-
Annales de Biologie Clinique Feb 2019Albuminuria is associated with the progression of chronic kidney disease and the occurrence of cardiovascular events in patients with and without diabetes. The evolution... (Review)
Review
Albuminuria is associated with the progression of chronic kidney disease and the occurrence of cardiovascular events in patients with and without diabetes. The evolution of albuminuria appears to be associated with patient's prognosis. How exactly microalbuminuria is linked to cardiovascular risk remains unclear. This association is probably explained by endothelial dysfunction or chronic low-grade inflammation. Albuminuria/creatininuria ratio allows reduction of potential errors in urine collection. In France, the recommendations for the monitoring of albuminuria depend on the cause of albuminuria. An increase in urinary albumin excretion could signify the need for an intensive multifactorial intervention strategy and albuminuria is a relevant biological marker to monitor therapeutic effectiveness, since a reduction of albuminuria in patients, irrespective of their diabetic status, predicts reduction of cardiovascular risk.
Topics: Albuminuria; Biomarkers; Cardiovascular Diseases; Diabetes Mellitus; Disease Progression; France; Humans; Nephrology; Predictive Value of Tests; Prognosis; Renal Insufficiency, Chronic; Risk Factors; Urinalysis
PubMed: 30799295
DOI: 10.1684/abc.2018.1402 -
Cureus Oct 2022Background The present study was conducted to assess the renal effects of high dose versus low dose lisinopril in patients with diabetic nephropathy. Methodology A...
Background The present study was conducted to assess the renal effects of high dose versus low dose lisinopril in patients with diabetic nephropathy. Methodology A prospective observational study was conducted at the Khyber Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan, between July 1, 2019, to January 1, 2020. Patients were divided into two groups. Group A patients were administered a low dose (5 mg per day) of Lisinopril and group B were administered a higher dose of therapy (20 mg/day) for three months. At the end of the study, baseline renal functions, electrolytes, and status of microalbuminuria were compared with follow-up values. The primary outcome was to assess the change in microalbuminuria levels in patients at baseline, one month, and three months of therapy. Results A total of 72 patients were included in group A (low dose) and 72 patients were enrolled in group B (high dose). The mean ages of group A and group B were 56.3 ± 12.9 years and 53.48 ± 12.2 years, respectively. The majority of the patients in the groups were male. At baseline, the mean microalbuminuria levels in the two groups were not significantly different however, at three months post treatment, the levels were significantly much lower in high dose patients as compared to patients who were on low dose lisinopril (146.06 ± 23.89 vs. 184.69 ± 26.27; p < 0.0001). The three-month urea levels were significantly lower in group A as compared to group B (38.91 ± 7.07 vs. 43.26 ± 3.02; p = 0.008). Three-month creatinine and potassium levels were not significantly different between the groups (p = 0.7 and 0.12, respectively). Conclusion Our study revealed that even though group B (high dose lisinopril) had significantly reduced microalbuminuria, the urea levels were found to be higher in this cohort of patients as compared to group A patients on low-dose lisinopril. Moreover, the majority of the patients in group B reported significant improvements in blood pressure control as compared to group A, which indicated that a high dose of lisinopril is more effective in patients with diabetic nephropathy than a low dose of lisinopril. The levels of creatinine after three months of treatment did not differ significantly. Further randomized trials are warranted in order to ascertain the effectiveness of high dose of lisinopril in patients with diabetic nephropathy.
PubMed: 36348831
DOI: 10.7759/cureus.29873 -
Kidney Research and Clinical Practice Jun 2020Bariatric surgeries were reported to improve diabetes and hypertension; however, the effect on renal recovery has not been fully explored. The aim of this study was to...
BACKGROUND
Bariatric surgeries were reported to improve diabetes and hypertension; however, the effect on renal recovery has not been fully explored. The aim of this study was to evaluate the effect of laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients on renal function, degree of albuminuria, and kidney injury molecule-1 (KIM-1) level.
METHODS
This was a prospective observational study conducted at Mansoura University Hospitals from January to June 2017. Forty-four morbidly obese patients (29 females and 15 males) who met the 1991 WHO criteria for obesity surgery were included. Patients underwent surgical LSG for treatment of morbid obesity, and all were followed for 6 months after surgery. Demographic, clinical, and laboratory data were collected and compared before and after surgery. Primary endpoints were the differences of albuminuria, estimated glomerular filtration rate (eGFR) and serum KIM-1 between baseline (pre-surgery) and 6-month post-surgery values.
