Urinary Microalbumin Levels Research Articles

Relationship between pre-procedural microalbuminuria and renal functional changes after coronary computed tomography in diabetic patients

BackgroundDiabetes is one of the risks for development of contrast-induced nephropathy (CIN). The percentage change in cystatin C (CyC), a recent new reliable marker for detecting subtle renal dysfunction, of ≥10% for 24h after procedure is an independent predictor for developing CIN. Urinary microalbumin is one of the markers for preclinical nephropathy in diabetic patients. We investigated the relationship between pre-procedural urinary microalbumin and renal functional changes using CyC after coronary computed tomography angiography (CCTA) in diabetic patients. MethodsTwo hundred and six patients with diabetes scheduled for CCTA were enrolled. The serum creatinine and CyC levels were measured before and 24h after CCTA. The percentage change in CyC (%CyC) and absolute change in estimated glomerular filtration rate (eGFR) from pre- to post-procedure were calculated. The pre-procedural urinary microalbumin was measured. The patients were classified into 2 groups as follows: group A comprised 93 patients with pre-procedural urinary microalbumin of ≥30mg/g creatinine; and group B comprised 113 patients with one of <30mg/g creatinine. ResultsThe %CyC, fasting plasma glucose levels, and HbA1c were significantly greater in group A than in group B. The absolute change in eGFR was significantly less in group A than in group B. A significant correlation was seen between urinary microalbumin and %CyC (r=0.49, p<0.0001). Multivariate regression analysis revealed that pre-procedural urinary microalbumin and HbA1c were independent predictors for a %CyC≥10% (OR: 1.030, 95% CI: 1.020–1.039, p=0.008; and OR: 1.011, 95% CI: 1.007–1.016, p=0.004, respectively). The optimal cut-off value of a pre-procedural urinary microalbumin level was 64mg/g creatinine for predicting a %CyC≥10% using receiver-operating characteristic curve analysis with a sensitivity, specificity, and area under the curve of 56%, 88%, and 0.72, respectively. ConclusionsRenal functional changes should be paid attention to after CCTA, particularly in diabetic patients exhibiting elevated pre-procedural urinary microalbumin even though they indicate preserved eGFR.

THU-315 - Urinary Micro-Albumin Level and its Modification Status Serve as an Non-Invasive Marker for Outcome Prediction in Acute-On-Chronic Liver Failure (ACLF) Patients

THU-315 - Urinary Micro-Albumin Level and its Modification Status Serve as an Non-Invasive Marker for Outcome Prediction in Acute-On-Chronic Liver Failure (ACLF) Patients

Ischemia Modified Albumin (IMA) - A Marker of Glycaemic Control and Vascular Complications in Type 2 Diabetes Mellitus.

Ischemia modified albumin (IMA) has emerged as a marker for ischemic injury and oxidative damage, particularly in myocardial infarction. There are very few studies on the significance of IMA in other conditions associated with ischemia. The complications of diabetes mellitus (DM) arising out of poor glycaemic control have an underlying ischemic aetiology. To evaluate correlation of IMA with glycaemic control in type 2 DM (T2DM). Secondary aim was to assess the utility of IMA as a marker for vascular complications in T2DM. During this cross-sectional study, a total of 100 diagnosed cases of T2DM were recruited between May 2013 and September 2013. The IMA, HbA1c, lipid profile, creatinine and urine micro-albumin levels were measured and analysed with respect to clinical condition of the patients. The epidemiological software, Epi-Info 7.1.5, was used for the statistical analysis, p-value<0.05 was defined as level of significance. The study subjects were in the age group from 30 to 75 years and 52.4% were males. There was a great degree of variance in the level of glycaemic control and majority (64.6%) had poor or very poor glycaemic control as reflected by their HbA1c levels. The IMA (Mean ± SEM) levels were found to be higher (62.9 ± 1.7ABSU) in the patients with poor glycaemic control compared to those with good glycaemic control (54.2 ± 3.5 ABSU, p-value < 0.05) and correlated with HbA1c levels (r(2)=0.14). IMA levels also appeared to be related with the changes in lipid profile and increased with increasing total cholesterol levels. The subjects with macro-vascular complications (retinopathy and neuropathy) showed non-significantly higher levels of IMA. The elevation in IMA correlated with the HbA1c and changes in the lipid profile. IMA correlates with poor glycaemic control and dyslipidaemia associated with T2 DM and could serve as an indicator of oxidant stress in these patients.

