Presence Of Proteinuria Research Articles

Trajectories in HbA1c and other risk factors among adults with type 1 diabetes by age at onset

IntroductionIn type 1 diabetes, potential loss of life-years is greatest in those who are youngest at the time of onset. Using data from a nationwide cohort of patients with type...

Changes in renal function and predictors affecting renal outcome of living kidney donors: a nationwide prospective cohort study.

The safety of donors is an important issue in living donor kidney transplantation. We investigated serial changes in renal function and predictors affecting the renal outcome of living kidney donors. We obtained the data of 456 kidney donors registered to the Korean Organ Transplantation Registry from 2014 to 2016. The estimated glomerular filtration rate (eGFR) changes according to the development of incident chronic kidney disease (CKD) and factors related to CKD were analysed. CKD was defined as an eGFR <60 ml/min/1.73 m2 or the presence of proteinuria or albuminuria. The change in eGFR over time was analysed using a linear mixed model. At 2 years after kidney donation, 21.7% of the donors (99/456) developed CKD. Annual eGFR changes after nephrectomy were 2.2 ml/min/1.73 m2 /year in donors without CKD, and - 0.4 ml/min/1.73 m2 /year in donors with CKD. Higher systolic blood pressure was associated with higher risk of CKD (odds ratio [OR] 1.322 per 10 mmHg increment, 95% confidence interval [CI] 1.036-1.686, p = .025). Higher pre-donation eGFR (OR 0.906 per 1 ml/min/1.73 m2 increment, 95% CI 0.876-0.936, p < .001) and higher ratio of eGFR at discharge to pre-donation (OR 0.603 per 0.1 increment, 95% CI 0.426-0.849, p = .004) were related to lower risk of CKD. Kidney donors without incident CKD at 2 years after donation showed gradual increases in eGFR, whereas donors with CKD had relatively constant eGFR. A low ratio of eGFR at discharge after nephrectomy to baseline was a risk factor of CKD.

Kidney Injury Caused by Preeclamptic Pregnancy Recovers Postpartum in a Transgenic Rat Model.

Preeclampsia (PE) is characterized by the onset of hypertension (≥140/90 mmHg) and presence of proteinuria (>300 mg/L/24 h urine) or other maternal organ dysfunctions. During human PE, renal injuries have been observed. Some studies suggest that women with PE diagnosis have an increased risk to develop renal diseases later in life. However, in human studies PE as a single cause of this development cannot be investigated. Here, we aimed to investigate the effect of PE on postpartum renal damage in an established transgenic PE rat model. Female rats harboring the human-angiotensinogen gene develop a preeclamptic phenotype after mating with male rats harboring the human-renin gene, but are normotensive before and after pregnancy. During pregnancy PE rats developed mild tubular and glomerular changes assessed by histologic analysis, increased gene expression of renal damage markers such as kidney injury marker 1 and connective-tissue growth factor, and albuminuria compared to female wild-type rats (WT). However, four weeks postpartum, most PE-related renal pathologies were absent, including albuminuria and elevated biomarker expression. Only mild enlargement of the glomerular tuft could be detected. Overall, the glomerular and tubular function were affected during pregnancy in the transgenic PE rat. However, almost all these pathologies observed during PE recovered postpartum.

POS-481 A STRUCTURAL EQUATION MODEL OF FACTORS ASSOCIATED WITH PREVALENT ALBUMINURIA IN YOUTH WITH TYPE 2 DIABETES IN THE iCARE NATIONAL COHORT

