Urine Microalbumin-creatinine Ratio Research Articles

Assessment of biomarkers of endothelial dysfunction in patients with angiographically proven coronary artery disease

Introduction: The endothelium plays an important role in vascular homeostasis. Endothelial dysfunction leads to vasospasm, vasoconstriction, excessive thrombosis, and abnormal vascular proliferation. Endothelial dysfunction may be present in asymptomatic individuals, those could later develop hypertension, diabetes mellitus, and heart-related problems, which is one of the major causes of morbidity and mortality in India. The markers of endothelial dysfunction studied in this work are high-sensitivity C-reactive protein (hs-CRP), urine microalbumin creatinine ratio, and associated other markers such as lipid profile and fasting plasma sugar. Aims and Objective: The primary aim of this study was to assess biomarkers of endothelial dysfunction in patients with angiographically proven coronary artery disease (CAD). The secondary aim of this study was to estimate the levels of serum hs-CRP, urine microalbumin creatinine ratio, lipid profile, and fasting plasma sugar level in patients with angiographically proven CAD. Materials and Methods: This cross-sectional descriptive study was carried out from May 1, 2017 to April 30, 2019, at MGM Medical College, Aurangabad on approval of the Institutional Ethics Committee. A total of 231 patients with CAD of both sexes aged 21–80 years were included in the study. Serum hs-CRP was estimated by immunoturbidimetry, lipid profile by microslide method on VITROS 5600 (Ortho Clinical Diagnostics, Raritan, NJ, USA), urine microalbumin by immunoturbidimetry, urine creatinine by enzymatic reaction, and urine microalbumin creatinine ratio is calculated. Results and Discussion: hs-CRP was elevated in smokers, especially in triple vessels as compared to single and double vessels in patients with CAD, whereas the difference was nonsignificant between two- and three-vessel disease groups. In this study, we found an increased association between patients with microalbuminuria and abnormalities in serum lipoproteins. These lipid abnormalities include a lower high-density lipoprotein (HDL) level as well as higher values for low-density lipoprotein (LDL) and total triglycerides. Conclusion: This study showed that hs-CRP and urine microalbumin creatinine ratio levels were higher especially in smoker patients with CAD. There was an increase in levels of serum triglycerides, hs-CRP, LDL, and reduced HDL cholesterol levels in patients with CAD.

Effect of acupressure at Sanyinjiao on albuminuria in patients with early diabetic nephropathy: A single-blind, randomized, controlled preliminary study

BackgroundElevated urinary albumin excretion is a clinical manifestation of early-stage diabetic nephropathy (DN). PurposeTo investigate effect of acupressure at Sanyinjiao on albuminuria in patients with early DN. MethodsTotal included 53 patients with DN and albuminuria; 21 were assigned to the sham group without acupressure, and 32 were assigned to the experimental group with acupressure at Sanyinjiao (SP6) for 8weeks. The experimental group was divided into experiment A (acupressure <45 days) and experiment B (acupressure ≥45 days). The primary outcome measure was the urine albuminuria/creatinine ratio (UACR) or logarithmic transformed urine microalbumin creatinine ratio (log-UACR) changes, and the secondary outcome measures were the estimated glomerular filtration rate and hemoglobin A1c. ResultsThe difference in UACR and log-UACR before and after the study was higher in the experiment B group than in the experiment A and sham groups. ConclusionAcupressure at Sanyinjiao for 8 weeks may reduce albuminuria in patients with DN. However, this study was a preliminary design.

Urinary nephrin is earlier, more sensitive and specific marker of diabetic nephropathy than microalbuminuria.