Evaluation of Serum Creatinine and Cockcroft-Gault Estimated GFR as an Early Biomarker of Renal Impairment in Patients with Type 2 Diabetes Mellitus

Background: Control of blood sugar level in Type 2 Diabetes Mellitus (DM) cases is of utmost importance in prevention of long term complications like chronic kidney disease (CKD). With an alarming increase of the incidence of Type 2 DM cases the early detection of renal impairment becomes more important. The study therefore was carried out to evaluate whether conventional biomarker like creatinine and creatinine based GFR has any implication or not for diagnosing early renal impairment in such cases. Materials and Methods: 60 Type 2 Diabetes Mellitus patients and 60, age and sex matched healthy controls were included in the study. Routine biochemical markers like FBS, PPBS, Serum urea creatinine, Lipid profile and special parameters like HbA1c and Urine microalbumin level was measured in all of them. Results: We have found out that serum urea and creatinine were not significantly raised in normoalbuminuric and microalbuminuric cases as compared to controls. But creatinine based GFR was significantly reduced in microalbuminuric cases when compared to controls but not significantly reduced (p=0.09) in normoalbuminuric diabetics when compared with controls. Conclusion: Creatinine based GFR can help us to diagnose early renal impairment in Type 2 Diabetes Mellitus cases.

Association of Comorbid and Metabolic Factors with Optimal Control of Type 2 Diabetes Mellitus.

Background:Type 2 diabetes mellitus (T2DM) is a poorly controlled epidemic worldwide that demands active research into mitigation of the factors that are associated with poor control.Aims:The study was to determine the factors associated with suboptimal glycemic control.Materials and Methods:Electronic medical records of 263 adult patients with T2DM in our suburban internal medicine office were reviewed. Patients were divided into two groups: Group 1 [optimal diabetes control with glycosylated hemoglobin (HbA1c) of 7% or less] and Group 2 (suboptimal diabetes control with HbA1c greater than 7%). The influence of factors such as age, gender, race, social history, comorbid conditions, gestational diabetes, family history of diabetes, diabetes management, statin use, aspirin use, angiotensin convertase enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) use, body mass index (BMI), blood pressures, lipid profile, and urine microalbumin level were analyzed in the two groups.Results:In the suboptimal diabetes control group (N = 119), the majority (86.6%) of the patients were 41-80 years old. Factors associated with the suboptimal control were male gender [odds ratio (OR) 2.6, 95% confidence interval (CI), 1.579-4.321], Asian ethnicity (OR 1.4, 95% CI, 0.683-3.008), history of peripheral arterial disease (PAD; OR 3.9, 95% CI, 1.017-14.543), history of congestive heart failure (CHF; OR 3.9, 95% CI, 1.017-14.543), elevated triglycerides (OR 1.004, 95% CI, 1.000-1.007), and elevated urine microalbumin level of 30 mg/24 h or above (OR 4.5, 95% CI, 2.446-8.380). Patients with suboptimal diabetes control had a 3.8 times greater odds (95% CI, 1.493-6.885) of receiving the insulin and oral hypoglycemic agent together.Conclusions:In adult patients with T2DM, male gender, Asian ethnicity, CHF, PAD, management with insulin along with oral hypoglycemic agents, hypertriglyceridemia, and microalbuminuria were associated with suboptimal control.

Serum Total Sialic Acid and Highly Sensitive C-reactive Protein: Prognostic Markers for the Diabetic Nephropathy.

