leads to ESRD. Treatment options for DN include the strict control of blood glucose levels and pressure (e.g., intraglomerular hypertension). However, the search for novel therapeutic strategies is ongoing. These include seeking specific molecules that contribute to the development and progression of DN to potentially interfere with these “molecular targets” as well as with the cellular targets within the kidney such as podocytes, which play a major role in the pathogenesis of DN. Recently, podocyte membrane protein urokinase receptor (uPAR) and its circulating form (suPAR) are found to be significantly induced in glomeruli and sera of DN patients, respectively, and elevated suPAR levels predicted diabetic kidney disease years before the occurrence of microalbuminuria. The intent of this review is to summarize the emerging evidence of uPAR and suPAR in the clinical manifestations of DN. The identification of specific pathways that govern DN will help us build a more comprehensive molecular model for the pathogenesis of the disease that can inform new opportunities for treatment.

Study of microalbuminuria and its correlation with glycaemic status in type 2 diabetes mellitus

Background: It is well established that diabetic nephropathy is a dreaded complication of Type 2 diabetes mellitus. However in the early stages; also known as incipient nephropathy, it can be detected by the presence of microalbuminuria. If the patient is identified in the incipient nephropathy stage itself, effective control measures can be initiated to retard the progression to end stage renal disease. Objective: To know the occurrence of microalbuminuria in patients with Type 2 diabetes mellitus and to correlate it with the glycaemic status of the patients. Methods: This study was undertaken in NRI Medical College and General Hospital, Chinakakani, Guntur District, Andhra Pradesh from Nov. 2010 to August 2012. A total of one hundred randomly selected diabetic patients satisfying the inclusion criteria were selected for the study. All patients were evaluated in detail along with the testing for microalbuminuria with dipsticks (Micral) and their glycaemic status along with other required parameters. Results: The overall occurrence of microalbuminuria in the test series was 38%. The occurrence of microalbuminuria showed a direct relationship with the poor glycemic status (p=0.053) and increasing duration of diabetes since diagnosis (p<0.001). An HbA1c value above 7% is associated with 50% or higher incidence of microalbuminuria (p=0.018). Patients with a body mass index of more than 25 kg/m2 have a significant increase in the incidence of microalbuminuria (p=0.027). The incidence of microalbuminuria is significantly associated with the presence of retinopathy (p=0.073), peripheral neuropathy (p=0.009), ischemic heart disease (p=0.011) and hypertension (p=0.001). Microalbuminuria is inversely associated with HDL (p= 0.089). Conclusion: The occurrence of microalbuminuria in Type 2 diabetic patients in the study was quite high and more so in patients with poor glycemic control.

A Correlation on the Occurrence of Microalbuminuria as a Potential Indicator of Early Renal Dysfunction Among Arthritis Patients

A Correlation on the Occurrence of Microalbuminuria as a Potential Indicator of Early Renal Dysfunction Among Arthritis Patients

Microalbuminuria: An early marker of diabetic kidney disease

Background: Diabetic nephropathy is the leading cause of end-stage renal disease globally and contributes to the total disease burden. The study was carried to estimate the occurrence of microalbuminuria in type II diabetics and to find its association with blood pressure, duration of disease and anthropometric measurements. Findings: The cross-sectional study was conducted for six months in Pakistan Medical Research Council Research Centre, Fatima Jinnah Medical College, Lahore. A total of 91 subjects who met the inclusion criteria were selected. A comprehensive questionnaire including age, education, socio-economic status, medical history, blood pressure and anthropometric measurements was used as a study tool. Random blood sample was used for the estimation of plasma glucose, blood urea and serum creatinine, while first morning urine sample was collected for the qualitative screening of microalbuminuria. Data analysis was done using Statistical Package for Social Sciences version 15 (SPSS-15). The mean age of 91 selected subjects was 50 ± 9 years and male to female ratio was 2:1. 80.2% subjects were diabetic hypertensive and remaining 19.8% had only diabetes. The overall prevalence of microalbuminuria was 58.2%. Prevalence of microalbuminuria among males was 30.2% and among females 69.8%. Correlation analysis showed that plasma glucose level, duration of diabetes and systolic blood pressure correlated with microalbuminuria at P<0.05. While age, BMI, waist to hip ratio were not statistically correlated with microalbumin. Among the 53 patients having microalbuminuria, serum urea and creatinine was found to be raised in 13.2%. Conclusion: Microalbumin has associations with systolic blood pressure, elevated plasma glucose level and duration of diabetes. Hence, diabetic patients should be subjected to routine screening for microalbuminuria at least once in a year.