Diabetic nephropathy (DN) is a leading cause of end-stage renal disease. Progressive damage and decline in the number of podocytes often occur in the early stages of DN. Thus, nephrin as a podocyte-specific protein may be regarded as a potential biomarker of early detection of DN. The aim of this study is to determine whether urinary nephrin is an earlier marker in DN than microalbuminuria and to test the significance of urinary nephrin as a marker for early detection of DN. Our cross-sectional study included 90 patients with type 2 diabetes mellitus (T2DM), 30 patients with diagnosed DN and 60 patients without diagnosed DN. As a control group, we used 30 healthy subjects. All patients with T2DM were classified into three subgroups according to urinary microalbumin/creatinine ratio (UMCR): normoalbuminuric, microalbuminuric and macroalbuminuric patients. Nephrin in urine was measured by immunoenzyme assay, microalbumin with turbidimetric and creatinine with the photometric method. In blood sera, we measured a few standard biochemical parameters. Nephrinuria was found to be present in 100% of patients with T2DM and macroalbuminuria, in 88% with microalbuminuria, as well as 82% of patients with T2DM and normoalbuminuria. A concentration of urinary nephrin was significantly increased in all groups of subjects with T2DM compared to the control group (p<0.05). Nephrinuria correlated statistically negative with eGFR (r=-0.54). ROC analysis showed that nephrin has a total predicted probability of 96% in patients with DN. Urinary nephrin is earlier, more specific and sensitive marker than microalbumin in early detection of DN.

IgA nephropathy associated acute kidney injury with ankylosing spondylitis and HLA-B27 positive: a case report

We are reporting a rare case with ankylosing spondylitis (AS), renal impairment with IgA nephropathy. Here, we discuss the course of diagnosis. A 32 year-old man with bilateral pain of the sacroiliac joints for 5 years and leg swelling for 10 days. A Diagnosis of AS by HLA-B27 and pelvic X-ray tests, pathological diagnosis and IgA nephropathy based on renal biopsy. We administered methylprednisolone 500 mg/d for 3 consecutive days, followed by methylprednisolone 40 mg oral QD for a month. The patient was followed up once a month. In the sixth month, the patient's serum creatinine had decreased to 0.96 mg/dL, urine microalbumin creatinine ratio decreased to 173.3 mg/g, and albumin had risen to 33.1 g/L. Pain and morning stiffness were relieved. Although the causal relationship between AS and IgA nephropathy in this patient still needs to be established. In clinical practice, patients with AS need to be screened for renal complications.&#x0D; CBMJ 2019 January: vol. 08 no. 01 P: 39-43

The Role of NT-proBNP as a Biomarker in Evaluating Residual Cardiovascular Risk in 200 Type 2 DM Patients Optimized for Conventional CV Risk Markers over Two Years

Methodology: Two hundred T2DM patients who were on standard glucose lowering agents and who may be on lipid and blood pressure lowering agents were optimised for conventional CV risk markers and followed for a period of 2 years. We evaluated CV risk using markers like BMI, HbA1c, Systolic blood pressure (SBP), diastolic BP (DBP), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides (TG), non-HDL cholesterol, cholesterol remnant, highly sensitive CRP (hsCRP), serum creatinine, eGFR and urine microalbumin/creatinine ratio (UACR). At the end of 2 years, N-terminal pro-b type natriuretic peptide (NTpro-BNP) was measured to assess its role as a residual CV risk marker. T2DM patients with recent history (&amp;lt;1 years) of revascularization or any major surgery were excluded. Data was analysed using SPSS version 20 and represented as Mean + 2SD with 95% confidence interval, paired t test was used and p value of 0.was considered significant. Results: Baseline characteristics were: 101(50.5%) males and 99 (49.5%) females, mean age was 61.63 ± 9.84 years, mean age since diagnosis 11.89 ± 7.3y and mean BMI 30.53 ± 5.7 kg/m2. There was an overall significant reduction from baseline to 2 years in HbA1c (7.61 ± 1.7 to 6.8 ± 1.05; p-&amp;lt;0.001), TC (142.55 ± 42.79 to 134.88 ± 40.56, p-0.01), LDL (79.79 ± 35.98 to 70.37 ± 30.69, p-&amp;lt;0.001), TG (133.31 ± 74.27 to 121.68 ± 74.11, p-0.018), Serum creatinine (0.97 ± 0.29 to 0.93 ± 0.26, p-&amp;lt;0.001), UACR (91.43 ± 34.4 to 56.49 ± 16.74), hsCRP (7.02 ± 2.77 to 4.1 ± 1.85, p-0.001). There was no significant change observed with respect to BMI, SBP, DBP, HDL and eGFR from baseline to 2 years. The mean NTpro-BNP at the end of 2 years was 166.33 ± 23.6. Conclusion: In the present study, inspite of reduction in various CV risk markers over a period of 2 years, mean NTpro-BNP level remained high. Hence, this may suggest the role of NT pro BNP to be of additional value as a CV risk assessment tool in T2DM patients. Disclosure V. Gupta: None. V. Teli: None.