RESULTS
Six-month post-surgery data showed significant reduction of body mass index, HbA1c, microalbuminuria, and serum KIM-1, and a significant increase in eGFR (all, < 0.001). The serum KIM-1 level positively correlated with microalbuminuria and serum creatinine (r = 0.596, = 0.001 and r = 0.402, = 0.034, respectively). Postoperative data showed that patients with microalbuminuria had significantly lower eGFR and higher KIM-1 values than those without microalbuminuria ( = 0.003 and 0.049, respectively).
CONCLUSION
We showed potential benefits of LSG against obesity-associated kidney damage. This is evidenced by improving eGFR and reducing levels of both KIM-1 and microalbuminuria. The serum level of KIM-1 may be a potential marker for renal recovery after LSG.
PubMed: 32487784
DOI: 10.23876/j.krcp.19.109 -
Journal of Inflammation Research 2021An important clinical feature of metabolic syndrome is abdominal obesity. Microalbuminuria is important in predicting the risk of cardiovascular and renal complications...
INTRODUCTION
An important clinical feature of metabolic syndrome is abdominal obesity. Microalbuminuria is important in predicting the risk of cardiovascular and renal complications in abdominal obesity patients. However, the association between microalbuminuria polymorphism and abdominal obesity has not been conducted. The objective of this study is to analyze the genetic polymorphism of microalbuminuria in participants with metabolically unhealthy obesity (MUO).
METHODS
Among 1325 MUO participants, we identified genomic loci underlying those with microalbuminuria, compared to those without microalbuminuria. Single nucleotide polymorphisms (SNPs) were selected with P < 1 × 10 from the Manhattan plot. Multivariable linear regression and analysis of variance were used to analyze the association between different SNP genotypes and microalbuminuria.
RESULTS
The analysis showed homozygous participants for the risk allele A of rs10105606 and Affx-31885823 had 1.978-fold risk and 1.921-fold increased risk of microalbuminuria, respectively. Heterozygous distribution of rs117180252, rs10105606, and Affx-31885823 also increased the risk of microalbuminuria compared to the wild type. Further analysis showed Lipoprotein lipase (, and were the candidate genes associated with lipid metabolism and abdominal obesity.
CONCLUSION
In conclusion, , and minor allele carriers with abdominal obesity are more susceptible to microalbuminuria, explaining the inter-individual differences of microalbuminuria in MUO patients.
PubMed: 34934334
DOI: 10.2147/JIR.S338010 -
Italian Journal of Pediatrics Nov 2019Evidence of kidney damage is observed in children with sickle cell anaemia (SCA) and this continues through adulthood with progression to severe functional impairment in... (Comparative Study)
Comparative Study
INTRODUCTION
Evidence of kidney damage is observed in children with sickle cell anaemia (SCA) and this continues through adulthood with progression to severe functional impairment in some. One of the earliest features of kidney damage associated with SCA is microalbuminuria. Our objective was to determine the risk factors of microalbuminuria in these children and its relationship with estimated glomerular filtration rate.
METHODS
This was a cross-sectional and comparative study involving three hundred and twenty three children with SCA in steady state and equal numbers of apparently healthy age and sex matched haemoglobin AA (HbAA) control, aged 6 months to 18 years. They were consecutively recruited over a 6 month period.
RESULT
Microalbuminuria was present in 26% of the study subjects compared with 1.85% of control P = 0.001). Anaemia and high estimated glomerular filtration rate (eGFR) showed strong positive correlation with microalbuminuria (OR = 3.19, CI 0.953-1.116, p = 0.003 and OR = 1.7, CI 1.042-1.066, p = 0.001 respectively). Similarly, eGFR was higher in subjects with SCA than in controls and as well as in those with microalbuminuria compared with those who do not (p = < 0.01).
CONCLUSIONS
The two most important risk factors for microalbuminuria were anaemia and high eGFR. Age category was associated more with microalbuminuria than just age as a variable. Glomerular filtration rate was higher in children with microalbuminuria than those who do not and it was also higher in children with SCA than in control.
Topics: Adolescent; Albuminuria; Anemia, Sickle Cell; Case-Control Studies; Child; Child, Preschool; Cross-Sectional Studies; Female; Glomerular Filtration Rate; Humans; Infant; Male; Nigeria; Prevalence; Risk Factors
PubMed: 31718702
DOI: 10.1186/s13052-019-0720-0 -
The Lancet. Diabetes & Endocrinology Apr 2020Microalbuminuria is an early sign of kidney disease in people with diabetes and indicates increased risk of cardiovascular disease. We tested whether a urinary proteomic... (Observational Study)
Observational Study Randomized Controlled Trial
Early detection of diabetic kidney disease by urinary proteomics and subsequent intervention with spironolactone to delay progression (PRIORITY): a prospective observational study and embedded randomised placebo-controlled trial.