Background:This study was undertaken to evaluate and establish the role of total sialic acid (TSA) and highly sensitive C-reactive protein (hs-CRP) in type 2 diabetes mellitus (T2DM) and its correlation with complications such as diabetic nephropathy.Materials and Methods:One hundred fifty-seven patients with T2DM with nephropathy (DN) and 162 patients of T2DM without nephropathy (DM) along with 165 unrelated age and sex-matched healthy controls were included in the study. Serum glucose (fasting and postprandial) levels, renal profile, and lipid profile were done as per standard protocol. Serum TSA test levels and hs-CRP level were evaluated using thiobarbituric acid assay and immunoturbidimetric method respectively.Results:We observed a higher concentration of serum TSA (82.67 ± 6.63 mg/dl) and hs-CRP (3.2 ± 1.44 mg/L) in diabetic nephropathy than the diabetes mellitus group (73.83 ± 6.90 mg/dl and 2.07 ± 1.32 mg/L, respectively). Both TSA and hs-CRP levels were found significantly correlated with fasting and postprandial blood sugar, hemoglobin A1c, and urine microalbumin levels in both DM and DN groups. Multinomial logistic regression analysis showed that both TSA and hs-CRP was independently associated with diabetic nephropathy.Conclusion:High serum TSA and hs-CRP levels may increase the microangiopathic (diabetic nephropathy) complications of T2DM.

Serum Creatinine and Urine Microalbumin Level in Hypertensive and Non hypertensive Patients.

Introduction: Hypertension is one of the most common cardiovascular disorders, more likely to accelerateatherosclerosis causing cardiovascular complications and benign arteriolar nephrosclerosis for an extendedperiod of time may manifest as a mild to moderate elevation of serum creatinine and/or microalbuminuria.Methods: The present study was carried out on total 100 subjects. Which were divided into two groups. Firstgroup of experimental group consist of 50 subjects with known Hypertensive Subjects. Another group is controlgroup consist of 50 Non-Hypertensive Subjects with no present and past family history of hypertension.Results: The serum creatinine and microalbuminuria were estimated, compared and correlated in hypertensivecase group with healthy normotensive group. In case group there was signiÞ cantly elevated urine microalbuminand serum creatinine levels when compared to controls and also signiÞ cant positive correlation betweenserum creatinine and urine microalbumin levels in case group (hypertensive) as compared to control (nonhypertensive) groupConclusions: In the present study it has concluded that in Hypertensive patients serum creatinine, urinemicroalbumin is stastistically elevated in subjects group when compared to the control group.doi: http://dx.doi.org/10.3126/mjsbh.v12i2.12923

Does Stepwise Voltage Ramping Protect the Kidney from Injury During Extracorporeal Shockwave Lithotripsy? Results of a Prospective Randomized Trial

BackgroundRenal damage is more frequent with new-generation lithotripters. However, animal studies suggest that voltage ramping minimizes the risk of complications following extracorporeal shock wave lithotripsy (SWL). In the clinical setting, the optimal voltage strategy remains unclear. ObjectiveTo evaluate whether stepwise voltage ramping can protect the kidney from damage during SWL. Design, setting, and participantsA total of 418 patients with solitary or multiple unilateral kidney stones were randomized to receive SWL using a Modulith SLX-F2 lithotripter with either stepwise voltage ramping (n=213) or a fixed maximal voltage (n=205). InterventionSWL. Outcomes measurements and statistical analysisThe primary outcome was sonographic evidence of renal hematomas. Secondary outcomes included levels of urinary markers of renal damage, stone disintegration, stone-free rate, and rates of secondary interventions within 3 mo of SWL. Descriptive statistics were used to compare clinical outcomes between the two groups. A logistic regression model was generated to assess predictors of hematomas. Results and limitationsSignificantly fewer hematomas occurred in the ramping group(12/213, 5.6%) than in the fixed group (27/205, 13%; p=0.008). There was some evidence that the fixed group had higher urinary β2-microglobulin levels after SWL compared to the ramping group (p=0.06). Urinary microalbumin levels, stone disintegration, stone-free rate, and rates of secondary interventions did not significantly differ between the groups. The logistic regression model showed a significantly higher risk of renal hematomas in older patients (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00–1.05; p=0.04). Stepwise voltage ramping was associated with a lower risk of hematomas (OR 0.39, 95% CI 0.19–0.80; p=0.01). The study was limited by the use of ultrasound to detect hematomas. ConclusionsIn this prospective randomized study, stepwise voltage ramping during SWL was associated with a lower risk of renal damage compared to a fixed maximal voltage without compromising treatment effectiveness. Patient summaryLithotripsy is a noninvasive technique for urinary stone disintegration using ultrasonic energy. In this study, two voltage strategies are compared. The results show that a progressive increase in voltage during lithotripsy decreases the risk of renal hematomas while maintaining excellent outcomes. Trial registrationISRCTN95762080

