Urine Micro Research Articles

BK Virus Nephropathy After Kidney Transplantation and Its Diagnosis Using Urinary Micro RNA

BK virus-associated nephritis (BKVAN) is an important cause of graft loss in renal transplant recipients B K viremia occurs in up to 30% of renal transplant recipients. Since the discovery of BKV in 1971, effective prophylaxis and treatment have not been established, and it is not uncommon for a transplant kidney to be lost without cure of BKVAN. BK virus infection is reactivated when cellular immunity is suppressed, which is often during the first year after kidney transplantation when cellular immunity is most suppressed. Clinically, it is caused by reactivation of latent infection or new infection from the donor kidney, leading to viremia, viremia, and transplant nephropathy. BK virus nephropathy is currently diagnosed definitively by measuring the amount of BK virus DNA in the blood and proving SV40-positive cells in transplant kidney tissue obtained by transplant kidney biopsy, but the time required for diagnosis and the low sensitivity of immunohistochemistry using antibodies are problematic. Therefore, we investigated whether the diagnosis of BK virus nephropathy could be made earlier by searching for miRNAs in the urine of renal transplant recipients.

Evaluation and Correlation of Urinary Micro Albumin in Early Diagnosis of Patients with Hypertension Related Chronic Kidney Disease

Abstract One of the main organs targeted by hypertension, which is now understood by science to be an inflammatory disease, is the kidney. Urinary microalbumin, serum blood urea nitrogen, and creatinine are examples of clinical biochemical indicators for kidney illness that are often employed. This study aimed to study the role of Urinary microalbumin as a marker of inflammation in hypertensive chronic kidney disease patients. Evaluate the association of Urinary microalbumin levels in chronic kidney disease with/without hypertension. Possible usage of this marker as a predictive index for regular kidney disease occurrence. A case–control study was conducted on 100 participants, including 48 individuals identified as male and 52 individuals identified as female; in addition, their ages ranged from (20 to 70), these 100 participants, including (35) chronic kidney disease patients with hypertension (35) chronic kidney disease patients without hypertension, and (30) healthy control group, were evaluated concerning Urinary Micro Albumin using an immunochromatographic test kit. The results illustrated that Urinary microalbumin, Urea and Creatinine in CKD with the HBP group showed a highly significant increase (p˂0.05) compared to the control group according to case/ control, sex and age. In contrast, the most negligible value was in the Control group. In conclusion The research findings indicate a correlation between hypertension and chronic kidney disease (CKD). The presence of hypertension resulted in elevated levels of Urinary microalbumin, urea, and creatinine in patients as compared to the control group. Urinary microalbumin has the potential to serve as a marker for the assessment of glomerular and tubular function in adults. It performs comparably to the Cr-based estimating equations as an indicator of renal function.

Treatment of early stage diabetic nephropathy using Siddha drug Sirupeelai kudineer - Single Case Study

Background: Nephropathy is one of the major micro-vascular complications of DiabetesMellitus, which can be detected in the earlier stage by the investigation of urinarymicroalbumin excretion level, estimation of ACR and GFR. The Siddha drug SirupeelaiKudineer indicated for the complications of Diabetes Mellitus is selected for this Case study.The efficiency of the drug was reported by measuring the change in Renal function over theperiod of study and the KD QOL assessment. Case description: A male patient of 62 yearswith the history of DM and hypertension since 20 years came to the hospital with complaintsof bilateral pedal oedema, general weakness, frequent nocturnal micturition and weariness oflimbs since last two months. His renal profile and glycaemic index was deranged (SerumCreatinine -1.42 mg/dl; Blood Urea -54.3 mg/dl; Urine Micro albumin -99.45mg/L; UrineCreatinine -74.8 mg/dl; ACR -15.02 mg/mmol; eGFR - 64.5 ml/min; BSL (Fasting) -157mg/dl; BSL (Postprandial) -289 mg/dl). Patient was taking certain oral allopathic medicinesand injection huminsuline 30/ 70 in the dose of 35 units before lunch, and 30 units beforedinner subcutaneously. As per Siddha concept his three humours deranged and seen with theClinical features of Madhumega roga avathaigal and Neeradaippu. He was given Siddhamedicine Sirupeelai kudineer-120ml twice a day for the period of one month. Significantrelief in symptoms and improvement in certain renal parameters was noted in the subject.Conclusion: The clinical and laboratory parameters in this case study suggest that this drugmay be used along with other allopathic drugs in the treatment of Diabetic nephropathypatients.