Youth living with type 2 diabetes (T2D) are at high risk of early renal injury. We evaluated interrelationships between biological, psychological, socioeconomic factors and prevalent albuminuria in youth with T2D in the Improving renal Complications in Adolescents with type 2 diabetes through REsearch (iCARE) cohort. We performed a cross-sectional structural equation model (SEM) analysis on 319 youth with T2D 10-24 years old from 8 Canadian sites involved in the iCARE cohort. The main outcome measure was non-orthostatic albuminuria (urine ACR >2mg/mmol). Main factors of interest (indicator variables) were blood pressure (daytime and night systolic and diastolic loads), urine cytokines (IL-6, RANTES, Fractalkine, ENA78, TNFα, IL-1βB, sTNFRI51, sTNFRII53, MCP1), systemic inflammatory markers (c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen), mental health (Resiliency Scales for Children and Adolescents, Kessler-6, Perceived Stress Scale-14), and the Canadian Index of Multiple Deprivation (CIMD) scores. Additional covariates were hemoglobin A1c (HbA1c) and duration of diabetes. Multiple imputation addressed missing data. Youth were 15 ± 2.3 years old, lived with diabetes for 2.3 ± 1.9 years, 66% were female, and 33% had albuminuria. Factors significantly associated with albuminuria were blood pressure (standardized coefficient, b=0.31), urinary cytokines (IL-6, RANTES, Fractalkine, ENA78, TNFa, IL-1β) (b=0.34) and HbA1c (b=0.32); Residential Instability (b=0.21) and ethnic composition (b= -0.36). The factor mental health was positively correlated with systemic inflammation (CRP, ESR, fibrinogen), which was predictive of albuminuria (b=0.29). Diabetes duration was not associated with albuminuria. The model fit well per the CFI (0.988), RMSEA (0.012), and SRMR (0.057) statistics. The presence of albuminuria in youth with T2D is associated with blood pressure, HbA1c, renal and systemic inflammation and residential instability. Mental health was indirectly associated with albuminuria via systemic inflammation. Albuminuria is complex and requires multi-pronged approaches for prevention.

Approach toward diabetic nephropathy and its management in patients with type 2 diabetes: results of a web-based italian survey

AIM The purpose of this survey was to investigate the attitudes and clinical approach of Italian diabetologists toward diabetic nephropathy (DN). METHODS A 28-item web survey was distributed to Italian diabetologists by the Associazione Medici Diabetologi. The first part of the questionnaire was aimed at describing the sample of clinicians involved (age, gender, practice setting, etc.). The second part analyzed more deeply the clinical approach to DN. RESULTS Two hundred and thirty-five clinicians, expert in the field (over 44% have been working as diabetologists for more than 20 years) and well distributed across the country, participated in the survey. The lack of medical care provided from a team remains a main concern, since only in a minority of diabetes centers diabetologists can collaborate with health professionals with expertise and a special interest in diabetes. Screening of DN is performed at first visit by 95% of participants. Urinary albumin creatinine ratio and estimated glomerular filtration rate by CKD-EPI are two approaches used. The relevance of intensive glycemic treatment respect to the onset and progression of DN is mostly considered in patients with microalbuminuria, less frequently in patients with more advanced kidney disease. Almost the totality of participants prescribes renin angiotensin system blocking drugs for the treatment of hypertension, mainly in presence of albuminuria. This class of drugs is less frequently recommended in normotensive patients with microalbuminuria. Regarding the new anti-hyperglycemic drugs, more attention is paid for SGLT2 inhibitors or GLP-1 receptor agonist. CONCLUSIONS The present survey highlights the clinical relevance of DN and the high attention for this diabetic complication by Italian diabetologists. Although the lack of medical care provided from a team remains a main concern, the diabetologists are engaged in promoting educational and screening programs. They are also in keeping with guidelines in choosing antihypertensive treatment or new antihyperglycemic drugs showing to protect kidney function. Finally, participants to the survey declare that they are willing to collaborate with nephrologists, mainly in the more advanced stage of DN. KEY WORDS diabetes mellitus; chronic kidney disease; SGLT2 inhibitors; GLP-1 receptor agonist; diabetic nephropathy.

URINARY EXOSOME MIR-146A IS A POTENTIAL MARKER OF ALBUMINURIA IN ESSENTIAL HYPERTENSION

Objective: There is increasing interest in using extracellular vesicle-derived microRNAs (miRNAs) as biomarkers in renal dysfunction and injury. Preliminary evidence indicates that miRNAs regulate the progression of glomerular disease. Indeed, exosomes from the renal system have provided novel evidence in the clinical setting of albuminuria. Thus, the aim of this study was to quantify the urinary miRNAs present in exosome and microvesicles (MVs), and to assess their association with the presence of increased urinary albumin excretion (UAE) in essential hypertension. Design and method: Exosomes were isolated from urine specimens from a cohort of hypertensive patients with (n = 24) or without albuminuria (n = 28), and from 20 healthy volunteers as a control group. Urinary exosomes were phenotyped by Western blot, tunable resistive pulse sensing (TRPS), electronic microscopy and western blot. Expression of exosomal miR-146a and miR-335∗ was analysed by qRT-PCR and any associations between albuminuria and exosomal miRNAs were established. Results: Urinary miRNAs are highly enriched in exosome subpopulations compared to MVs, both in patients with or without increased UAE (p &lt; 0.001), but not in the control group. High albuminuria was associated with 2.5-fold less miR-146a in exosomes (p = 0.017), whereas miR-146a levels in MV did not change. In addition, exosome miR-146a levels were inversely associated with albuminuria (r = 0.65, p &lt; 0.0001), and discriminated the presence of urinary albumin excretion presence [area under the curve (AUC) = 0.80, 95% confidence interval: 0.66–0.95; p = 0.0013). Conclusions: Our results indicate that miRNAs were enriched in the urinary exosome subpopulation in hypertensive patients and that low miR-146a expression in exosomes was associated with the presence of albuminuria. Thus, urinary exosome miR-146a may be a potentially useful tool for studying early renal injury in hypertension.