A lack of association between vitamin d-binding protein and 25-hydroxyvitamin d concentrations in pediatric type 1 diabetes without microalbuminuria

The risk of vitamin D deficiency might increase along with the increased urinary loss of vitamin D binding protein (VDBP) consequent to impaired 25-hydroxyvitaminD (25-OHD) circulation. We aimed to evaluate the possible increased urinary loss of VDBP, a correlation between VDBP and circulating 25-OHD levels, and the risk factors influencing low vitamin D levels in pediatric type 1 diabetes patients without microalbuminuria. Subjects with T1DM without microalbuminuria (n=45) and age-matched healthy control subjects (n=29), aged 9–14 yr, residing in Seoul and the Gyeonggi-Do in Korea (37°N) were studied. Height, weight and pubertal stage were evaluated. The percentage of body fat was measured by bioelectrical impedance analysis (inbody). A questionnaire was used to assess the amount of daylight outdoor activity and vitamin D intake. Serum levels of calcium, phosphorus, intact parathyroid hormone, 25-OHD, 1,25 dihydroxyvitamin D and VDBP, as well as urinary levels of VDBP, microalbumin and creatinine (Cr) were measured. 25-OHD deficiency was defined as ≤20 ng/mL. The urinary VDBP to Cr ratio (VDBPCR) in type 1 diabetes patients was higher than that in the control group (P = 0.016) and correlated positively with the urinary microalbumin to Cr ratio in both groups (P <0.001). The serum 25-OHD levels did not correlate with the serum VDBP or urinary VDBPCR. A multivariate regression analysis including known vitamin D deficiency risk factors (age, gender, body fat percentage, vitamin D intake, daylight outdoor hours, and urinary VDBPCR) revealed that daylight outdoor hours (β = 2.881, P = 0.009) and vitamin D intake (β = 2.342, P = 0.050) affected the 25-OHD levels in type 1 diabetes patients. In pediatric type 1 diabetes patients without microalbuminuria, the urinary VDBP loss was increased proportionally with the urinary mACR. However, the urinary VDBPCR did not correlate with the serum 25-OHD levels. The factors associated with 25-OHD levels during winter periods were daylight outdoor hours and vitamin D intake.

Renal tubular damage may contribute more to acute hyperglycemia induced kidney injury in non-diabetic conscious rats

AimsGrowing evidences suggest that acute hyperglycemia is strongly related to kidney injury. Our study aimed to investigate the effects of acute hyperglycemia on kidney glomerular and tubular impairment in non-diabetic conscious rats. MethodsNon-diabetic conscious rats were randomly subjected to 6h of saline (control group) or high glucose (acute hyperglycemia group) infusion. Blood glucose was maintained at 16.0–18.0mmol/L in acute hyperglycemia group. Renal structure and function alterations, systemic/renal inflammation and oxidative stress markers were assessed, and apoptosis markers of renal inherent cells were evaluated. ResultsAcute hyperglycemia caused significant injury to structure of glomerular filtration barrier, tubular epithelial cells and peritubular vascular endothelial cells. It increased urinary microalbumin (68.01±27.09μg/24h vs 33.81±13.81μg/24h, P=0.014), β2-microglobulin, Cystatin C, urinary and serous neutrophil gelatinase-associated lipocalin levels (P<0.05). Acute hyperglycemia decreased megalin and cubilin expression, activated systemic and renal oxidative stress as well as inflammation and promoted renal inherent cell apoptosis. ConclusionsAcute hyperglycemia causes significant injury to kidney function and structure. Compared with damages of glomerular filtration barrier, renal tubular injury may contribute more to acute hyperglycemia induced proteinuria. Activation of inflammation especially renal inflammation, oxidative stress and enhanced apoptosis may be the underlying mechanisms.