Study on urine micro albuminuria as an isolated risk factor for cardiac morbitdity and mortality in non-diabetics and non-hypertensives

Background: There is a relative paucity of data on the link between urine micro albumin and IHD in non-diabetics as well as non-hypertensive’s compared to diabetics. This study was meant to look for the association between urine micro albumin and in cardiac morbidity and mortality among non-diabetic and non-hypertensive’s, which may further provide insight to the early diagnosis of micro albuminuria and its potential for predicting cardiac morbidity and thus needed inputs for better clinical management. Aims and objectives: To assess the relationship between micro albuminuria and proven risk factors and markers of cardiovascular disease in non-diabetic & non-hyper extensive ischaemic heart disease patients. Materials and methods: Among the 200 patients which were taken in the study, 141 (69.8%) were males and the rest29.2%were females. 34.5% each were from the age of 41-50 years and51-60 years respectively. Only 26 (13.0%) patients were from the age group of morethan60years. Results: The mean age of patients was 50.66 with a SDof 9.33. Majority of males were from the age group of 41-50 years (38.3%), while 42.4% of females were from the age group of 51-60 years. Mean age of male patients was found to be 49.41±9.16,while female patients was of 52.44±9.57.

Emerging role of urinary micro RNA-21 and microRNA-342 in arsenic-induced toxicity

Emerging role of urinary micro RNA-21 and microRNA-342 in arsenic-induced toxicity

Association of microalbuminuria and glycosylated hemoglobin in type 2 diabetes mellitus

HbA1c is highly prognostic for long term diabetes related complications such as microalbuminuria. Albumin is one of the most commonly assessed clinical parameters in diabetic patients. Present study was aimed a) to estimate microalbuminuria, HbA1c, urinary creatinine and urinary albumin to creatinine ratio (ACR) in patients with type 2 DM and b) to find out the correlation of glycemic control with microalbuminuria and urinary creatinine. This work is extension of our previous work on microalbuminuria in type 2 DM. Patients with type 2 DM were involved in the study. Biochemical investigations like Blood sugar, Glycosylated hemoglobin (HbA1c), Urinary micro albumin and urinary creatinine were analyzed.There was a significant difference in the values of all parameters i) between patients and normal standard values, ii) Among the three groups based on duration of diabetes. Significantly lower values of urinary creatinine (p<0.000) and significantly higher values of microalbumin (p<0.000) and ACR (p<0.000) were found in patients with poor glycemic control than moderate glycemic control in our study. We observed positive correlation between microalbuminuria and glycemic control.Hyperglycemia in type 2 diabetes is leading to lethal effects by damaging the kidney. Early detection and prevention of nephropathy in patients with type 2 DM will be possible by frequent and timely screening the patients for HbA1c, microalbuminuria, urinary creatinine and ACR. This will definitely help to reduce the mortality rate due to diabetic nephropathy and also the economic burden of society.

IDF21-0084 Role of serum copeptin levels in Type II Diabetes Mellitus patients with progressive stages of diabetic nephropathy