BACKGROUND
Microalbuminuria is an early sign of kidney disease in people with diabetes and indicates increased risk of cardiovascular disease. We tested whether a urinary proteomic risk classifier (CKD273) score was associated with development of microalbuminuria and whether progression to microalbuminuria could be prevented with the mineralocorticoid receptor antagonist spironolactone.
METHODS
In this multicentre, prospective, observational study with embedded randomised controlled trial (PRIORITY), we recruited people with type 2 diabetes, normal urinary albumin excretion, and preserved renal function from 15 specialist centres in ten European countries. All participants (observational cohort) were tested with the CKD273 classifier and classified as high risk (CKD273 classifier score >0·154) or low risk (≤0·154). Participants who were classified as high risk were entered into a randomised controlled trial and randomly assigned (1:1), by use of an interactive web-response system, to receive spironolactone 25 mg once daily or matched placebo (trial cohort). The primary endpoint was development of confirmed microalbuminuria in all individuals with available data (observational cohort). Secondary endpoints included reduction in incidence of microalbuminuria with spironolactone (trial cohort, intention-to-treat population) and association between CKD273 risk score and measures of impaired renal function based on estimated glomerular filtration rate (eGFR; observational cohort). Adverse events (particularly gynaecomastia and hyperkalaemia) and serious adverse events were recorded for the intention-to-treat population (trial cohort). This study is registered with the EU Clinical Trials Register (EudraCT 20120-004523-4) and ClinicalTrials.gov (NCT02040441) and is completed.
FINDINGS
Between March 25, 2014, and Sept 30, 2018, we enrolled and followed-up 1775 participants (observational cohort), 1559 (88%) of 1775 participants had a low-risk urinary proteomic pattern and 216 (12%) had a high-risk pattern, of whom 209 were included in the trial cohort and assigned to spironolactone (n=102) or placebo (n=107). The overall median follow-up time was 2·51 years (IQR 2·0-3·0). Progression to microalbuminuria was seen in 61 (28%) of 216 high-risk participants and 139 (9%) of 1559 low-risk participants (hazard ratio [HR] 2·48, 95% CI 1·80-3·42; p<0·0001, after adjustment for baseline variables of age, sex, HbA, systolic blood pressure, retinopathy, urine albumin-to-creatinine ratio [UACR], and eGFR). Development of impaired renal function (eGFR <60 mL/min per 1·73 m) was seen in 48 (26%) of 184 high-risk participants and 119 (8%) of 1423 low-risk participants (HR 3·50; 95% CI 2·50-4·90, after adjustment for baseline variables). A 30% decrease in eGFR from baseline (post-hoc endpoint) was seen in 42 (19%) of 216 high-risk participants and 62 (4%) of 1559 low-risk participants (HR 5·15, 95% CI 3·41-7·76; p<0·0001, after adjustment for basline eGFR and UACR). In the intention-to-treat trial cohort, development of microalbuminuria was seen in 35 (33%) of 107 in the placebo group and 26 (25%) of 102 in the spironolactone group (HR 0·81, 95% CI 0·49-1·34; p=0·41). In the safety analysis (intention-to-treat trial cohort), events of plasma potassium concentrations of more than 5·5 mmol/L were seen in 13 (13%) of 102 participants in the spironolactone group and four (4%) of 107 participants in the placebo group, and gynaecomastia was seen in three (3%) participants in the spironolactone group and none in the placebo group. One patient died in the placebo group due to a cardiac event (considered possibly related to study drug) and one patient died in the spironolactone group due to cancer, deemed unrelated to study drug.
INTERPRETATION
In people with type 2 diabetes and normoalbuminuria, a high-risk score from the urinary proteomic classifier CKD273 was associated with an increased risk of progression to microalbuminuria over a median of 2·5 years, independent of clinical characteristics. However, spironolactone did not prevent progression to microalbuminuria in high-risk patients.
FUNDING
European Union Seventh Framework Programme.
Topics: Adult; Aged; Albuminuria; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Disease Progression; Early Diagnosis; Female; Glomerular Filtration Rate; Humans; Male; Middle Aged; Mineralocorticoid Receptor Antagonists; Prospective Studies; Proteomics; Spironolactone; Treatment Outcome
PubMed: 32135136
DOI: 10.1016/S2213-8587(20)30026-7 -
International Journal of Cardiology Mar 2023Microalbuminuria is associated with adverse outcomes in acute coronary syndrome (ACS) patients.