ANGIOTENSIN II INCREASES FORMATION OF NEUTROPHIL EXTRACELLULAR TRAPS: ROLE IN HYPERTENSION AND DIABETES

Objective: Endothelial dysfunction plays a central mechanistic role in the pathogenesis of hypertension and diabetes. However, the molecular determinants of endothelial dysfunction are not fully understood. Peptidylarginine deiminases (PADs) irreversibly convert arginine to citrulline in protein, generating neoantigens that are unrecognizable to the immune system. PAD4, an isoform predominantly expressed in neutrophils is upregulated in autoimmune and coronary artery disease. PAD4 activation, in turn, promotes vascular injury through the formation of neutrophil extracellular traps (NETs), networks of chromatin and protein-containing extracellular fibres released to fight infection. Whether PAD4 activity is altered in hypertension and diabetes and whether this contributes to disease pathogenesis is not known. The objective of the present study was to examine the effect of angiotensin II on formation of neutrophil extracellular traps in vitro and in an animal model of hypertension and diabetes. Design and method: Neutrophil-like cells were generated from differentiation of the HL-60 cell line and then treated with angiotensin II (10-7 M) for 24 hours. NET formation was assessed by Western blot analysis of citrullinated histone H3 (a primary component of NETs). We further assessed NET formation in mice expressing human renin under the control of the transthyretin promoter (TTRhRen) intercrossed with OVE26 diabetic mice [i.e. hypertensive-diabetic, HD mice] and compared with wild-type (WT) FVBN/J mice. We examined levels of citrullinated histone H3, neutrophil elastase, and PAD4 expression in the kidney of HD and WT mice by immunohistochemistry. Results: Treatment of neutrophil-like cells with angiotensin-II increased levels of citrullinated histone H3 by ∼2-fold. Similarly, in HD mice we observed a significant increase in citrullinated histone H3 (P &lt; 0.0001), in neutrophil elastase (P &lt; 0.0001), and in PAD4 protein levels (P &lt; 0.0001) compared with WT. Increased PAD4 activity was associated with the presence of albuminuria, renal interstitial fibrosis and reduced glomerular filtration rate. Conclusions: Taken together these data suggest that angiotensin II induces NET formation leading to renal accumulation in hypertension and diabetes. PAD4 may therefore play a role in target organ injury in hypertension and diabetes.

Association of metabolic syndrome with the incidence of low-grade albuminuria: a cohort study in middle-aged and elderly Chinese adults.

Background: Individuals with metabolic syndrome have elevated risks of micro- and macro-albuminuria as well as chronic kidney disease (CKD).Objective: To assess the influence of metabolic abnormalities on the presence of low-grade albuminuria (below the threshold for microalbuminuria).Design, participants, and main outcome measures: This community-based cohort study included 3,935 eligible individuals aged 40 years or older. The presence of low-grade albuminuria was detected in those without micro- or macro-albuminuria and analyzed according to the highest quartile of the baseline urinary albumin-to-creatinine ratio (ACR ≥11.13 mg/g). CKD was defined by an estimated glomerular filtration rate <60 mL/min/1.73 m2 or the new presence of albuminuria (ACR ≥30 mg/g).Results: Overall, 577 (14.7%) participants developed low-grade albuminuria and 164 (4.2%) participants developed CKD during a mean follow-up period of 3.6 years. Compared with participants without metabolic syndrome, those with metabolic syndrome had greater risks of low-grade albuminuria [adjusted odd ratio (OR) and 95% confidence interval (95% CI): 1.30 (1.05–1.61)] and CKD [1.71 (1.20–2.44)]. Moreover, the incidence rates of low-grade albuminuria and CKD increased as the number of metabolic syndrome components increased (P for trend <0.0001).Conclusions: The presence of metabolic syndrome is associated with increased incidence rates of low-grade albuminuria and CKD the middle-aged and elderly Chinese populations.