Background: Type II Diabetes mellitus (DM) is one of the leading metabolic diseases. It has multiple serious complications. Diabetic nephropathy is one of them. Progressive deterioration in renal functions due to DM makes the patient’s life completely handicapped. Thus, patients start depending on dialysis and ultimately develop its complications. Arginine Vasopressin (AVP) maintains glucose hemostasis and therefore, plays an important role in the pathophysiology of DM and its related complications such as diabetic nephropathy. Copeptin is an inactive analogue of AVP and considered as a reliable surrogate biomarker of AVP. Therefore, it is hypothesized that changes in the levels of copeptin can be correlated with diabetic and renal markers and thus may have potential role in predicting progressive stages of DM and diabetic nephropathy. Aim: The aim of the study is to find out the relation of copeptin with different diabetic and renal function biomarkers and to find out a potential role of copeptin as a predictive biomarker in DM and its associated progressive diabetic nephropathy. Method: It was a comparative cross-sectional study. A total number of 120 individuals were recruited into four groups i.e. controls, pre- diabetes, DM without nephropathy and DM with nephropathy as per the criteria of American Diabetes Association (ADA) 2018 and National Kidney Foundation/ Kidney Disease Outcome Quality Initiative (NKF/ KDOQI) 2018 guidelines. All cases were controlled hypertensive. Serum copeptin levels were measured by sandwich ELISA. While, Blood Urea Nitrogen (BUN), creatinine, Glycosylated Hemoglobin (HbA1c), urine micro albumin (UAE) and urinary creatinine were got done using spectrophotometry on Abbott Architect c8000 and electrolytes (Na+, K+ and Cl−) by iso electric method from Dow Diagnostic Research and Reference Laboratory (DDRRL), Dow University of Health Sciences. Statistical analysis was done using Analysis of Variance (ANOVA) and Pearson’s correlation tests on SPSS. Confounders were controlled using univariate linear regression. Results: The average copeptin levels of the study population were 215.096 pg/ml. Copeptin levels were significantly elevated in subjects with positive family history of DM (p = 0.025), levels were also raised in pre diabetes patients (252.85pg/ml) as compared to other groups. Copeptin levels were positively correlated with HbA1c r=0.171 (p=0.101), urea r=0.244 (p=0.007), creatinine r=0.215 (p=0.018), UAE r=0.310 (p=0.001), UACR r=0.375 (p=< 0.001). No significant correlation of copeptin was found with major electrolytes of the body. However, copeptin is found to be significantly associated with progressive stages of albuminuria and declining Glomerular Filtration Rate (GFR). Discussion: The raised levels of copeptin in subjects with positive family history of DM recommends its role in the early prediction of DM. Moreover, significant association of copeptin with progressive stages of albuminuria and declining GFR suggest the contribution of copeptin in the worsening of renal functions in DM and its associated nephropathy.

A study of microalbuminuria in patients with type 2 diabetes mellitus, visiting tertiary care center Sangli

Diabetic nephropathy is accompanied with significant micro vascular risk and is the leading cause of kidney disease. Hence there is an immense need to detect early for better quality of the care of affected patients and treat effectively those at high risk of diabetic kidney disease. Our study was aimed to assess the levels of microalbuminuria, glycated hemoglobin, urinary creatinine, urinary albumin to creatinine ratio (ACR) along with blood urea and serum creatinine in patients with type 2 DM, and to observe the incidence of microalbuminuria at tertiary care center; and correlate the presence of microalbuminuria to the duration of DM as well as with ACR. : Estimation of Blood sugar, Blood Urea, Serum Creatinine, Glycosylated hemoglobin (HbA1c), Urinary micro albumin and creatinine was done. Values of urinary creatinine, microalbumin, urinary albumin to creatinine ratio (ACR) showed highly significant (p&amp;#60;0.000) difference between the two age groups a) below 60 years and b) above 60 years of the age. Highly significant difference (p&amp;#60;0.000) was found among the results of the three groups based on duration of diabetes. We found microalbuminuria was more predominant in patients having age more than 60 years as well as in patients having more than 10 years of duration of DM. Routine screening for microalbuminuria in type 2 diabetic patients will certainly helpful for early detection of renal damage and thus to minimize the burden of diabetic complications due to renal involvement. Hence addition of microalbuminuria along with diabetic profile for medical checkup will help to assess microalbuminuria at frequent intervals.