English

Type 2 diabetes mellitus is one of the major cause of the mortality and morbidity in the world. Type 2 diabetes mellitus is a chronic disease characterized by relative deficiency of insulin, resulting in glucose intolerance. Aims and objectives: The present study was planned to understood more about hyperuricemia and microalbuminuria and its complications in type 2 diabetes mellitus patients. Material and methods: In present study, 565 patients of type 2 diabetes mellitus and age and sex matched controls were included. Observation and results: We found increased levels of serum uric acid and urine microalbumin in type 2 diabetic patients as compared to controls (p<0.001). We observed the positive correlation between serum uric acid and urine microalbumin (p<0.001). Conclusion: The serum uric acid and urine microalbumin are not only early diagnostic markers for atherogenic cardiovascular disease and renal disease but also prognostic monitoring of the disease in type 2 diabetes mellitus patients.

Effects of Astragaloside IV on diabetic nephropathy in rats.

The aims of this study were to explore the effects of Astragaloside IV on diabetic nephropathy (DN) rats. A total of 38 male Sprague-Dawley (SD) rats were divided into three groups: 10 in the normal (control) group, 14 in the DN model group, and 14 in the AS-IV group. Treatment began one week after the streptozotocin DN model was successfully established. Blood glucose and urine micro-albumin levels were measured every four weeks. After being treated for 12 weeks, all SD rats were sacrificed for blood and renal specimen collec-tion. Renal cortex specimens were observed after hematoxylin and eo-sin and Masson staining. Expression levels of protein β1, β1-integrin-linked protein kinase (ILK) and α-actinin-4 were also measured. After eight weeks of intervention, blood glucose levels in the AS-IV group decreased significantly when compared with those of the model group (P < 0.01). By the end of the twelfth week, the urine micro-albumin levels showed significant differences (P < 0.01) between the AS-IV and model groups, and the expression levels of integrin β1, ILK, and α-actinin-4 also showed significant differences (P < 0.05, respectively). Concomitantly, expression levels of integrin β1, ILK, and α-actinin-4 in the model group were significantly different from those of normal group (P < 0.05). These results suggest that AS-IV can be quite effective in decreasing blood glucose levels, reducing urine albumin excretion, and improving the adhesion function of potocytes, and can thus delay the development of DN.

Assessment of microalbuminuria and albumin creatinine ratio in patients with type 2 diabetes mellitus.

Aim:We aimed to evaluate the levels of urine microalbumin, urine albumin creatinine ratio, plasma creatinine and glycosylated hemoglobin (HbA1c) among type 2 diabetic patients and assessed the correlation between microalbuminuria and plasma creatinine levels.Materials and Methods:A retrospective chart review study was conducted at Department of Clinical Chemistry, King Abdulaziz Medical City in Riyadh, Saudi Arabia, during August to December 2014. The study included 100 male and female patients diagnosed with type 2 diabetes mellitus (DM) and excluding patients with type 1 DM. Medical history and biochemical laboratory data were obtained from medical records and from biochemistry laboratory database.Results:Increase in mean level of plasma creatinine (138 μmol/L), urine microalbuminuria (240 mg/L), albumin creatinine ratio (82) and HbA1c (8.7%) was observed among type 2 DM patients. Moderate positive correlation was observed between microalbuminuria and urine albumin creatinine ratio (r = 0.509 P = 0.0006) and between urine albumin creatinine ratio and plasma creatinine (r = 0.553 P = 0.017).Conclusion:We concluded that type 2 DM patients who are at risk of developing renal impairment must be regularly monitored for microalbuminuria, urine albumin creatinine ratio, and HbA1c levels.