Donor Family History of ESKD and Long-term Outcomes Among African American Living Kidney Donors: A Retrospective Cohort Study

Rationale & ObjectiveLive kidney donation is associated with a small increased risk for kidney disease and hypertension in African American donors. We investigated a possible association between donor family history of end-stage kidney disease (ESKD) and their postdonation kidney function and the development of hypertension. We tested whether this association was modified by kidney donation.Study DesignRetrospective cohort.Setting & ParticipantsFormer African American live kidney donors between 1993 and 2010. Healthy nondonors were selected from the Coronary Artery Disease in Young Adults (CARDIA) Study.ExposureFamily history of ESKD in a first-degree relative.OutcomesKidney function and blood pressure ≥ 140/90 mm Hg or use of antihypertensive medications at follow-up.Analytical ApproachDonors were grouped based on family history of ESKD. Outcomes were first compared between donor groups and then between donors and healthy nondonors matched for demographics, follow-up time, and family history. A mixed-effect model was used to compare outcomes.ResultsOf 179 donors, 139 (78%) had a first degree relative with ESKD. Predonation characteristics were similar between the 2 groups. At a median follow-up of 11 years postdonation, there was no difference in postdonation estimated glomerular filtration rates (68 ± 19 vs 69 ± 13 mL/min/1.73 m2; P = 0.71) and the presence of albuminuria (P = 0.16). There was a trend toward a higher incidence of hypertension (51% vs 35%; P = 0.08) among donors with a family history of ESKD than for those without. Although there was no difference in annual change in estimated glomerular filtration rate (P = 0.17), the risk for hypertension was higher in donors than nondonors (relative risk, 2.44 [95% CI, 1.56-3.84]), but there was no interaction by family history (P = 0.11).LimitationsRetrospective small study. Lack of data across donor-recipient specific biological relationship.ConclusionsFamily history of ESKD is not associated with postdonation kidney function among African American kidney donors. Live kidney donation is associated with an increased risk for hypertension among African Americans, independent of donor family history of ESKD.

Prognostic value of estimated glomerular filtration rate and presence of proteinuria in type B aortic intramural hematoma.

BackgroundAlthough aggressive medical treatment is recommended in patients with type B aortic intramural hematoma (IMH), a variety of aortic events can occur during the later period. For early identification of these patients, the present study was aimed at evaluating the prognostic validity of estimated glomerular filtration rate (eGFR) and the presence of proteinuria in type B aortic IMH.MethodsData of 61 patients with type B IMH in Peking University People’s Hospital from January 2008 to December 2018 were retrospectively collected. The serum creatinine level and urine protein levels were measured at admission. And eGFR were calculated by the CKD-EPI equation. Adverse aortic-related events were defined as a composite of satisfaction of criteria for surgical conversion (with or without actual surgical intervention) and death from aortic rupture.ResultsInitial eGFR was significantly different between patients with adverse aortic-related events and those without (P=0.003). On multivariate analysis, eGFR <90 mL/min/1.73 m2 (OR, 8.726; 95% CI: 1.711–46.144; P=0.009) and ULP (OR, 17.516; 95% CI: 3.322–92.258; P=0.001) were independent predictors of adverse aorta-related events. Furthermore, eGFR <90 mL/min/1.73 m2 and proteinuria (+) (OR, 8.344; P=0.030) had significantly greater rates of aortic-related events. In addition, eGFR <90 mL/min/1.73 m2 and proteinuria (+) had incremental prognostic value (C-statistic, 0.860, P=0.039) compared with ulcer-like projection (C-statistic, 0.815) alone.ConclusionsInitial eGFR and presence of proteinuria were able to provide incremental prognostic information in addition to ulcer-like projection in patients with type B aortic IMH.

