Urinary Microalbumin Research Articles

The Effects of Febuxostat on Urine NGAL and Urine KIM-1 in Patients with Hyperuricemia.

Retrospective analysis of the effects of febuxostat on urine neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) in patients with hyperuricemia was performed. From January 2018 to June 2018, there were 45 patients with asymptomatic hyperuricemia in the outpatient or inpatient of Changzhou Second People's Hospital, which were divided into the febuxostat group (25 cases) and the control group (20 cases). We collected the patients' baseline indicators and testing indicators after three months of treatment, including blood urea nitrogen, blood creatinine, blood uric acid, urine microalbumin, urine NGAL, urine KIM-1, and other indicators. The subjects in both groups were given lifestyle intervention, instructed to drink more water, and given a low-purine diet. The patients in the febuxostat group took febuxostat 40 mg/D or 80 mg/D. We used SPSS 25.0 statistical software for statistical analysis. Baseline indexes between the febuxostat group and the control group and indexes after treatment between two groups were both performed by independent sample t-test, and paired t-test was used for self-comparison between the groups before and after treatment. There was no significant difference in age, sex, body mass index (BMI), urea nitrogen, creatinine, uric acid, urine microalbumin/creatinine, urine NGAL/creatinine, and urine KIM-1/creatinine between the two groups before treatment (P > 0.05). Compared with before treatment, after 3 months of intervention, the levels of serum uric acid, urine microalbumin/creatinine, urine NGAL/creatinine, and urine KIM-1/creatinine were significantly decreased in the febuxostat group (P < 0.05), while the changes of blood urea nitrogen, serum creatinine, and epidermal growth factor receptor (eGFR) were not statistically significant (P > 0.05). After 3 months of intervention, the control group had no significant changes in blood urea nitrogen, creatinine, eGFR, uric acid, microalbumin/creatinine, urine NGAL/creatinine, and urine KIM-1/creatinine (P > 0.05). After 3 months of intervention, compared with the control group, the serum uric acid, microalbumin/creatinine, urine NGAL/creatinine, and urine KIM-1/creatinine were significantly decreased in the febuxostat group (P < 0.05), but there was no significant difference in blood urea nitrogen, creatinine, and eGFR (P > 0.05). Febuxostat can reduce urine NGAL/creatinine and urine KIM-1/creatinine levels in patients with hyperuricemia and has the protective effects on renal tubular injury caused by hyperuricemia, which can provide evidences for the early prevention and treatment of asymptomatic hyperuricemia.

The clinical efficacy and safety of dapagliflozin in patients with diabetic nephropathy

ObjectiveTo investigate the clinical efficacy and safety of dapagliflozin in the treatment of diabetic nephropathy (DN).MethodsA total of 120 DN patients admitted to our hospital from June 2017 to March 2020 were divided into control and experimental groups, with 60 cases in each group. The control group received valsartan, and the experimental group received dapagliflozin for 3 months. Body mass index (BMI), hemoglobin A1c (HbA1c), serum creatinine (sCr), uric acid (UA), urine microalbumin (uMA), urine creatinine (uCr), and bilateral kidney function were compared before and after treatment, and adverse reactions in both groups were observed. Serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were also evaluated.ResultsAfter treatment, except for BMI in the control group, all indexes in both groups were significantly improved. The BMI, HbA1c, sCr, UA, and uMA/uCr ratios of the experimental group were lower than those of the control group. Serum albumin (sAlb) levels were increased in both groups, and the experimental group showed a significant difference compared with the control group. Estimated glomerular filtration rate (eGFR) levels were increased in both groups, and the experimental group was higher than the control group, with no significant differences. Serum IL-6 and TNF-α levels in both groups were lower, and the experimental group was significantly lower than the control group. No serious adverse reactions were observed in either group.ConclusionThe efficacy of dapagliflozin was demonstrated by its ability to improve diabetes, prevent nephropathy exacerbation, and reduce symptomatic reactions. The low rate of adverse reactions makes dapagliflozin a very safe medication.