The relationship of serum uric acid and urinary microalbumin with the progression and cognitive dysfunction of patients with Parkinson's disease

Objective To study the relationship of the levels of serum uric acid and urinary microalbumin with the progression and cognitive dysfunction of patients with Parkinson' s disease (PD).Methods A retrospective analysis of 102 confirmed cases of PD (including both outpatients and inpatients of our hospital from January 2007 to April 2014) was carried out.102 patients were divided into early-onset group and late-onset group according to patients' ages at onset,PD with cognitive dysfunction group and PD without cognitive dysfunction group according to the assessment of patients' cognitive dysfunction,Ⅰ stage,Ⅱ stage,Ⅲ stage,Ⅳ stage,Ⅴ stage according to the assessment of patients' motor dysfunction (Ⅰ-Ⅱ stage for early stage,Ⅲ stage for mid-stage,Ⅳ-Ⅴ stage for advanced stage).Besides,102 healthy people who had physical examinations in our hospital were recruited as control group.The levels of serum uric acid and urinary microalbumin were detected,statistically analyzed and compared among sub groups.Results The level of serum uric acid of PD group was significantly lower than that of control group (P ＜ 0.01).There was no statistically significant difference in serum uric acid between early-onset group and late-onset group (P ＞ 0.05).The level of serum uric acid of PD with cognitive dysfunction group was lower than that of PD without cognitive dysfunction group (P ＜ 0.05).There were no statistically significant differences in serum uric acid among early stage,mid-stage,advanced stage (P ＞ 0.05).The levels of serum uric acid of each sub group were all lower than that of control group.There were no statistically significant differences in the level of urinary microalbumin between each sub group and control group (P ＞ 0.05).Conclusions The level of serum uric acid in patients with Parkinson' s disease is lower than that of healthy subjects,and low serum uric acid level may be one of risk factors for Parkinson's disease.There is no significant correlation between low serum uric acid level in Parkinson's disease and the disease progression.However,low uric acid level seems to have something to do with the cognitive impairment in patients with PD.There is no significant correlation between urinary microalbumin and the occurrence and development of Parkinson's disease.Appropriate intervention on blood uric acid level may not only help to improve PD patients' quality of life,but also save their medical expenses. Key words: Parkinson's disease; Uric acid; Urinary microalbumin

High sensitive C- reactive protein and microalbumin in type 2 diabetes mellitus

Background: Diabetes mellitus is one of the leading causes of m orbidity and mortality because of its role in the development of optic, renal, neuropathic and cardio vascular diseases (CVD). It is major public health care problem in developed countries as well as developing areas like India. Objectives: The aim of this study is to determine the serum high sensitive C- Reactive Protein (hs-CRP) a nd urinary microalbumin levels in patients with typ e 2 diabetes mellitus and to compare with healthy controls. Materials and Methods: In this study total 80 subjects were included above 40 years of age. 40 clinically diagn osed type 2 diabetic patients and 40 normal subject s were recruited as control. Microalbumin and hs-CRP were measured by latex turbidimetric method. Statistical Analysis: Data were analyzed using student ‘t’ test for their level of significance. Results: The mean microalbumin level in type 2 diabetic patients was significantly higher t han in the controls. The serum hs-CRP levels were s ignificantly higher in patients as compared to control subjects. Conclusion: Increased levels of hs-CRP and microalbumin may be implicated in the development of cardiovascular disease and renal impairment and these investigatio ns will defiantly help in the management of diabetic patien ts.

Retinopathy among young adults with Diabetes Mellitus from a tertiary care setting in Sri Lanka