Occurrence of microalbuminuria among children and adolescents with insulin-dependent diabetes mellitus

Microalbuminuria precedes the onset of diabetic nephropathy in insulin-dependent diabetes mellitus (IDDM) pediatric patients. Its prevention is among the most important challenges in managing IDDM. We attempted to determine the occurrence of microalbuminuria among IDDM Saudi children and adolescents and its associated risk factors. This is a retrospective cross-sectional study conducted on 409 IDDM children and adolescents attending the pediatric clinic at King Abdul-Aziz University Hospital from 2006 to 2010. Their ages ranged from 1 to 18 years and the mean ± standard deviation (mean ± SD) was 12.3 ± 4.1 years. Twenty-four-hour urinary albumin excretion (on two separate occasions or more, 3 - 6 months apart each), HbA1c, duration of IDDM, Tanner staging and body mass index (BMI) were reviewed. Prevalence of microalbuminuria in our cohort was 11.3%. IDDM duration was ≥2 years in 55.8% of our patients; of them, 15.6% had microalbuminuria while 45.2% had IDDM duration <2 years (6% had microalbuminuria) (P <0.01). The prevalence of microalbuminuria was higher among the post-pubertal subjects (50%) than that among the pre-pubertal (8.7%) and pubertal (41.5%) subjects. Furthermore, microalbuminuria was present in 16.7% of those with elevated blood pressure, but only in 8.5% among those with normal blood pressure (P <0.05). The enrolled overweight and obese subjects showed a higher prevalence of microalbuminuria (14%) when compared with that among those with a normal BMI (6.6%) (P <0.05). In our cohort, duration of IDDM, pubertal status, hypertension and BMI affected the prevalence of microalbuminuria. Annual screening for microalbuminuria in IDDM children and adolescents is imperative.

A study of the levels of urinary microalbumin in non-diabetic normotensive obese individuals

Diabetes mellitus, hypertension and obesity are associated with endothelial dysfunction. Microalbuminu-ria is an early sign of endothelial dysfunction. The occurrence of microalbuminuria in long standing diabetes mellitus and hypertension is well established. This study intends to find the occurrence of microal-buminuria in non-diabetic normotensive obese individuals. Objectives: To estimate urinary albumin creatinine ratio (UACR) in non-diabetic normotensive obese individuals. Design and Methods: 41 non- diabetic normotensive obese adults with Body Mass Index > 23 kg/m2 were taken as cases and 41 age and sex matched healthy non-obese adults with Body Mass Index < 23 kg/m2 were taken as controls. An-thropometric measurements (Body Mass Index and Waist circumference) and biochemical estimations (fasting blood glucose, lipid profile & spot urinary albumin creatinine ratio) were carried out. Results: urinary albumin creatinine ratio was lesser than the established microalbuminuric range of 30 - 300 mg/g, in both cases and controls irrespective of the values obtained for lipid profile and anthropometric indices. Conclusion: Microalbuminuria may not be present in obese patients without diabetes and/hypertension.

Angiotensin Receptor Blocker to Prevent Microalbuminuria?

Haller H, Ito S, Izzo JL Jr, Januszewicz A, Katayama S, Menne J, Mimran A, Rabelink TJ, Ritz E, Ruilope LM, Rump LC, Viberti G, for the ROADMAP Trial Investigators: Olmesartan for delay or prevention of microalbuminuria in type 2 diabetes. N Engl J Med 364:907–917, 2011 Objective. Microalbuminuria is a predictor of cardiovascular disease (CVD), as well as diabetes-related nephropathy. This study was designed to determine whether the occurrence of microalbuminuria could be prevented or delayed in patients with type 2 diabetes with the angiotensin receptor blocker (ARB) olmesartan. Design and methods. This study was a randomized, multicenter, double-blind, controlled trial of 4,447 patients with type 2 diabetes. The patients were 18–75 years of age and had normoalbuminuria at the onset of the trial. They were randomized to receive either placebo or olmesartan, 40 mg daily, for a median of 3.2 years. During the trial, patients were treated to a blood pressure of < 130/90 mmHg using conventional antihypertensive medications (excluding ACE inhibitors, ARBs, or aldosterone blockers except for the ARB olmesartan in the active treatment group). Patients who had used ACE inhibitors or ARBs during the 6-month period leading up to the study were excluded. Blood pressure was measured with an automated device at each follow-up visit. The blood pressure value used was the mean of three measurements taken at 3-minute intervals by an automated device. The primary outcome was the elapsed time until the initial onset of microalbuminuria. Urine was tested by validated measurements of morning spot urine samples. Microalbuminuria was described in this trial as a urinary albumin (mg) to creatinine (g) ratio of > 35 in women or > 25 in men. Any new abnormal albumin-to-creatinine ratio was confirmed by another positive result (out …

Increased TLR2 expression in patients with type 1 diabetes: evidenced risk of microalbuminuria