Impact of intrauterine growth restriction on cerebral and renal oxygenation and perfusion during the first 3 days after birth

Intrauterine growth restriction (IUGR) is associated with a higher incidence of perinatal complications as well as cardiovascular and renal diseases later on. A better insight into the disease mechanisms underlying these sequalae is important in order to identify which IUGR infants are at a higher risk and find strategies to improve their outcome. In this prospective case–control study we examined whether IUGR had any effect on renal and cerebral perfusion and oxygen saturation in term neonates. We integrated near-infrared spectroscopy (NIRS), echocardiographic, Doppler and renal function data of 105 IUGR infants and 105 age/gender-matched controls. Cerebral and renal regional oxygen saturation values were measured by NIRS during the first 12 h after birth. Echocardiography alongside Doppler assessment of renal and anterior cerebral arteries were performed at 6, 24, 48 and 72 h of age. Glomerular and tubular functions were also assessed. We found a left ventricular dysfunction together with a higher cerebral oxygen saturation and perfusion values in the IUGR group. IUGR term infants showed a higher renal oxygen saturation and a reduced oxygen extraction together with a subclinical renal damage, as indicated by higher values of urinary neutrophil gelatinase-associated lipocalin and microalbumin. These data suggest that some of the haemodynamic changes present in growth-restricted foetuses may persist postnatally. The increased cerebral oxygenation may suggest an impaired transition to normal autoregulation as a consequence of intra-uterine chronic hypoxia. The higher renal oxygenation may reflect a reduced renal oxygen consumption due to a subclinical kidney damage.

Evaluation of Microalbuminuria in Patients with Urinary Tract Infection

Background: Urinary tract infection is a collective term for infections that involve any part of the urinary tract. It is one of the most common infections in local primary care. There are wide range of factors identified that can increase susceptibility to UTI, like sexual intercourse, congenital abnormalities, urinary obstruction, prior history of UTI, diabetes, urogenital surgery, estrogen deficiency. Diabetes mellitus has been a significant risk factor for complicated UTI. Presence of microalbumin in urine in patients of urinary tract infection may be a predictor of intrinsic renal pathology and its presence is a predictor of ongoing progressive damage to kidneys. Microalbuminuria is also associated with cardiovascular events and diabetic nephropathy. Early diagnosis of microalbuminuria will decrease the incidence of end stage renal disease and cardiovascular events. The present study was thus conducted to evaluate prevalence of microalbuminuria in patients diagnosed with urinary tract infections.Material &amp; Methods:The present hospital based case control study was conducted on 60 patients visiting the outpatient clinic (OPD) of Department of Urology, Government Medical College and Rajindra Hospital, Patiala and diagnosed with UTI and the control group consisted of 20 age and gender matched individuals. Estimation of urine microalbumin was done by Enyme linked immunoassay(ELISA) kit method in Department of Biochemistry, GMC Patiala.Results:Out of 60 cases of UTI included in the present study, prevalence of microalbuminuria was observed in 43.3% among cases of UTI . A total of 85% of the cases with positive urine culture had microalbuminuria (p&lt;0.01).Conclusions:Microalbuminuria and ACR can be recommended for predicting ESRD at an early stage of kidney disease.

Insufficient Fruit and Vegetable Intake and Low Potassium Intake Aggravate Early Renal Damage in Children: A Longitudinal Study.

Insufficient fruit and vegetable intake (FVI) and low potassium intake are associated with many non-communicable diseases, but the association with early renal damage in children is uncertain. We aimed to identify the associations of early renal damage with insufficient FVI and daily potassium intake in a general pediatric population. We conducted four waves of urine assays based on our child cohort (PROC) study from October 2018 to November 2019 in Beijing, China. We investigated FVI and other lifestyle status via questionnaire surveys and measured urinary potassium, β2-microglobulin (β2-MG), and microalbumin (MA) excretion to assess daily potassium intake and renal damage among 1914 primary school children. The prevalence of insufficient FVI (<4/d) was 48.6% (95% CI: 46.4%, 50.9%) and the estimated potassium intake at baseline was 1.63 ± 0.48 g/d. Short sleep duration, long screen time, lower estimated potassium intake, higher β2-MG and MA excretion were significantly more frequent in the insufficient FVI group. We generated linear mixed effects models and observed the bivariate associations of urinary β2-MG and MA excretion with insufficient FVI (β = 0.012, 95% CI: 0.005, 0.020; β = 0.717, 95% CI: 0.075, 1.359), and estimated potassium intake (β = −0.042, 95% CI: −0.052, −0.033; β = −1.778, 95% CI: −2.600, −0.956), respectively; after adjusting for age, sex, BMI, SBP, sleep duration, screen time and physical activity. In multivariate models, we observed that urinary β2-MG excretion increased with insufficient FVI (β = 0.011, 95% CI: 0.004, 0.018) and insufficient potassium intake (<1.5 g/d) (β = 0.031, 95% CI: 0.023, 0.038); and urinary MA excretion increased with insufficient FVI (β = 0.658, 95% CI: 0.017, 1.299) and insufficient potassium intake (β = 1.185, 95% CI: 0.492, 1.878). We visualized different quartiles of potassium intake showing different renal damage with insufficient FVI for interpretation and validation of the findings. Insufficient FVI and low potassium intake aggravate early renal damage in children and underscores that healthy lifestyles, especially adequate FVI, should be advocated.