BackgroundDiabetic retinopathy (DR) is one of the leading causes for complete loss of vision among working-aged adults around the world. The present study aims to evaluate the rate of DR and its risk factors among the adults with young-onset diabetes from a tertiary care setting in Sri Lanka.MethodsA consecutive sample of 1,007 individuals referred from multiple centers, were invited for the study. Ophthalmological evaluation was done, with dilated indirect ophthalmoscopy by an Ophthalmologist. Retinopathy was classified according to the International Clinical DR Disease Severity Scale. An interviewer-administered questionnaire was used to collect socio-demographic and anthropometric details. Seated blood pressure, Fasting Blood Glucose (FBG), HbA1c and urine microalbumin were also measured. Data were analysed using SPSSv14. A binary logistic regression analysis was performed in all patients, with ‘presence of DR’ as the dichotomous dependent variable and other independent covariates.ResultsSample size was 684 (response rate–67.9%), mean age was 37.1 ± 5.9 years and 36.0% were males. Mean duration of diabetes was 5.2 ± 4.0 years. Previous retinal screening had been done in 51.0% by a non-specialist doctor and in 41.5% by a consultant ophthalmologist. Rate of any degree of DR in the study population was 18.1% (Males 16.4%, Females 20.0%; P = NS). In patients with DR, majority had mild Non-Proliferative DR (NPDR) (57.2%), while 32.2% had moderate NPDR, 0.8% had severe NPDR and 9.7% had maculopathy. Mean age, duration of diabetes, systolic (SBP) and diastolic blood pressure (DBP), FBG, HbA1c and urine microalbumin levels were significantly higher amongst the patients with DR. The results of the binary logistic regression indicate that the duration of diabetes (OR:1.24), HbA1c (OR:1.19), age (OR:1.11), urine Microalbumin (OR:1.11) and DBP (OR:1.04) all were significantly associated with DR.ConclusionsIn this large multi center study, nearly one in five adults with young-onset diabetes was found to have retinopathy. Age, duration of diabetes, HbA1C and urine Microalbumin levels were significantly associated with the presence of retinopathy, while HbA1c was also a significant factor determining severity. Nearly 50% of the study population has never undergone retinal screening by an ophthalmologist, highlighting the need for well organized screening programs.

Estimated glomerular filtration rate and associated risk factors in overweight or obese patients with type 2diabetes and normal urine microalbumin level

From August 2011 to March 2012,5 241 type 2 diabetic patients with body mass index ≥ 24kg/m2 were enrolled from 60 hospitals in Guangdong Province.According to estimated glomerular filtration rate (eGFR),a total of 2 631 subjects with norml urine microalbumin level (＜30 ng/L) were divided into normal eGRF group and decreased eGRF group.Binary logistic regression was used to analyze the associations between eGFR and its related risk factors.The results showed that age,blood uric acid,blood urea nitrogen,history of hypertension and coronary heart disease,family history of diabetes,and hyperuricemia were positively related to lowering of eGFR (P＜ 0.05 or P＜0.01).HbA1C＜7％,regular glucose monitoring,and regular physical activity were negatively related to eGFR decrease (all P＜ 0.01).These results suggest that urine microalbumin and eGFR should be applied to overweight or obese patients with type 2 diabetes in order to screen diabetic nephropathy.Furthermore,intensive control of blood glucose,uric acid,and blood pressure is beneficial to lowering the risk of diabetic nephropathy. Key words: Overweight; Obesity; Diabetes mellitus, type 2 ; Estimated glomerular filtration rate; Urine microalbumin

Assessment of urinary microalbumin levels in type 1 and type 2 diabetic subjects

Abstract: Introduction: Diabetes mellitus is one of the most prevalent metabolic diseases all over the globe, including India. Prolonged diabetes is accompanied with many complications including diabetic nephropathy. Diabetic nephropathy is defined clinically as the presence of microalbuminuria or overt nephropathy in patients with diabetes without the manifestations of renal diseases due to other causes. The earliest sign of diabetic nephropathy leading to an end stage renal disease is microalbuminuria and is estimated as UAE (Urinary Albumin Excretion) in 24 h urine samples and also as UACR (Urinary Albumin Creatinine Ratio) by estimating the albumin/creatinine ratio in spot urine specimens. Indian clinical guidelines strategize the aspects of prevention or prolongation or even reversion of diabetic complications such as diabetic nephropathy at primary, secondary and tertiary stages to yield beneficial effects. With a view of beneficial effect of assessing the onset of nephropathy in diabetic patients we analyzed the microalbumin levels for an early detection of the existence of microalbuminuria and its prevalence in both type-1 and type-2 diabetic patients. Materials and Methods: Morning spot urine samples were collected from diabetic patients. Microalbumin and creatinine were estimated from these urine samples by immuno-turbidometric and alkaline-picrate methods respectively. Microalbumin was expressed in terms of mg/ g creatinine. Lipid profile was also estimated in these patients. Student’s ‘t’ test was applied for significance. Results: A total of 75 samples were analyzed for microalbuminuria, of these 25 were healthy controls and 50 were diabetics (both type-1 and type-2) with 4 to 25 years duration of diabetes. We observed an incidence of 72% microalbuminuria in diabetics (both type-1 and type-2) patients and 65% in type-2 diabetic patients. A good correlation was found between duration of diabetes & incidence of microalbuminuria (p = 0.02) in both types of diabetes. Conclusion: Percentage of subjects with microalbuminuria was significantly high in both the types of diabetes, and it correlates with higher age and longer duration of diabetes. Early and routine screening for microalbuminuria in diabetic patients is desirable for an early detection and prevention of diabetic nephropathy.