To study the activation of an inflammatory cascade through leukocyte mRNA expression of TLR2, TLR4, MyD88, and pro-inflammatory cytokines in individuals with childhood onset type 1 diabetes. Seventy-six type 1 diabetic patients and 100 normoglycemic subjects (NG) 6 to 20 years old were recruited. Type 1 diabetic patients (DM1) were considered to have good (DM1G) or poor (DM1P) glycemic control according to the values of glycated hemoglobin. TLR2, TLR4, MyD88, interleukin -1β (IL-1β), IL-6, and tumor necrosis factor alpha (TNF-α) mRNA expressions were measured in peripheral blood leukocytes (PBL) by real-time polymerase chain reaction (PCR). Urea, creatinine, albumin, and total protein serum levels were determined. Urinary albumin-to-creatinine ratio (ACR) was calculated. DM1 and DM1P patients showed higher glycated hemoglobin (10 and 11%, respectively) and serum glucose concentrations (208 and 226 mg/dL, respectively) compared to NG (Glycated hemoglobin: 7% and glucose: 76 mg/dL) (p < 0.05). PBL mRNA expressions of TLR2, MyD88, IL-1β, IL-6, and TNF-α were higher in DM1 and TLR2, IL-1β, and IL-6 expressions were higher in DMP1 compared to NG (p < 0.05). In DM1, serum albumin and total protein were lower, while serum urea and ACR were higher in comparison to NG (p < 0.05). However, these differences compared to NG were more pronounced in DM1P, which included nine individuals with microalbuminuria. Increased mRNA expression of TLR2, MyD88, and pro-inflammatory cytokines in leukocytes of patients with childhood onset type 1 diabetes indicates the development of a TLR2-mediated pro-inflammatory process, which may also be associated with an early inflammatory process in the kidney and the occurrence of microalbuminuria.

314* Occurrence of microalbuminuria in cystic fibrosis-related diabetes (CFRD) and its clinical significance

314* Occurrence of microalbuminuria in cystic fibrosis-related diabetes (CFRD) and its clinical significance

Microalbuminuria in Stage 2 Hypertensive Patients with Left Ventricular Hypertrophy

Objective: Microalbuminuria (MA, albuminuria: 20 -200 μg min -1 ) is associated with several cardiovascular risk factors including left ventricular hypertrophy (LVH). The relationship, usually assumed to reflect an increased blood pressure (BP) load on the heart and the kidney. To evaluate this relation between MA and LVH, left ventricular mass index (LVMI) was deter-mined in stage 2 hypertensive patients with LVH. Study Design: Descriptive Case series Setting and Duration of Study: Department of Me-dicine, King Edward Medical University, Mayo Hos-pital Lahore, from 1st April 2009 to 31 st March 2010. Methodology: Hundred cases of non diabetic patients with stage 2 hypertension and left ventricular hypertrophy visiting outdoor and indoor patients of East medical ward Mayo Hospital Lahore were registered. Microalbuminuria was detected using standardized dipstick technique (MICRAL, Roche, USA) and recor-ded in mg/dL. Left ventricular hypertrophy was deter-mined by measuring LVMI in gram/m 2 using GE Logic pro 500 echocardiography with color Doppler. All this information was collected through a specially designed proforma. Results : Microalbuminuria was present in 65% of the hypertensive individuals with LVH. When the occur-rence of microalbuminuria was analyzed according to the different clinical parameters like age and gender and duration of hypertension, a significant correlation was found with age and duration of hypertension, but no significant relation was found with either gender. Conclusion: There is high frequency of microalbumi-nuria in hypertensive individuals with left ventricular hypertrophy. This is associated with advanced age, duration of hypertension and degree of left ventricular hypertrophy. So microalbuminuria is an important pre-dictor of cardiovascular morbidity and mortality in hypertensive patients with left ventricular hypertrophy and should be checked routinely in all hypertensive patients, regardless of the presence of diabetes. Key words: Hypertension, Left Ventricular Hypertro-phy, Microalbuminuria.

Impact of Cytotoxin-Associated Gene Product-A Positive &lt;i&gt;Helicobacter Pylori&lt;/i&gt; Strains on Micro-albuminuria in Type 2 Diabetes

Introduction: Available data on the possible association between Helicobacter Pylori (H. pylori) infection and diabetes mellitus (DM) are contradictory. The prevalence of cytotoxin associated gene product A (cagA) positive H. pylori is high in Egypt. This study aims to examine its association with type 2 DM, and its effect on glycemic control and the occurrence of microalbuminuria. Methods: The study involved 98 dyspeptic type 2 diabetic patients and 102 dyspeptic non-diabetic subjects who underwent upper gastrointestinal tract endoscopy in Zagazig university hospital. H. pylori infection was diagnosed by histopathology and/or culture. The presence of cagA positive strains was confirmed by polymerase chain reaction (PCR) and gel electrophoresis. Fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c) and urinary albumin excretion ratio (UAER) were compared between infected and non-infected diabetic patients. Results: Diabetic patients had similar age and gender distribution but significantly higher body mass index (BMI) compared to controls. The prevalence of H. pylori infection (54.1% versus 56.9%, P = 0.3) and the prevalence of cagA positive H. pylori strains (40.8% versus 36.3%, P =0.1) were not significantly different between the two groups. Diabetic patients infected with cagA positive H. pylori strains had higher mean FBS (199±22 versus 163±20, P=0.00), higher mean HbA1c (8.6±0.8 versus 6.3±0.8, P=0.00) and higher rate of microalbuminuria (67.5% versus 10.3%, P=0.00) than non infected diabetic patients. Conclusion: H. pylori infection with cagA positive strains was similarly common in dyspeptic diabetic patients and controls. It was associated with poorer glycemic control and higher rates of microalbuminuria in diabetic subjects. Key words: cagA positive strains; Diabetes mellitus; Helicobatcer pylori; Microalbuminuria