Analysis of Rehabilitation Effect of Neurology Nursing on Stroke Patients with Diabetes Mellitus and Its Influence on Quality of Life and Negative Emotion Score.

Objective To explore and analyze the rehabilitation effect of neurology nursing on stroke patients with diabetes mellitus (DM) and its influence on quality of life and negative emotion score. Methods In this experiment, 110 stroke patients with DM diagnosed and treated in our hospital from 2018 to 2020 were randomly selected and assigned to the study group (SG) and the control group (CG) according to different nursing methods, with 55 cases in each group. In SG, they were given neurology nursing. In CG, they were given routine nursing. The rehabilitation efficacy, quality of life, and negative emotion scores were compared between the two groups. Results Compared with the CG, the levels of fasting blood glucose, 2 h postprandial blood glucose, and urinary microalbumin in SG were obviously better after treatment. In SG, the proportion of patients with basic recovery and significant improvement after treatment was higher, and the proportion of patients without treatment effect was significantly lower. Overall, the nursing effect of the SG after treatment was better than that of the CG. There was no striking difference in the quality of life and Morisky scores between the two groups before nursing intervention (P > 0.05), but the quality of life and Morisky scores of patients in SG were obviously higher than those in CG after nursing intervention. After nursing intervention, SAS and SDS scores of patients in SG were obviously lower than those of patients in CG, and patients in SG were less affected by negative emotions. Questionnaires were used to investigate the satisfaction of patients in both groups, and the results showed that the satisfaction of patients in SG was higher (all P < 0.05). Conclusion Neurology nursing has better clinical efficacy for stroke patients with DM and has obvious rehabilitation effect. The quality of life and negative emotion score of patients are better, which is worthy of extensive clinical promotion and application.

Sex-specific differences in early renal impairment associated with arsenic, lead, and cadmium exposure among young adultsin Taiwan.

Exposure to a single metal has been reported to damage renal function in humans. However, information regarding the association between multiple-metal exposure and markers for early renal impairment in different sexes among the young adult Taiwanese population is scarce. We assessed the association between exposure to arsenic (As), cadmium (Cd), and lead (Pb), and early renal impairment markers using urinary microalbumin (MA), β2-microglobulin (β2MG), and N-acetyl-beta-D-glucosaminidase (NAG) by analyzing 157 young adults aged 20‒29 years, in Taiwan. Inductively coupled plasma mass spectrometry was used to determine urinary As, Cd, and Pb levels. Regression models were applied to different sex groups. The results showed that after adjusting for potential confounding factors and each metal, urinary Cd levels were significantly positively associated with urinary MA (β = 0.523, 95% CI: 0.147–0.899) and β2MG (β = 1.502, 95% CI: 0.635–2.370) in males. However, the urinary Cd level was significantly positively associated with only urinary NAG (β = 0.161, 95% CI: 0.027–0.296) in females. This study thus indicates that the effect of exposure to metals (especially Cd) on early renal impairment among young adults in Taiwan is sex-specific. Our study results could contribute toward developing early intervention programs for decreasing the incidence of renal dysfunction. Further studies are warranted to confirm our findings and clarify the potential mechanisms involved.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11356-022-19521-3.