N-Terminal Pro–B-Type Natriuretic Peptide and Incident CKD

IntroductionSerum N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels have been associated with the progression of kidney impairment among patients with chronic kidney disease (CKD), but only a few studies have investigated the association between serum NT-proBNP levels and incident CKD in general populations.MethodsA total of 2486 Japanese community-dwelling residents ≥40 years of age without CKD at baseline were followed up by repeated annual health examinations for 10 years. Participants were divided into 4 groups according to serum NT-proBNP levels. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2 or the presence of proteinuria. Cox proportional hazards models were used to estimate hazard ratios (HRs) for risk of CKD. Linear mixed models were used to compare changes in eGFR.ResultsDuring the follow-up period, 800 participants developed CKD. The multivariable-adjusted HRs (95% confidence intervals [CIs]) for developing CKD were 1.00 (reference), 1.32 (1.11–1.57), 1.40 (1.10–1.78), and 1.94 (1.38–2.73) for serum NT-proBNP levels of <55, 55–124, 125–299, and ≥300 pg/ml, respectively (P for trend <0.001). The decline of eGFR during the follow-up was significantly more rapid among participants with higher serum NT-proBNP levels (P for trend <0.001). Adding serum NT-proBNP to the model composed of known risk factors for CKD improved the predictive ability for developing CKD.ConclusionsHigher serum NT-proBNP levels were associated with greater risks of developing CKD and greater decline in eGFR. Serum NT-proBNP could be a useful biomarker for assessing the future risk of CKD in a general Japanese population.

Health-related quality of life in children with immunoglobulin A nephropathy - results of a multicentre national study.

IntroductionImmunoglobulin A nephropathy (IgAN) may lead to end stage renal disease and severely affect patient functioning and wellbeing. The aim of the study was to evaluate health-related quality of life (HRQoL) in children and adolescents with IgAN, and compare HRQoL in relation to the disease course, social status and psychological factors, such as expressing anger and perceived personal competence.Material and methodsThe multicentre cross-sectional study included 51 patients ≥ 8 years from 7 paediatric nephrology centres in Poland. Psychometric analysis was performed using the Kidscreen-52 questionnaire to evaluate HRQoL, the Anger Expression Scale to evaluate the severity of anger and the Personal Competence Scale to measure general perception of personal competence.ResultsMean age of patients was 14.54 ±3.69 years; duration since the diagnosis of IgAN was 4.98 ±3.9 years. Patients with IgAN rated their psychological wellbeing as significantly worse compared to healthy peers (p < 0.05). The presence of proteinuria was associated with significantly worse physical wellbeing (58.72 ±18.45 vs. 74.44 ±22.97; p < 0.05). Current therapy (steroids/immunosuppressive drugs) had no effect on HRQoL in the study group. Perceived personal competence was rated high by 49% of children in the study group. Children with IgAN were characterized by lower intensity of expressed anger (p < 0.001) and significantly higher intensity of suppressed anger (p < 0.01) compared to reference ranges. Severity of expressed anger correlated positively with the parent relations and school environment dimensions of HRQoL.ConclusionsWe found lower HRQoL in regard to physical and psychological wellbeing in a group of Polish children with IgAN compared to healthy peers. HRQoL should be monitored in this patient group.

Chronic kidney disease among adults in Rio Branco, State of Acre: a population-based survey

The scope of this study was to establish the prevalence of CKD and associated factors among young adults (18-59 years of age) from Rio Branco in the State of Acre. It involved a population-based survey conducted in 2014, in the urban and rural areas of the municipality and CKD was defined as the glomerular filtration rate (GFR) < 60ml/min/1.73m², estimated by the CKD-EPI, and the presence of albuminuria > 29 mg/g. Association measures were estimated by logistic regression, with a confidence level of 95%. The overall prevalence of CKD was 6.2%. The presence of CKD was higher among women, aged 40 to 59 years, with non-white skin color, with lower schooling, and of sedentary disposition. There were statistically significant differences in the distribution according to the presence of CKD in the hypertension, diabetes and hospitalization variables over the past 12 months. CKD among adults was associated with the female sex (OR: 2.41, 95%CI: 1.14-5.12), diabetes (OR: 4.67, 95%CI: 1.28-17.03) and arterial hypertension (OR: 1.98; 95%CI: 1.16-3.37). CKD reveals a high prevalence and is associated with chronic diseases, calling for the need for public health measures for early detection and prevention of its progression.