STUDY OF MICROALBUMINURIA IN SEPSIS WITH REFERENCE TO APACHE II SCORE

Sepsis has very high morbidity and mortality, which leads to major healthcare burden in the world. Though there is far from advancement in the therapeutic options, the mortality rate remains high due to the delay in the diagnosis because of lack of availability of reliable diagnostic methods. In sepsis there is potent activation of inammatory cascade leads to endothelial dysfunction and increase in systemic capillary permeability. In kidney there is loss of barrier integrity and capillary leak in the glomerulus results in increased excretion of albumin in the urine. This study was done to evaluate the degree of microalbuminuria in sepsis in correlation with APACHE II score and to test whether the degree of microalbuminuria could predict the mortality in critically ill sepsis patients. Methodology: The present study was conducted on 50 patients admitted to medical emergency/ Medical ICU in Kamineni Institute of Medical Sciences Narketpally. Spot urine sample was collected within 6 hours and at 24 hours of admission to medical emergency/ICU /ward. Sample testedfor urine micro albumin by using immunoturbidometric method and for urine creatinine by Jaffee method. Urine albumin: creatinine ratio was calculated. (At 6 hours ACR-1 and at 24 hours ACR-2). APACHE II scoring was done at 24 hours of admission. Patients was followed up during hospital stay and the outcome of the patient (i.e., Death/Survival) is recorded. RESULTS: The present study included 50 patients, among which 31 were males and 19 were females. Mean age was 43.5 years. Mortality was 38%. Mortality was more among male patients than in female. APACHE II score ranges from 6 - 37, mean APACHE II among survivors were 16.35 with Standard Deviation of 6.78 and among non survivors were 25.47 with Standard Deviation of 6.93 with p value of &lt;0.0001 for predicting mortality. Urine ACR 1 was 74.06±20.83 µgm/mg among survivors and 164.53±46.61 µgm /mg among non survivors and ACR 2 was 45.81±17.92µgm/mg among survivors and 157.84±36.96 µgm/mg among non survivors. Both were statistically signicant with p value of 0.0001 for predicting mortality. The degree of microalbuminuria correlates with disease severity. CONCLUSION: Signicant microalbuminuria is predictive of mortality which is equivalent to APACHE II score. Microalbuminuria is an inexpensive and rapid diagnostic tool. Serial measurements may help in the clinical assessment of critically ill patients at risk of worse prognosis, even in resource poor areas.

Is there a renoprotective value to leukodepletion during heart valve surgery? A randomized controlled trial (ROLO)

BackgroundAcute Kidney Injury (AKI) adversely affects outcomes after cardiac surgery. A major mediator of AKI is the activation of leukocytes through exposure to the cardiopulmonary bypass circuit. We evaluate the use of leukodepletion filters throughout bypass to protect against post-operative AKI by removing activated leukocytes during cardiac surgery.MethodsThis is a single-centre, double-blind, randomized controlled trial comparing the use of leukodepletion versus a standard arterial filter throughout bypass. Elective adult patients undergoing heart valve surgery with or without concomitant procedures were investigated. The primary clinical outcome measured was the development of AKI according to the KDIGO criteria. Secondary measures included biomarkers of renal tubular damage (urinary Retinol Binding Protein and Kidney Injury Molecule-1), glomerular kidney injury (urinary Micro Albumin and serum Cystatin C) and urinary Neutrophil Gelatinase Associated Lipocalin, as well as the length of hospital stay and quality of life measures through EQ-5D-5L questionnaires.ResultsThe ROLO trial randomized 64 participants with a rate of recruitment higher than anticipated (57% achieved, 40% anticipated). The incidence of AKI was greater in the leukodepletion filter group (44% versus 23%, risk difference 21, 95% CI − 2 to 44%). This clinical finding was supported by biomarker levels especially by a tendency toward glomerular insult at 48 h, demonstrated by a raised serum Cystatin C (mean difference 0.11, 95% CI 0.00 to 0.23, p = 0.068) in the leukodepleted group. There was however no clear association between the incidence or severity of AKI and length of hospital stay. On average, health related quality of life returned to pre-operative levels in both groups within 3 months of surgery.ConclusionsLeukocyte depletion during cardiopulmonary bypass does not significantly reduce the incidence of AKI after valvular heart surgery. Other methods to ameliorate renal dysfunction after cardiac surgery need to be investigated.Trial registrationThe trial was registered by the International Standard Randomized Controlled Trial Number Registry ISRCTN42121335. Registered on the 18 February 2014. The trial was run by the Bristol Clinical Trials and Evaluation Unit. This trial was financially supported by the National Institute of Health Research (Research for Patient Benefit), award ID: PB-PG-0711-25,090.