Impact of diabetes group visits on patient clinical and self-reported outcomes in community health centers

BackgroundDiabetes group visits (GVs) are a promising way to deliver high quality care but have been understudied in community health centers (CHCs), across multiple sites, or with a focus on patient-centered outcomes.MethodsWe trained staff and healthcare providers from six CHCs across five Midwestern states to implement a 6-month GV program at their sites. We assessed the impact of diabetes GVs on patient clinical and self-reported outcomes and processes of care compared to patients receiving usual care at these sites during the same period using a prospective controlled study design.ResultsCHCs enrolled 51 adult patients with diabetes with glycosylated hemoglobin (A1C) ≥ 8% for the GV intervention and conducted chart review of 72 patients receiving usual care. We analyzed A1C at baseline, 6, and 12 months, low-density lipoproteins (LDL), blood pressure, and patient-reported outcomes. GV patients had a larger decrease in A1C from baseline to 6 months (-1.04%, 95% CI: -1.64, -0.44) and 12 months (-1.76, 95% CI: -2.44, -1.07) compared to usual care; there was no change in blood pressure or LDL. GV patients had higher odds of receiving a flu vaccination, foot exam, eye exam, and lipid panel in the past year compared to usual care but not a dental exam, urine microalbumin test, or blood pressure check. For GV patients, diabetes distress decreased, diabetes-related quality of life improved, and self-reported frequency of healthy eating and checking blood sugar increased from baseline to 6 months, but there was no change in exercise or medication adherence.ConclusionsA diabetes GV intervention improved blood glucose levels, self-care behaviors, diabetes distress, and processes of care among adults with elevated A1Cs compared to patients receiving usual care. Future studies are needed to assess the sustainability of clinical improvements and costs of the GV model in CHCs.

Spot urinary microalbumin concentration, metabolic syndrome and type 2 diabetes: Tehran lipid and glucose study

AimThis study aimed to determine the association of urinary microalbumin concentrations with type 2 diabetes mellitus (T2DM), metabolic syndrome (MetS), and its phenotypes. The optimum cut-off values of urinary microalbumin and microalbumin-to-creatinine ratio (MCR) for predicting the chance of having T2DM and MetS were also defined.MethodsAdult men and women (n = 1192) participated in the sixth phase (2014-2017) of the Tehran Lipid and Glucose Study (TLGS), with completed data, were included in the analyses. Odds ratios (ORs) (and 95% confidence intervals (CIs)) of T2DM, MetS, and its components across tertile categories of urinary microalbumin concentrations were estimated using multivariable logistic regressions. The optimal cut-off points of urinary microalbumin and MCR were determined using the receiver operator characteristic (ROC) curve analysis.ResultsParticipants’ mean (±SD) age was 44.9 (±14.0) years, and 44.6% of the participants were men. The prevalence of microalbuminuria was 14.4%. Chance of having T2DM was significantly higher in the highest tertile of urinary microalbumin concentration (OR = 2.29, 95% CI = 1.43-3.67) and MCR (OR = 1.82, 95% CI = 1.15-2.89). Subjects with the highest urinary microalbumin concentration were more likely to have MetS (OR = 1.66, 95% CI = 1.17-2.35), hypertension (OR = 1.63, 95% CI = 1.16-2.30) and hyperglycemia (OR = 1.78, 95% CI = 1.24-2.56). No significant association was observed between urinary microalbumin concentrations and other components of MetS. The optimal cut-off points of urinary microalbumin for predicting the chance of having T2DM and MetS were 14.0 and 13.6 mg/L, respectively.ConclusionsElevated spot urinary microalbumin, below the values defined as microalbuminuria, was associated with the chance of having T2DM and MetS.

Cardiovascular disease (CVD) risk assessment of HIV medication regimens using hematopoietic CD34+\u2009progenitor cells