What is the Effect of Pseudoexfoliation Syndrome on Renal Function in Patients without Glaucoma?

Purpose: To evaluate renal function in patients with pseudoexfoliation syndrome.Materials and Methods: This prospective, cross-sectional, case-control study involved 49 patients with pseudoexfoliation syndrome (PEX) and 42 control subjects. Renal function was examined by biochemical parameters and Doppler ultrasonography. Serum creatinine, blood urea nitrogen, urea levels, urine microalbumin level and creatinine clearance were measured. Renal volume, resistive index and pulsatility index were calculated using Doppler ultrasonography.Results: The mean laboratory values for both groups were as follows: Creatinine, PEX: 0.81 ± 0.28 mg/dL – Control: 0.79 ± 0.22 mg/dL; urea, PEX: 31.6 ± 9.7 mg/dL – Control: 32.2 ± 8.4 mg/dL; blood urea nitrogen, PEX: 14.8 ± 4.6 mg/dL – Control: 15.1 ± 4.0 mg/dL; creatinine clearance, PEX: 89.1 ± 35.6 mL/min – Control: 99.0 ± 47.2 mL/min; microalbumin, PEX: 5.8 ± 22.7 mg/dL – Control: 2.7 ± 6.0 mg/dL. The differences between groups were not significant (p > 0.300). Renal volume, resistive index and pulsatility index values were similar in both groups (p > 0.200).Conclusions: This study showed that pseudoexfoliation syndrome does not affect biochemical and ultrasonographic parameters associated with renal function.

Pyridoxamine, an inhibitor of protein glycation, in relation to microalbuminuria and proinflammatory cytokines in experimental diabetic nephropathy

Diabetic nephropathy (DN) is one of the major complications that develop as consequence of chronic and uncontrolled hyperglycaemia. Hyperglycaemia initiates various processes, one of which is protein glycation, leading to the formation of advanced glycation end products. Alteration of intracellular signalling, gene expression, release of proinflammatory molecules and free radicals are examples of such changes and they contribute to the initiation of diabetic complications. In the current manuscript, we studied the effect of pyridoxamine (PM) on protein glycation, oxidative stress, interleukin-1α (IL-1α), IL-6, C-reactive protein (CRP), gene expression of tumour necrosis factor-α (TNF-α) and transforming growth factor-β1 (TGF-β1) in relation to microalbuminuria and kidney functions in a model of alloxan-induced diabetic rats. We have observed that onset of microalbuminuria has preceded the gradual increase of blood sugar level in diabetic rats. In diabetic rats, gene expression of TNF-α and TGF-β1 recorded a gradual increase and marked increase was observed after one and two weeks of alloxan administration, in comparison with normal rats. PM induced significant decrease in kidney malondialdehyde content and the gene expression of TNF-α and TGF-β1, in addition to levels of serum glucose, fructosamine, urea, creatinine, IL-1α, IL-6, CRP and urine microalbumin. Histopathological examination of kidney tissues showed certain improvements as compared with diabetic control. In conclusion, our results may provide a supporting evidence for the therapeutic benefit of PM in DN.