An observational study for assessment of point-of-care management received by diabetic patients before referral to a tertiary care hospital

Introduction: Quality of diabetes care is suboptimal worldwide and it varies in rural and urban areas. Indian studies assessing the quality of diabetic care are few. We conducted a study to identify the gap in diabetes management as rural patients received before referral to a tertiary care hospital. Methods: The study was conducted over 2 years in our institution. Rural patients managed previously outside our institution were included in the study. Patients were interviewed for treatment history. Prescriptions and related documents were evaluated for basic examinations, investigations, proper advices, and management processes. Results: A total of 352 diabetic patients were evaluated. Blood pressure (BP) checkup was more regular than blood sugar monitoring (91% vs. 58%). Glycosylated hemoglobin was monitored rarely (2%). Eye checkup (2%), screening of neuropathies (7%), autonomic features (3%), electrocardiography (11%), and lipid screening (9%) were infrequent. Urine microalbumin-creatinine ratio was checked rarely (1%). Advice on diet (62%), exercise (56%), smoking cessation (15%), and foot care (2%) were suboptimal. Usages of insulin, oral hypoglycemic agents (OHA), and antihypertensive agents were suboptimal. Only 86 cases (29%) out of 295 with indications of OHA got adequate dose of OHAs and only 5 cases (9%) out of 57 cases with indications of insulin got adequate dose of insulin. Among diabetic hypertensives (115 cases), only 19% got adequate dose of antihypertensives. Conclusion: Diabetic patients were managed inadequately. The study provides data for developing interventions for improving the quality of diabetes care of rural patients outside the tertiary care setup.

Abstract 17689: Omega-3 Fatty Acid Supplementation Reduces Inflammation and Improves Physical Function in Patient With Coronary Artery Disease

Introduction: Poor physical function impairs fitness and is associated with worse cardiovascular outcomes and all-cause mortality. Arthritis and joint dysfunction limit physical function in coronary artery disease (CAD) patients. Hypothesis: Omega-3 fatty acids (FA) improve physical function in CAD patients through reducing inflammation. Methods: We randomized 249 subjects with stable CAD to 3.6 of omega-3 FA (1.86 g of eicosapentaenoic acid + 1.5 g of docosahexaenoic acid) per day or no omega-3 (control) for one year. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to evaluate pain, stiffness and physical function at baseline and one year follow-up. Inflammation was assessed by total white blood cell (WBC) count and its subsets as well as urine microalbumin-creatinine ratio (MCR). Results: Mean age was 63.0 ± 7.58 years; 17% were women. Controls had worsening stiffness (% Δ = 8.4%; p = 0.036) at 1 year follow-up while those on omega-3 FA had no change (% Δ = 0.4%, p = 0.886 - see Table)(a lower percent change indicates better functioning). Compared to controls, those on omega-3 FA had better physical function (% Δ = 8.5% vs. -2.8%, p = 0.011), and total WOMAC scores (% Δ = 7.8% vs. -2.5%, p = 0.011) and a significant decrease in WBC (% Δ = -3.5 vs. -9.4%; p=0.009) and neutrophils (% Δ = -3.5% vs. -11.6%; p=0.005) at one year follow-up. MCR significantly worsened only in the control group (% Δ = 53.3%, p = 0.037) at one year follow-up (p-value for control vs. omega-3 FAs groups = 0.026). Monocytes were decreased in the omega-3 FAs group at one year compared to baseline (% Δ = -11.1%, p &lt; 0.001) and directly correlated with physical function and total scores (p = 0.033 and p = 0.024, respectively). Conclusions: Omega-3 FAs attenuate worsening of physical function over a one year period in CAD patients possibly mediated through an anti-inflammatory effect. Therefore, omega-3 FA may benefit CAD patients by improving their physical function.

Ambulatory blood pressure profiles in a subset of HIV-positive patients pre and post antiretroviral therapy.