BackgroundTo determine the effects of integrase inhibitor (INSTI) in comparison with non-INSTI-based regimens such as non-nucleoside reverse transcriptase inhibitors (NNRTIs)-based regimens on cardiovascular disease (CVD) risk in HIV+ patients without overt history of CVD or diabetes, with normal CD4:CD8 count. For CVD risk assessment we primarily used hematopoietic CD34+ progenitor cells, as a biomarker.MethodsNineteen male subjects, ages 32–61 years with BMI 21.0–36.0, were enrolled. This was a single time point, cross-sectional, observational study. Subjects were enrolled under 2 groups (either on INSTI-based regimen with 13 subjects or NNRTI (non-INSTI)-based regimens with 6 subjects) who were taking stable doses of HAART. The medication regimens were a combination of one NRTI (typically tenofovir–emtricitabine) plus one INSTI or NNRTI. Our outcome measures were focused on cardiovascular and endothelial cell function and systemic inflammation. Our primary outcome measures were peripheral blood-derived hematopoietic progenitor cell number (CD34 and CD133 positive), CD34+ cell function and gene expression studies. Our secondary outcomes were arterial stiffness measures and serum-based markers of inflammation.ResultsA significant increase in percentage number of progenitor cells, CD133+ cells (p = 0.004), was noted along with an increase of double progenitor mark positive CD133+/CD34+ progenitor cell population being observed in INSTI group as compared to NNRTI group, by flow cytometry. mRNA gene expression for antioxidant gene catalase was noted along with a trend toward a decrease in gene expression of inflammatory marker IL6 (p = 0.06) being observed in CD34+ from INSTI group vs NNRTI group. The plasma IL-6 and CRP levels did not change significantly between the groups. Neutrophil–Lymphocyte ratio (NLR), an important marker of inflammation, was noted to be lower in INSTI group. A mean fasting glucose level was also lower in the INSTI group compared to NNRTI group (p = 0.03). Interestingly, urine microalbumin levels were higher in the INSTI group compared to NNRTI group (p = 0.08), while eGFR levels were significantly lower in the INSTI group (p = 0.002). The arterial stiffness measures did not show statistically significant differences between the two groups.ConclusionWe conclude that the INSTI regimen may provide a better CVD risk profile compared to NNRTI-based HAART regimen; however, the increased albuminuria along with lower eGFR, noted in INSTI group, is of concern. Because of the small size, these results would need replication in additional studies before changing clinical practice.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT03782142?cond=Hiv&spons=Sabyasachi+sen&cntry=US&state=US%3ADC&city=Washington&draw=2&rank=1. ClinicalTrials.gov Identifier: NCT03782142.

Urinary MMP-7: A Predictive, Noninvasive Early Marker for Chronic Kidney Disease Development in Patients with Hypertension.

Upregulation of matrix metalloproteinase-7 (MMP-7) is associated with hypertension and kidney fibrosis, which can progress to chronic kidney disease (CKD). Currently, kidney fibrosis is only detectable by an invasive procedure. Therefore, we set out to determine whether MMP-7 can act as a noninvasive biomarker in patients with hypertension to enable early detection of kidney fibrosis. Diagnosed patients with hypertension and control patients were sampled. We diagnosed CKD using clinical and laboratory parameters. Serum urea, creatinine, urinary microalbumin, the albumin-to-creatinine ratio, and urinary MMP-7 were analyzed. The 195 patients with hypertension had significantly elevated MMP-7. Of these patients, 166 had MMP-7 >25.8 μg/L, whereas only 29 had MMP-7 <25.8 μg/L. Thirty-two patients with hypertension showed features of CKD, all of whom had urinary MMP-7 >25.8 μg/L. However, the urinary MMP-7 level did not differ with the severity of CKD or with the duration of hypertension. Elevated urinary MMP-7 can be a potential noninvasive, early indicator in patients with hypertension progressing to CKD, thus enabling early therapeutic intervention.

D2 MTE4 Case 10: Dilemma of diagnosis

14 year 6 month child presented to us with complaints of polyuria and polydipsia for 3 months. He was morbidly obese (116 kg) and had lost 22 kg in last 1.5 months. There was history of dental abscess 1 month back for which he was prescribed Tablet Wysolone (5 mg BD) for 5 days. He had normal perinatal and developmental history. Mother had history of gestational diabetes. There was history of DM, dyslipidemia and hypertension in both the parents. On examination: His height and weight were 173 cm (+1.25 SDS) and 92.9 kg (+4.1 SDS), respectively with a BMI of 31.04 kg/m2 and a waist hip ratio of 0.93. He had acanthosis nigricans over neck, axilla and thighs. His SMR staging was A2 P3 TV 12/12 ml SPL of 7 cm along with lipomastia. Rest of the systemic examination was normal. Investigations: His investigations showed fasting blood glucose of 316 mg/dl with HbA1c of 16.4% and no acidosis on blood gas. Urinary glucose was +++ and ketone bodies +++ along with urine microalbumin of 81.8 mg/L. He also had dyslipidemia with normal thyroid functions. His C-peptide level was 2.15 ng/ml and HOMA IR 2.96. He also had Vitamin D and Vitamin B12 deficiency.