Tetrahydrocurcumin protects against sepsis-induced acute kidney injury via the SIRT1 pathway

Sepsis-induced acute kidney injury (AKI) continues to be associated with poor outcomes in critical care patients. Previous research has revealed that tetrahydrocurcumin (THC) exerts renoprotective effects in multiple nephritic disorders by modulating inflammation and oxidative stress. However, the effects of THC on sepsis-induced AKI and the underlying mechanisms remain unclear. In this study, a mouse model of sepsis-induced AKI, generated by cecal ligation and puncture operation, was used to investigate the protective effects of THC and the role of SIRT1. Histological manifestation and TUNEL analysis were observed to determine the severity of kidney damage. Levels of BUN, SCr, KIM-1, and UAlb/Cr were calculated to assess the renal function. Expressions of IL-1β, IL-6, and TNF-α were measured to evaluate the inflammatory response. MDA content, SOD, GSH, CAT, and GPx activities and DHE staining were analyzed to estimate the degree of oxidative stress. Protein expressions of SIRT1, Ac-p65, and Ac-foxo1 were detected to explore the underlying mechanisms. We observed that THC not only increased the survival rate, improved the kidney function and ameliorated the renal histological damage of septic mice, but also inhibited inflammatory response, prohibited oxidative stress, and prevented cell apoptosis in renal tissues in septic mice. Mechanistically, THC remarkably increased the expression of SIRT1, accompanied by decreased expressions of downstream molecules Ac-p65 and Ac-foxo1. Meanwhile, the beneficial effects of THC were clearly abolished by the SIRT1-specific inhibitor EX527. These results delineate that THC prevents sepsis-induced AKI by suppressing inflammation and oxidative stress through activating the SIRT1 signaling. Abbreviation: Ac-p65: acetylated p65; Ac-foxo 1: acetylated forkhead box O1; AKI: acute kidney injury; BUN: blood urea nitrogen; CAT: catalase; DHE: dihydroethidium; GPx: glutathione peroxidase; GSH: reduced glutathione; IL-1β: Interleukin-1 beta; IL-6: Interleukin-6; KIM-1: kidney injury molecule 1; MDA: malondialdehyde; SCr: serum creatinine; SIRT1: silent information regulator 1; SOD: superoxide dismutase; THC: tetrahydrocurcumin; TNF-α: tumor necrosis factor-alpha; TUNEL: TdT-mediated dUTP Nick-End Labeling; UAlb/Cr: urine micro albumin/creatinine.

Changes in Renal Function Test Following Kidney Donation

Objectives: The aim of this study was to find out any Changes in renal function test following kidney donation. Materials and Methods: A Hospital based prospective study was conducted in the Department of Urology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from April 2011 to September 2012. Investigations included specific gravity and urinary microalbumin, serum creatinine. According to inclusion and exclusion criteria a total of 37 donors were enrolled in this study. Subsequent follow up were taken at the end of three months, six months and nine months. Data were evaluated by Paired t-test, Significance was defined p value&lt;0.05. Results: The age range varied from 25 to 39 years and 45.9% of patients belonged to 25- 30 years and male to female ratio was 1:2.4. The mean baseline specific gravity was 1016.97±8.03, serum creatinine 1.03±0.24. The baseline urinary micro albumin was found nil and subsequent 1st, 2nd, and 3rd follow up were also nil. The mean difference of specific gravity, urinary micro albumin, and serum creatinine (mg/dl) were almost consistent between baseline and the subsequent follow-up, no statistical significant (P&gt;0.05) was found between baseline and the subsequent follow-up. Conclusion: Renal function test of the remaining kidney in living donors does not significantly change after donor nephrectomy. Bangladesh Journal of Urology, Vol. 18, No. 1, Jan 2015 p.3-7

Assessment of Albuminuria, Estimated-Glomerular Filtration Rate And Uric Acid As Markers For Chronic Kidney Disease among Family Members of Sudanese Renal Failure Patients On Hemodialysis