SummaryObjectivesHuman immunodeficiency virus (HIV) and antiretroviral therapy (ART) are associated with renal disease and increased cardiovascular risk. The relationship between HIV and ambulatory blood pressure (ABP) non-dipping status, a risk factor for cardiovascular events and target-organ damage, has never been assessed in South Africa. Study objectives were to establish the prevalence of chronic kidney disease, and assess the ABP profile in asymptomatic HIV-positive clinic out-patients.MethodsThis was a prospective cohort study. Office blood pressure (BP), urinary microalbumin–creatinine ratio, urine dipsticks, serum creatinine and estimated glomerular filtration rate (eGFR) were measured at baseline and six months after ART initiation. A subset of HIV-positive subjects and an HIV-negative control group underwent 24-hour ABP monitoring.ResultsNo patient had an eGFR < 60 ml/min, three patients (4.7%) had microalbuminuria and one had macroalbuminuria. Mean office systolic BP was 111 ± 14 mmHg at baseline and increased by 5 mmHg to 116 ± 14 mmHg (p = 0.05) at six months. This increase was not confirmed by ABP monitoring. In the HIV-positive and -negative patients, the prevalences of non-dipping were 80 and 52.9%, respectively (p = 0.05, odds ratio = 3.56, 95% CI: 0.96–13.13). No relationship between dipping status and ART usage was found.ConclusionThe prevalence of chronic kidney disease (CKD) was lower than anticipated. HIV infection was associated with an ambulatory non-dipping status, which suggests an underlying dysregulation of the cardiovascular system. In the short term, ART does not seem to improve loss of circadian rhythm.

MP72-04 MICROALBUMINURIA AS A PREDICTOR OF DELAYED RENAL FUNCTION AFTER DONOR NEPHRECTOMY

You have accessJournal of UrologyTransplantation & Vascular Surgery II1 Apr 2014MP72-04 MICROALBUMINURIA AS A PREDICTOR OF DELAYED RENAL FUNCTION AFTER DONOR NEPHRECTOMY Young Eun Yoon, Kwang Suk Lee, Kyung Hwa Choi, Kwang Hyun Kim, Kang Su Cho, Joong Shik Lee, Won Sik Ham, Koon Ho Rha, Young Deuk Choi, Seung Choul Yang, and Woong Kyu Han Young Eun YoonYoung Eun Yoon More articles by this author , Kwang Suk LeeKwang Suk Lee More articles by this author , Kyung Hwa ChoiKyung Hwa Choi More articles by this author , Kwang Hyun KimKwang Hyun Kim More articles by this author , Kang Su ChoKang Su Cho More articles by this author , Joong Shik LeeJoong Shik Lee More articles by this author , Won Sik HamWon Sik Ham More articles by this author , Koon Ho RhaKoon Ho Rha More articles by this author , Young Deuk ChoiYoung Deuk Choi More articles by this author , Seung Choul YangSeung Choul Yang More articles by this author , and Woong Kyu HanWoong Kyu Han More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2243AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Kidney donation results in small increase in urinary protein because of compensatory hyperfiltration of contralateral remnant kidney. This study was conducted to determine the clinical implication of the urinary microalbumin/creatinine ratio (UACR) and the relationship between UACR and renal function after living donor nephrectomy. METHODS Between October 2009 and January 2013, 349 patients in our hospital underwent live donor nephrectomy. Among them, we excluded 160 patients who did not want to participate in this prospective study and did not visit our clinic 6 months postoperatively. Serum creatinine and cystatin C were measured prospectively to estimate the renal function. We divided normal (n=124) versus chronic kidney disease subjects (MDRD eGFR < 60mL/min/1.73m2 at 6 months postoperatively, n=65) to compare UACR at preoperation, immediate postoperation, 1st, 3rd, and 6th postoperative month. RESULTS During follow up period, the normal group constantly showed higher MDRD and cystatin C eGFR than CKD group. When we compared UACR between two groups, there were no differences preoperatively and immediate postoperatively (4.18 vs 5.02, 20.81 vs 20.06 mg/mmol, respectively). However, UACR at 1 month after nephrectomy was higher in CKD group (8.57 vs 15.21 mg/mmol, p=0.008). Although UACR of CKD group showed higher tendency at postoperative months 3 and 6, there were no statistical significance. As a continuous variable, UACR at postoperative 1 month was associated with new onset of CKD (odds ratio: 1.07 for each 0.1mg/mmol increase; p=0.003). When we generate an ROC curve for CKD prediction with MDRD eGFR, cystatin C eGFR and UACR at postoperative 1 month, the predictive probability was very powerful (AUC = 0.875, P<0.001). CONCLUSIONS The higher UACR in the CKD group at 1 month after surgery indicates their recovery of renal function is still ongoing while that of the normal group has already finished. And we should observe donors who showed higher UACR at postoperative 1 month closely. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e824 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Young Eun Yoon More articles by this author Kwang Suk Lee More articles by this author Kyung Hwa Choi More articles by this author Kwang Hyun Kim More articles by this author Kang Su Cho More articles by this author Joong Shik Lee More articles by this author Won Sik Ham More articles by this author Koon Ho Rha More articles by this author Young Deuk Choi More articles by this author Seung Choul Yang More articles by this author Woong Kyu Han More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Outcomes Associated With Microalbuminuria