Nonlinear causal effects of estimated glomerular filtration rate on myocardial infarction risks: Mendelian randomization study

BackgroundPrevious observational studies suggested that a reduction in estimated glomerular filtration rate (eGFR) or a supranormal eGFR value was associated with adverse cardiovascular risks. However, a previous Mendelian randomization (MR) study under the linearity assumption reported null causal effects from eGFR on myocardial infarction (MI) risks. Further investigation of the nonlinear causal effect of kidney function assessed by eGFR on the risk of MI by nonlinear MR analysis is warranted.MethodsIn this MR study, genetic instruments for log-eGFR based on serum creatinine were developed from European samples included in the CKDGen genome-wide association study (GWAS) meta-analysis (N=567,460). Alternate instruments for log-eGFR based on cystatin C were developed from a GWAS of European individuals that included the CKDGen and UK Biobank data (N=460,826). Nonlinear MR analysis for the risk of MI was performed using the fractional polynomial method and the piecewise linear method on data from individuals of white British ancestry in the UK Biobank (N=321,024, with 12,205 MI cases).ResultsNonlinear MR analysis demonstrated a U-shaped (quadratic P value < 0.001) association between MI risk and genetically predicted eGFR (creatinine) values, as MI risk increased as eGFR declined in the low eGFR range and the risk increased as eGFR increased in the high eGFR range. The results were similar even after adjustment for clinical covariates, such as blood pressure, diabetes mellitus, dyslipidemia, or urine microalbumin levels, or when genetically predicted eGFR (cystatin C) was included as the exposure.ConclusionGenetically predicted eGFR is significantly associated with the risk of MI with a parabolic shape, suggesting that kidney function impairment, either by reduced or supranormal eGFR, may be causally linked to a higher MI risk.

Hypertension-mediated organ damage in masked hypertension.

Masked hypertension - a blood pressure (BP) phenotype characterized by a clinic BP in the normal range but elevated BP outside the office - is associated with early hypertension-mediated organ damage. This study examined early target organ manifestations of masked hypertension diagnosed by home (HBPM) and ambulatory (ABPM) BP monitoring. Left ventricular (LV) structure and diastolic function measured by echocardiography, microalbuminuria, and coronary artery calcification were evaluated in 420 patients with high clinic BP (SBP 120-150 mmHg or DBP 80-95 mmHg). Evidence of hypertension-mediated organ damage was compared in patients with sustained normotension, masked hypertension, and sustained hypertension based on measurements by HBPM, daytime ABPM, and 24-h ABPM. The 420 participants averaged 48 (12) [mean (SD)] years of age; the average clinic BP was 130 (13)/81 (8) mmHg. In individuals with masked hypertension diagnosed by HBPM, indexed LV mass, relative wall thickness, and e' and E/e' (indices of LV relaxation), were generally intermediate between values observed in normotensives and sustained hypertensive patients, and were significantly greater in masked hypertension than normotensives. Similar trends were observed when masked hypertension was diagnosed by ABPM but a diagnosis of masked hypertension was not as reliably associated with LV remodeling or impaired LV relaxation in comparison to normotensives. There were trends towards greater likelihoods of detectable urinary microalbumin and coronary calcification in masked hypertension than in normotensives. These results support previous studies demonstrating early hypertension-mediated organ damage in patients with masked hypertension, and suggest that HBPM may be superior to ABPM in identifying patients with masked hypertension who have early LV remodeling and diastolic LV dysfunction.