Evaluation of Glomerular Hyperfiltration and Albuminuria in Sickle Cell Disease Adolescents: Cross-Sectional Retrospective Study

Background: Sickle Cell Disease (SCD) renal abnormalities commence early in childhood. The glomerular abnormalities, glomerular hyperfiltration and albuminuria are the most prevalent. However, these SCD glomerulopathies have not been considered exclusively in the adolescent age group. Objective: To determine the prevalence of glomerular hyperfiltration and albuminuria as well as identify the determinants for glomerular hyperfiltration in adolescents with SCD. Patients and Methods: The electronic patient records of 153 adolescents with SCD aged 10 - th to 23rd June 2019. Clinical information and laboratory parameters were obtained. The glomerular filtration rate was derived using the Bedside Schwartz’s method. Grouping of the adolescents was based on the presence and absence of glomerular hyperfiltration, which was defined as glomerular filtration rate > 140 ml/min/m2. The presence of albuminuria was defined as urine albumin-to-creatinine ratio > 3 mg/mmol or protein-to-creatinine ratio of >15 mg/mmol. The clinical and laboratory determinants of glomerular hyperfiltration in the total study population were investigated. Result: Prevalence of glomerular hyperfiltration was 33.3% in the adolescents studied, and that of albuminuria was 15.7% amongst the SCD adolescents studied, of which 13.7% of those with glomerular hyperfiltration also had albuminuria. On univariable analysis, the SCD adolescents with glomerular hyperfiltration had significantly lower weight (48.0 ± 18.0 versus 54.8 ± 17.0 kg; p = 0.02), height (155.1 ± 13.1 versus 160.6 ± 13.1 cm; p = 0.01), body mass index (19.4 ± 5.0 versus 21.0 ± 4.3; p = 0.04), haemoglobin level (88.7 ± 13.3 versus 98.1 ± 21.7 g/L; p = 0.001), and serum creatinine level (0.4 ± 0.1 versus 0.6 ± 0.2 mg/dl; p = 0.0001) as compared to those with no glomerular hyperfiltration. The SCD adolescents with glomerular hyperfiltration also had significantly higher lactate dehydrogenase levels (525.9 ± 180.3 versus 449.6 ± 170.3 IU/L; p = 0.01) than those with no glomerular hyperfiltration. But, multivariable analysis revealed no associations. Conclusion: This study revealed that the prevalence of glomerular hyperfiltration in SCD children in the adolescent age group is high, and the high glomerular filtration rates begin to decline toward normal values in middle adolescence.

Hypertension Management in Patients with Chronic Kidney Disease in the Post-SPRINT Era.

The management of high blood pressure (BP) is crucial for improving outcomes in patients with chronic kidney disease (CKD). The updated Kidney Disease: Improving Global Outcomes 2021 BP guideline proposes treating adults with CKD to a target systolic BP (SBP) of <120 mmHg based on the standardized office BP measurement. This suggestion is largely based on the finding of SPRINT (Systolic Blood Pressure Intervention Trial) that targeting an SBP of <120 mmHg versus <140 mmHg is beneficial for cardiovascular and mortality outcomes, regardless of the patient’s kidney disease status. However, extended follow-up studies of CKD trials showed that intensive versus usual BP control was associated with a lower risk of kidney failure in patients with, but not in those without, proteinuria. Similarly, a recent population-based study in Korea demonstrated that the optimal on-treatment BP for composite cardiorenal and mortality outcomes was left-shifted in adults with CKD, particularly in those with albuminuria, relative to that in patients without CKD. Moreover, in meta-analyses of randomized trials, more intensive versus standard BP control was associated with a lower risk of all-cause mortality in patients with CKD and albuminuria but not in those without CKD. Meanwhile, a 2020 Cochrane review reported that lower BP targets (≤135/85 mmHg), compared with standard targets (≤140/90 mmHg), resulted in a small reduction in cardiovascular events, an increase in other serious adverse events, and no reduction in total serious adverse events. Lowering SBP to <120 mmHg can potentially increase the risk of treatment-related adverse events beyond the cardioprotective benefits, and standardized BP measurement increases the burden on patients and resources. Thus, targeting a BP of <130/80 mmHg with appropriate office BP measurement can be an option in patients with CKD. The presence of albuminuria would need to be additionally considered to determine individualized BP targets.