Background: Chronic kidney disease (CKD) is a global public health problem that increased rapidly throughout the world, and it was recommended that it should be discovered earlier especially among high risk population.&#x0D; Objective: To assess albuminuria, estimated glomerular filtration rate (eGFR) and uric acid as markers for CKD among first degree relatives (FDRs) of hemodialysis patients.&#x0D; Materials and methods: This is an analytical, case control study conducted at Khartoum state during May 2015 to May 2018, targeting 135 FDRs of end stage renal disease (ESRD) Sudanese patients on hemodialysis and other 161 healthy individuals serving as control group. Their plasma was prepared and analyzed for creatinine, uric acid, calcium, phosphate, and alkaline phosphatase. Also spot random urine sample was collected and analyzed for creatinine and micro albumin, from which albumin to creatinine ratio (ACR) was calculated. The plasma parameters were analyzed by Mendray BS 200 auto analyzer, while urine parameters were analyzed by using Cobas auto analyzer.&#x0D; Results: The mean levels of ACR and urine micro albumin were significantly increased while the mean levels of e-GFR and urine creatinine were significantly reduced in FDRs when compared to control group (The means ± SD were: 10 ± 4.4, 123.1 ± 68.2, 93.1 ± 25.6 and153.3 ± 115.3 versus 0.92±0.10, 14.9±2.05, 99.4±22.5 and 190.3±108.8, the p values were: 0.024, 0.001, 0.027 and 0.005 respectively). But there were no significant differences between means levels of calcium, phosphorus, uric acid and alkaline phosphatase when compared in FDRs versus control group. The correlation analysis showed significant positive correlation of serum uric acid with serum creatinine(r= 0.587, P value = 0.000).&#x0D; Conclusion: Albuminuria which was detected by ACR was significantly increased among FDRs of hemodialysis patients, while the eGFR was reduced, hence they are prone to develop CKD.

Study of microalbuminuria as a nephropathic marker in type 2 diabetes mellitus and its correlation with the glycated hemoglobin

Diabetic nephropathy is the main cause of morbidity and mortality in patients with diabetes mellitus. The results of many clinical studies shows variation in the correlation of HbA1c and microalbuminuria in type 2 diabetes mellitus. In the present study we tried to correlate the HbA1c levels and microalbuminuria with respect to duration in type 2 diabetes mellitus cases and also studied microalbuminuria as a marker of nephropathy in type 2 diabetes mellitus. Materials and Methods: The study was conducted in the Department of Biochemistry at Raichur Institute of Medical Sciences. 100 subjects were recruited based on the inclusion and exclusion criteria, 50 were healthy controls and 50 were type 2 DM patients. FBS, PPBS, blood urea, serum creatinine, HbA1c, serum sodium, serum potassium and urinary micro albumin were analyzed. Statistical analysis was done by using student ‘t’ test and Chi square test. Results: A statistically significant difference was observed in values of FBS, PPBS, blood urea, serum creatinine, HbA1c, serum sodium, serum potassium and urinary microalbumin levels in cases compared to controls. In our study the mean HbA1c values were 5.1321.11% in controls and 7.5121.19% in cases & mean HbA1c value in patients without microalbuminuria is 7.130.84 and in patients with microalbuminuria is 8.121.44 which is statistically significant (p=0.005). Conclusion: The present study concluded that estimating glycosylated hemoglobin as an indicator of glycemic control and microalbuminuria in random urine sample for renal involvement in diabetic subjects provide a convenient method for early diagnosis and intervention. Thus the study suggests microalbuminuria as a nephropathic marker in type 2 diabetes mellitus. The possibility, delay or reverse the progression of diabetic nephropathy can be achieved only by perfect long term metabolic control. Keywords: Diabetic Nephropathy, HbA1c, Microalbuminuria, Type 2 Diabetes Mellitus.