Subclinical Target Damage of Organ and Creatinine Clearance in Patients with Primary Hypertension

Background: In spite of the broadly documented risk-factors of uncontrolled hypertension, this ailment is still not cured in most patients. This may be due largely to the symptomless disease nature in the initial 15-20 years, also with progressive damage to the cardio-vascular system. Therefore, the valuation of target damage of organs due to hypertension subclinically is an important procedure for diagnosis of risk-factors stratification in patients with hypertension. The aim of this study is to determine the subclinical target damage of organ among patients with primary hypertension Study Design: A prospective case-control study. Methods: A total of 120 patients were included in this study. Patients with &gt;60 creatinine clearance rate were taken as controls and &lt; 60 creatinine clearance rate as the case group. The 2 groups were made of equal patients 60 in each group. The Cockcroft-Gault formula was applied for determination of renal function and echocardiography was used for valuation of Left ventricular hypertrophy. Direct ophthalmoscopy was done in all patients to assess the retinal vascular changes. Urine microalbumin was evaluated from the morning spot sample. Results: 120 total patients were included in this study. There were 55 males and 65 females. 52.50 ± 8.61 years was the mean age in the control group and in the case group it was 62.20 ± 7.99 years. The incidence of left ventricular hypertrophy with CCR &lt;60 was 23.3% and 48.3% in patients with CCR &gt;60 (p = 0.001). The incidence of microalbuminuria in this analysis was 41.6% in the case group (p = 0.004) and it was 16.7% in the control group. Of the 120 patients in the study, 65 (54.2%) were taking medications for hypertension while 73.3% of the patients in the control group were using drugs for hypertension, the proportion of patients using antihypertensive drugs was 63.7%. Blood pressure was controlled in only 25.8% of the cases taking antihypertensive drugs Conclusions: The obtained outcomes indicate that decreased clearance of creatinine and / or the existence of microalbuminuria is indication of subclinical damage of organ and taken as a marker among individuals with essential hypertension and standard creatinine clearance, independent of BP burden and additional risk factors. Keywords: Target organ damage, primary hypertension, subclinical and creatinine clearance.

Effect of Lycium barbarum Polysaccharide on Decreasing Serum Amyloid A3 Expression through Inhibiting NF-κB Activation in a Mouse Model of Diabetic Nephropathy.

Lycium barbarum polysaccharide (LBP) as one of the main bioactive constituents of the fruit of Lycium barbarum L. (LBL.) has many pharmacological activities, but its antihyperglycemic activity is not fully understood yet. This study investigated the hypoglycemic and renal protective effects of LBP on high-fat diet/streptozotocin- (HFD/STZ-) induced diabetic nephropathy (DN) in mice. Blood glucose was assessed before and after 8-week administration of LBP, and the homeostasis model assessment-insulin resistance (HOMA-IR) index was calculated for evaluating the antidiabetic effect of LBP. Additionally, serum creatinine (sCr), blood urea nitrogen (BUN), and urine microalbumin were tested to evaluate the renal function. HE and PAS stainings were performed to evaluate the morphology and injury of the kidney. The results showed that LBP significantly reduces the glucose level and ameliorates the insulin resistance of diabetic mice. Importantly, LBP improves renal function by lowering the levels of sCr, BUN, and microalbumin in diabetic mice and relieves the injury in the renal glomeruli and tubules of the DN mice. Furthermore, LBP attenuates renal inflammation as evidenced by downregulating the mRNA levels of TNFα, IL1 β, IL6, and SAA3 in the renal cortex, as well as reducing the elevated circulating level and protein depositions of SAA3 in the kidney. In addition, our western blot results showed that NF-κB p65 nuclear translocation and the degradation of inhibitory κB-α (IκBα) occurred during the progress of inflammation, and such activated signaling was restrained by LBP. In conclusion, our findings suggest that LBP is a potential antidiabetic agent, which ameliorates the inflammation in DN through inhibiting NF-κB activation.

Comparison of the clinical characteristics and outcomes of pediatric patients with and without diabetic ketoacidosis at the time of type 1 diabetes diagnosis.