Association of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio with Diabetic Kidney Disease among Adult Patients with Type 2 Diabetes Mellitus: A Meta-Analysis of Observational Studies

Objective. This meta-analysis aimed to evaluate the association of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) with the presence of diabetic kidney disease (DKD) among adult patients with Type 2 diabetes mellitus (T2DM). Methods. A systematic search of articles was performed in various databases. Studies must have fulfilled the following criteria for inclusion: 1) Randomized controlled trial or observational study; 2) Included adults diagnosed with T2DM; 3) Reported data associating NLR or PLR with the presence of DKD; and 4) Controlled for confounders using logistic regression. Data analysis was performed using Review Manager 5.4 software. The estimates were derived using the generic inverse variance method and pooled using the random effects model. Results were presented as odds ratios (OR) and standard errors (SE) with 95% confidence intervals (CI), and graphically shown as forest plots. The I2 value and Chi-square test were used to assess heterogeneity across studies. Results. Seven studies were included in the review, totaling 1,486 patients. All were cross-sectional studies and had satisfactory methodological quality as evaluated using the Newcastle-Ottawa Quality Assessment Scale. Pooled analysis from six studies showed a statistically significant association between increased NLR and the presence of DKD, defined as either the presence of albuminuria (95% CI, OR 1.68 [1.28, 2.19], p<0.01); or an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 (95% CI, OR 1.56 [1.09, 2.23], p=0.01). In both analyses, there was no significant heterogeneity across studies (I2=0%, Chi2=3.54; and I2=28%, Chi2=2.76 respectively). On the other hand, pooled analysis from two studies did not show a statistically significant association between PLR and albuminuria (95% CI, OR 1.75 [0.85, 3.60], p=0.13), although both studies were homogeneous (I2=0%, Chi2=0.57). Conclusion. We found a statistically significant association between increased NLR and the presence of DKD. However, a similar association was not found with PLR. Larger studies with more robust designs are recommended.

Evaluation of Neutrophil–lymphocyte Ratio and Platelet–lymphocyte Ratio as Markers of Diabetic Kidney Disease in Bangladeshi Patients with Type 2 Diabetes Mellitus

Background: The roles of neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) as novel surrogate markers of diabetic kidney disease (DKD) are promising. Objective: The aim of this study was to evaluate whether NLR and PLR can predict DKD in type 2 diabetes mellitus (T2DM). Subjects and Methods: This cross-sectional study was conducted from July 2018 to June 2019, among 312 patients with T2DM recruited from eight tertiary hospitals throughout Bangladesh. Complete blood count (CBC) was performed in fully automated hematology analyzers, and NLR and PLR were calculated. The urine albumin-to-creatinine ratio (ACR) was measured in a random single-voided urine sample. The diagnosis of DKD was made based on the presence of albuminuria (ACR ≥30 mg/g) and/or reduced estimated glomerular filtration rate (eGFR &lt;60mL/min/1.73 m2) in the absence of signs or symptoms of other primary causes of kidney damage. Results: Among 312 study subjects, 150 (48.1%) had DKD. The mean age (51.9 ± 11.9 vs. 48.6 ± 9.6 years), fasting plasma glucose (10.3 ± 4.1 vs. 9.2 ± 3.0 mmol/L), 2-h postprandial plasma glucose (14.6 ± 5.6 vs. 12.8 ± 4.5 mmol/L), glycated hemoglobin (HbA1c) (9.2 ± 2.1 vs. 8.4 ± 1.9%), and serum triglyceride (213.6 ± 109.9 vs. 185.5 ± 100.8) were higher (P ≤0.05 in each instance) in subjects with DKD in comparison to those without DKD. DKD group had higher mean absolute neutrophil count (6.0 ± 2.0 vs. 5.4 ± 1.9 ×109/L, P = 0.022), platelet count (310.4 ± 87.3 vs. 287.0 ± 78.7 ×109/L, P = 0.013), NLR (2.16 ± 1.1 vs. 1.92 ± 0.96, P = 0.040), and PLR (115.45 ± 57.07 vs. 101.02 ± 40.06, P = 0.010). The levels of hemoglobin, total leukocyte count, absolute lymphocyte count, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and red cell distribution width were similar in the two groups. Conclusion: In this study, we found higher NLR and PLR in subjects with DKD than those without DKD. NLR and PLR may be considered as cheap, readily available alternative markers of DKD in resource-poor settings.

Akut Post Streptokokal Glomerülonefrit Gelişiminde Mannoz-Bağlayıcı Lektinin Rolü Nedir?