Study of risk factors associated with adverse outcome in a severe coronary artery disease (syntax score &gt;22) with different therapeutic strategies

Background: The specific question of whether PCI or surgical treatment offers any advantage over MT in patients with stable angina and multivessel disease remains unanswered. Objective of our research was to study various risk factors which interferes the outcome of various therapeutic procedures in coronary artery disease.Methods: This was prospective observational study carried out in a tertiary care center from July 2014 to July 2016. A total of 98 subjects undergoing different therapeutic strategies were followed up. Risk factors which interferes the outcome of various therapeutic procedures in coronary artery disease (CAD) were studied.Results: There was a significant difference in mean SYNTAX score (P = 0.003), urine micro albumin levels (P=0.006), and body mass index (0.046) between those who had MACE and who did not have MACE.Conclusions: The urine micro albumin &gt;30 mg/l and highest SYNTAX score were significantly associated with MACE at 1 year in subject with severe CAD.

1263-P: Diabetes Care Network: A Paradigm Shift in Diabetes Care Delivery Utilizing Collaborative Care Pathway

Diabetes Care Network is a telemedicine based collaborative care pathway with team-based approach to improve diabetes care and scale the endocrine expertise. Veterans with poorly controlled type 2 diabetes were identified from electronic database, consultation completed via E-consult, and continuity care collaborated with primary care liaisons. We studied the efficacy and sustainability of our approach in improving diabetes care over 12 months. Methods: Means (+/-SD), frequencies and percentages were presented, and Spearman correlations were assessed. Statistical significance set at p&amp;lt;0.05. Cohort (n=87) was predominantly white (90.8%) males (97.7%), with a mean age 67.2 (8.9), and had an average of 3.3 co-morbid conditions, 0.7 macro and 1.3 micro-vascular complications. Significant decline in A1C occurred from baseline A1C of 10.2% (1.4), to 8.1% (0.99) at 3 months, 7.6% (0.96) at 6 months, and 7.5 % (0.86) at 12 months (all p&amp;lt;0.0001). Proportion of patients out of 87 who achieved A1C of &amp;lt;8 were 38 (43.6%), 56 (64%), and 56 (64%) and those who achieved A1C &amp;lt;7 were 10 (11.4%), 21(24.1%), and 23 (26.4%) at 3, 6, and 12 months respectively. Non-significant improvements were noted in Weight {229.3 lbs (48.1) to 228.4 lbs (46.9)}, LDL {89.0 mg/dl (36.4) to 79.5 mg/dl (32.5)}, systolic BP {130.5 mmHg (16.1) to 123.9 mmHg (17.5)}, and triglycerides {226.9 mg/dl (195.3) to 159.3 (97.4)}. Compared to 12 months pre-enrollment period, no difference in healthcare utilization (ER visits or admissions) was noted in study period. From baseline to completion, non-significant improvement was noted in the use of anti-platelet agents, ACE/ARB, moderate to high-intensity statins and, in the frequency of Urine micro albumin measurements, annual foot and retinal exams. Conclusion: A paradigm shift in diabetes care delivery is urgently needed. Use of telehealth technologies based collaborative pathways can scale the endocrine expertise and help attain better care for diabetic patients. Disclosure A. Bandi: None. M.J. Larson: None. S.J. Lutz-McCain: None. A.M. Summerville: None. B.K. Lumley: Employee; Spouse/Partner; Quest Diagnostics. M.Y. Boudreaux-Kelly: None.

New Insights in Bladder Cancer Diagnosis: Urinary miRNAs and Proteins.

Bladder cancer is the 10th-most common cancer worldwide. The diagnosis and follow-up of patients require costly invasive methods and due to these expenses, bladder cancer continues to be one of the expensive malignancies. Early diagnosis is crucial in bladder cancer as it is in other cancers; therefore, non-invasive biomarkers for early diagnosis are very important. In this review, we aimed to focus on the most recent investigations on potential urinary micro RNA (miRNA) and protein biomarkers for bladder cancer diagnosis and their associated pathways. Studies performed by different groups were compiled and the biomarker properties of various proteins and miRNAs in the urine of bladder cancer patients were evaluated. Key studies were obtained by searching keywords “bladder cancer, urinary miRNA, urinary protein, urinary biomarker”. Targets and the pathways of the miRNAs and proteins were analyzed according to mirBase Catalogue and Panther Database. The major pathways that are targeted by aberrantly expressed miRNAs are Cholecystokinin receptor (CCKR), p53, Wnt signaling pathway, and feedback loops. We hereby conclude that urinary micro RNAs and proteins are promising candidates for bladder cancer diagnosis. It should be noted that urine collection, storage conditions, choice of fraction, and normalization strategies should be standardized.