PurposeWe investigated the possible effects of diabetic ketoacidosis (DKA) at the initial diagnosis of type 1 diabetes mellitus (T1DM) on the clinical outcomes of pediatric patients.Methods Medical records of children and adolescents with newly diagnosed T1DM seen in the Ajou University Hospital from January 2008 to August 2020 were reviewed and analyzed.ResultsAmong 129 diagnosed T1DM patients, 40.3% presented with DKA. Although demographic and basic characteristics did not differ between DKA and non-DKA patients, DKA patients needed a significantly higher insulin dosage than non-DKA patients for 2 years after diagnosis. However, control of glycated hemoglobin was not different between the DKA and non-DKA groups during the observation period. In the biochemical analysis, C-peptide, insulin-like growth factor-1, and insulin-like growth factor binding protein 3, high-density lipoprotein cholesterol, free T4, and T3 values were lower, but thyroid-stimulating hormone, initial serum glucose, uric acid, total cholesterol, triglyceride, and low-density lipoprotein cholesterol values were higher in DKA patients than non-DKA patients at the diagnosis of T1DM; however, these differences were temporarily present and disappeared with insulin treatment. Other clinical outcomes, such as height, thyroid function, and urine microalbumin level, did not vary significantly between the DKA and non-DKA groups during 5 years of follow-up.ConclusionsDKA at initial presentation reflects the severity of disease progression, and the deleterious effects of DKA seem to impact insulin secretion. Although no difference in long-term prognosis was found, early detection of T1DM should help to reduce DKA-related islet damage and the socioeconomic burden of T1DM.

Daily intake of up to two eggs for 11weeks does not affect the cholesterol balance of Chinese young adults.

Approximately 90% of the cholesterol content of the body is derived from de novo synthesis and the enterohepatic circulation. As numerous studies have shown previously, one egg per day intake has little impact of cholesterol balance in human body. Therefore, this study assumed that intake of up two eggs a day has little effect on biomarkers of cardiovascular diseases (CVDs) risk in Chinese young adults. With the increase in egg intake, total cholesterol, low‐density lipoprotein cholesterol (LDL‐C), high‐density lipoprotein cholesterol (HDL‐C), and choline all increased among all the groups as the study progressed from autumn to winter (p < .05). However, there were no differences in the plasma triglycerides, LDL‐C/HDL‐C ratio, glucose, liver enzymes, C‐reactive protein, and urinary microalbumin during the diet periods. Subjects who ate eggs at breakfast felt less hungry and more satisfied, which were relative with decreased fasting plasma ghrelin level (p < .05). Furthermore, egg‐derived cholesterol appeared to upregulate the mRNA levels of low‐density lipoprotein receptor and lecithin–cholesterol acyltransferase, and downregulate cholesteryl ester transfer protein and flavin‐containing monooxygenase 3 mRNA levels in isolated peripheral blood mononuclear cells. These results demonstrate that intake of up to two eggs a day had little effect on biomarkers of CVDs in young, healthy Chinese college students and provided useful evidence for the dietary guidelines regarding egg consumption.

Evaluation of cardiovascular risk in children with solitary functioning kidney.

The present study investigates cardiovascular risk and kidney damage in patients with solitary kidneys. Included in the study were 40 children with a unilateral functioning kidney and 60 healthy controls, all of whom were evaluated for carotid intima-media thickness, ischemia-modified albumin and oxidative stress parameters, and 24-h ambulatory blood pressure monitoring. Serum creatinine and urine microalbumin levels were higher and creatinine clearance was lower in the patient group than in the control group, and serum ischemia-modified albumin, carotid intima-media thickness, aldosterone, plasma renin activity and blood pressure were all higher in the patient group than in the control group. In addition, the patient group was showed a non-dipper pattern. Children with a normal functioning solitary kidney are likely at higher risk of developingcardiovascular disease and such patients should be followed closely before marked kidney impairment occurs.

Study of HbA1c &amp; microalbumin in urine in patients of metabolic syndrome

We aimed to provide correlation of HbA1c &amp; Microalbumin in urine in patients of metabolic syndrome.: 100 patients coming to OPD of Medicine department in Shri Mahant Indresh Hospital. Plasma samples taken for Hba1c and urine for microalbumin and run on VITROS 5600/7600 and reported for Hba1c &amp; microalbumin. : 51 were males and 49 were females out of 100 total patients. For males age mean &amp; SD was 55.84±13.52 &amp; for females was 57.56±10.08.For raised and unraised HbA1c 10.42±+9.628 &amp; 5.066±.0.216 for raised and unraised microalbumin 412.±1133 &amp; 11.97±7.129.When we compared both HbA1c and microalbumin in both males and females then mean and SD came out to for HbA1C for males 8.56±2.663 and females were 11.62±12.86 with t value 2.327 and p value 0.021 that states it was significant. And for micralbumin for male 391.5±1184 &amp; for females 60.37±116.6 t value was 2.7832 and p value was 0.0059 it also states it was significant. Therefore both the parameters were significant in patients of metabolic syndrome.