Objective: This study aims to determine the effects of the mannose-binding lectin (MBL) gene polymorphism on the clinical and laboratory findings, response to treatment, and progress of patients with acute post-streptococcal glomerulonephritis (APSGN). Methods: Codon 54 polymorphism found in exon 1 of the MBL gene was investigated by polymerase chain reaction-restriction fragment length polymorphism method in 110 children followed up with the diagnosis of APSGN and compared with healthy control group. Results: The normal allele AA and, the variant alleles AB and BB gene frequencies were determined within the APSGN group as 74.5%, 20% and, 5.5%, respectively. No statistically significant difference was found with concerning to the gene polymorphism in the APSGN group when compared with the control group (p&gt;0.05). No correlation was found in the patient group between gene polymorphism and the presence of hematuria, edema, central nervous system findings, and blood pressure (p&gt;0.05). Concerning laboratory findings during the diagnosis, no correlation existed between the gene polymorphism and high levels of urea, creatine, total cholesterol, and triglycerides, low levels of albumin, and the presence of proteinuria (p&gt;0.05). Within the first years following the diagnosis, no statistically significant difference was found in the glomerular filtration rates, blood creatine levels, proteinuria levels, duration of microscopic hematuria and proteinuria between the patients with the gene polymorphism and those without the gene polymorphism (p&gt;0.05) Conclusion: Our study determined that the MBL gene polymorphism was not important in the development, the laboratory and clinical findings, or the progression of the patients with APSGN.

Maternal Lipid Profile as Predictor for Mother and Fetus Outcome-an Artificial Neural Network Approach.

Purpose. The study aims to predict mother and fetus outcome based on the mother's lipid profile in the second and third trimester of pregnancy. Material and method. Blood and urinary samples were taken from 135 mothers that were prospectively monitored during the hole pregnancy. Total cholesterol (TC), triglycerides (TG), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), together with other parameters, were used as predictors in a multilayer perceptron (MLP) artificial neural network (ANN). Small for gestational age (SGA) was used to assess the fetal outcome, while Gestational diabetes mellitus (GDM) and, Hypertensive disorders in pregnancy (HDP) to assess the mother's outcome. Results. SGA prediction rate was 0.637±0.022 for the second trimester and 0.632±0.017 for the third trimester. GDM prediction rate was 0.897±0.006 for the second trimester and 0.632±0.017 for the third trimester. HDP prediction rate was 0.620±0.046 for the second trimester and 0.775±0.030 for the third trimester. When used with other parameters (hemoglobin, thrombocytes, uric acid, GOT, GPT, the presence of proteinuria, urea, and creatinine) the prediction rates raised, going over 90% for the GDM. Conclusions. Though individual lipid parameters do not statistically correlate with the output variables the use of ANN generated prediction rates raging from 60% to 90%. The lipid profile from the third trimesters seems to be a better prediction for both fetus and mother outcome.

Clinicopathological Correlation with Mesangial C4d Deposition in Primary Immunoglobulin A Nephropathy - A Descriptive study.

In immunoglobulin A (IgA) nephropathy, activation of lectin pathway leads to severe renal damage and more pronounced histological damage. As C4d is a marker of lectin pathway activation, the presence of mesangial C4d positivity will help in identifying those patients at risk. The study was conducted to study the prevalence of mesangial C4d positivity in patients with primary IgA nephropathy and to compare the clinical and histopathological features with C4d-positive and C4d-negative cases. It is a retrospective study conducted for four years. The inclusion criterion was IgA nephropathy with a minimum of four viable glomeruli. Biopsies with >25% of nonsclerotic glomeruli with mesangial positivity will be considered as positive for C4d. Seventy-six patients of IgA nephropathy were included of which mesangial C4d positivity was noted in 33 patients (43%). The mean age was 35 years. The male:female ratio was 2.3:1. The most common presentation was edema (56%) followed by microscopic hematuria (28%). Fifty-four patients were hypertensive. Among the clinical and laboratory parameters, absence of hematuria (P = 0.04) and presence of proteinuria (P = 0.02) showed a significant association with C4d positivity. The histological parameters in Oxford classification which had significant association with C4d positivity were segmental sclerosis (P = 0.01) and tubular atrophy (P = 0.001). Among 45 patients on follow-up with a maximum duration of 51 months, 10 developed end-stage renal disease of which four had C4d expression (0.05%) in the biopsy. Nearly half of IgA nephropathy patients have mesangial C4d positivity. Elevated creatinine with chronicity changes is more common in C4d-positive patients. Hence, C4d can be used as a marker for poor prognosis.