A6045 Influence of Child and Adult Elevated Blood Pressure on Adult Urinary Micro Albumin

Objectives: To explore the influence of child and adult elevated blood pressure on adult urinary micro albumin. Methods: Urinary albumin was examined in 2017 among 2112 adults followed up for 30years since baseline (1987, aged 6–18years).Childhood elevated blood pressure was defined as sytolic or diastolic BP were ≥90th percentile for age, sex and height according to recommended blood pressure reference cut-offs for Chinese boys and girls. Adult elevated blood pressure was defined as systolic BP ≥ 120mmHg, diastolic BP ≥ 80mmHg, or use of antihypertensive medications.Microalbumiuria was defined as the concentration of micro albumin≥30 mg/L in urine.According to the status of blood pressure,individuals were classified into 4 groups:group1,normal BP in childhood and normal BP as adults;group 2, normal BP in childhood but elevated BP as adult;group 3,elevated BP in childhood but not as adults;group 4,elevated BP in childhood and as adults. Results: Loglinear regression analysis indicates that adult elevated blood pressure has a strong associstion with urine micro albumin (p < 0.05),but did not hava significantly increased risk of MAU compared with adult nornal blood pressue (relative risk[95% confidence interval], 1.052 [0.988,1.120]). Comparison between chilidhood elevated BP and childhood nornal BP is the same (relative risk[95% confidence interval],1.005[0.928,1.089]). Poisson regression analysis shows that group 2,3,4 did not have significantly increased risk of MAU (relative risk[95% confidence interval],1.059[0.908,1.236],1.008[0.913,1.113]and 1.059 [0.958,1.170], respectively) compared with group 1. Conclusion: Adult elevated blood pressure seems to paly a more important role in development of microalbuminuria compared with child blood pressure but it still need further exploration.

Association between mean platelet volume and Microalbuminuria in Type 2 Diabetes Mellitus Patients

Background: Type 2 DM is characterized by increased platelets activation, hence platelet functional markers like the mean platelet volume (MPV) can play a vital role in identifying subjects at high risk of developing microvascular complications. Objectives: To study the association between mean platelet volume and micro albuminuria and to analyse factors associated with MPV in patients with Type 2 diabetes mellitus. Materials & Methods: A cross sectional study was conducted in the department of internal medicine, Velammal medical college and hospital, between June 2016 and December 2016. Subjects with DM, with age > 20 years were included. Latex Turbidimetric method was used to assess urine micro albumin. Results: A total of 269 diabetic patients with mean duration of disease of 4.84 years were included. There was a moderate, statistically significant positive correlation between HbA1 C level and Mean platelet volume (PCC=-0.198, p value 0.001). The other factors had shown no statistically significant correlation with MPV. There was a Statistically significant mild negative correlation between serum uric acid and MPV (PCC= -0.196, p value 0.001). The mean MPV in people with low and high Urine micro albumin was 7.716 ± 0.876 and 7.705 ± 0.890 respectively, and the difference was statistically not significant. Concussions: Poor glycaemic control may lead to higher MPV in diabetic population. Very minimal and statistically non-significant difference was observed in mean MPV value between subjects with high micro albuminuria and low micro albuminuria.

Development of a Urinary Micro Particle Detection System Based on Spatial Coordinate Tracking Method

In order to accurately detect various micro particles in patient's urinary samples, a urinary micro particle detection system based on spatial coordinate tracking method was developed. A hierarchical microscopic image analysis method was described and the detailed spatial coordinate tracking algorithm was designed. The architecture and the procedure of proposed system were presented. Moreover, the prototype system was introduced and six patients' urinary samples were analyzed to verify the reliability and simplicity of unattended operation.