This study sought to compare the association of microalbuminuria with outcomes in patients with different comorbidities. The risk of adverse outcomes associated with lower levels proteinuria has been found to be linearly decreasing with even low-normal levels of microalbuminuria. It is unclear whether comorbid conditions change these associations. We examined the association of urine microalbumin-creatinine ratio (UACR) with mortality and the slopes of estimated glomerular filtration rate (eGFR) in a nationally representative cohort of 298,875 U.S. veterans. Associations of UACR with all-cause mortality overall and in subgroups of patients with and without diabetes mellitus, hypertension, cardiovascular disease, congestive heart failure, and advanced chronic kidney disease (CKD) were examined in Cox models, and with the slopes of eGFR in linear and logistic regression models. Very low levels of UACR were linearly associated with decreased mortality and less progression of CKD overall: adjusted mortality hazard ratio and estimated glomerular filtration rate slope (95% confidence interval [CI]) associated with UACR ≥200 μg/mg, compared to <5 μg/mg were 1.53 (95% CI: 1.38 to 1.69, p < 0.001) and -1.59 (95% CI: -1.83 to -1.35, p < 0.001). Similar linearity was present in all examined subgroups, except in patients with CKD in whom a U-shaped association was present and in whom a UACR of 10 to 19 was associated with the best outcomes. The association of UACR with mortality and with progressive CKD is modified in patients with CKD, who experience higher mortality and worse progression of CKD with the lowest levels of UACR. Proteinuria-lowering interventions in patients with advanced CKD should be implemented cautiously, considering the potential for adverse outcomes.

Abstract 8900: Urinary β 2 -Microglobulin-Creatinine ratio is Associated with High Risk in Chronic Heart Failure Patients

Background It has been reported that renal dysfunction has strong association with clinical outcomes in chronic heart failure (CHF) patients. Recent study demonstrated that several urinary markers were related to cardiac prognosis in CHF patients. Urinary μ 2 -microglobulin-creatinine ratio (UBCR) is a marker for renal tubular damage (RTD) and related to rapid deterioration of renal function. However, association between UBCR and cardiac prognosis has been not studied. The purpose of the present study was to examine whether: (1) UBCR is correlated with severity of heart failure; and (2) UBCR can predict clinical outcomes in CHF patients. Methods and Results We measured UBCR, urinary microalbumin-creatinine ratio, N-acetyl-beta-D-glucosamidase and estimated glomerular filtration rate (eGFR) in 193 CHF patients. Patients were prospectively followed during a median follow up period of 353 days. There were 46 cardiac events, including 10 cardiac deaths and 36 re-hospitalizations for worsening heart failure. Levels of UBCR increased with advancing NYHA functional class. Patients with cardiac events had higher levels of UBCR than those without. In the univariate Cox proportional hazard analysis, age, NYHA functional class, brain natriuretic peptide, eGFR and UBCR were independent risk factor for cardiac events. A multivariate Cox proportional hazard analysis revealed that UBCR is an independent predictor of cardiac events in CHF patients. We defined RTD as UBCR &gt; 300 μg/g according to our previous report. Kaplan-Meier analysis demonstrated that cardiac event rate was higher in patients with RTD than in those without. In addition, Kaplan-Meier analysis demonstrated that RTD could strictly classify the prognosis of CHF patients without chronic kidney disease. Conclusion UBCR was related to the severity of heart failure and associated with high risk in CHF patients. RTD, as implicated by UBCR, could add clinical information about cardiac prognosis in CHF patients.