Microalbuminuria during acute coronary syndrome: Association with 22-year mortality and causes of death. The ABC-8* study on heart disease. (*ABC is an acronym for Adria, Bassano, Conegliano, and Padova Hospitals).
BACKGROUND
Microalbuminuria is associated with adverse outcomes in acute coronary syndrome (ACS) patients.
METHODS
To evaluate the very long-term association between Microalbuminuria and the overall mortality and causes of death in this clinical setting, we prospectively studied 579 unselected ACS patients admitted to three hospitals. The baseline albumin-to-creatinine ratio (ACR) was measured on days 1, 3, and 7 in 24-h urine samples. Patients were followed for 22 years or until death.
RESULTS
Virtually all patients completed follow-up; 449(78%) had died: 41% due to non-sudden cardiac death (non-SCD), 19% sudden cardiac death (SCD), 40% due to non-cardiac (non-CD) death. Using unadjusted Cox regression analysis, ACR was a significant predictor of all-cause mortality (hazard ratio [HR] 1.26;95%confidence interval [CI] 1.22-1.31; p˂0.0001) and the three causes of death (HR 1.40;95%CI 1.32-1.48; p˂0.0001), (HR 1.22;95%CI 1.12-1.32; p˂0.0001) and (HR 1.16;95%CI 1.09-1.23; p˂0.0001) for non-SCD, SCD and non-CD respectively. Using a fully adjusted model, ACR was a significant independent predictor of all-cause mortality (HR 1.12; 95%CI 1.08-1.16; p˂0.0001) and only non-SCD (HR 1.21; 95%CI 1.14-1.29; p˂0.0001). There was a positive interaction between ACR level and history of AMI (HR 1.15; 95%CI 1.03-1.29; p = 0.01) and the presence of heart failure at admission (HR 1.11; 95%CI 1.01-1.24; p = 0.04), and negative interaction with higher than median LVEF (HR 0.89; 95%CI 0.80-0.99; p = 0.03) for all-cause mortality at the multivariable level.
CONCLUSION
Based on the present analysis, baseline urinary albumin excretion during ACS is a strong independent predictor of the very long-term mortality risk, chiefly due to non-sudden cardiac death.
Topics: Humans; Acute Coronary Syndrome; Cause of Death; Prospective Studies; Death, Sudden, Cardiac; Hospitals; Albumins; Risk Factors
PubMed: 36535560
DOI: 10.1016/j.ijcard.2022.12.025 -
Diagnostics (Basel, Switzerland) Sep 2021Microalbuminuria is closely associated with the risk of cardiovascular disease and all-cause mortality in the general population. Less is known about its relationship...
Prevalence of Microalbuminuria and Its Association with Subclinical Carotid Atherosclerosis in Middle Aged, Nondiabetic, Low to Moderate Cardiovascular Risk Individuals with or without Hypertension.
Microalbuminuria is closely associated with the risk of cardiovascular disease and all-cause mortality in the general population. Less is known about its relationship with subclinical atherosclerosis. We aimed to assess the prevalence of microalbuminuria and its relationship with subclinical atherosclerosis in middle-aged, nondiabetic, apparently healthy individuals (N = 187; 40.1% men, 59.9% women; aged 35-55 years) as well as to evaluate its potential associations with established risk modifiers, especially with the presence of carotid plaque. Clinical and laboratory parameters, the estimated 10-year fatal cardiovascular risk (SCORE), as well as circulating, functional (flow mediated vasodilation, ankle-brachial index, augmentation index, and pulse wave velocity), and morphological markers (mean carotid intima-media thickness, and carotid plaque) of subclinical atherosclerosis were analysed in group with vs. without microalbuminuria. Microalbuminuria was present in 3.8% of individuals with SCORE risk 0.43 ± 0.79%. Functional markers predominated in both groups. Carotid intima-media thickness (mean ± SD) in both groups was in range: 0.5-0.55 ± 0.09-0.14 mm. Carotid plaque was more frequent in group with (14.3%) vs. without (4.4%) microalbuminuria. Microalbuminuria had no statistically significant effect on most markers of subclinical atherosclerosis, but the increasing value of microalbuminuria was significantly associated with the occurrence of carotid plaque ( = 0.035; OR = 1.035; 95% CI = 1.002-1.07). Additional multiple logistic regression analysis, where variables belonged to microalbuminuria, number of risk factors, and family history, finally showed only two variables: microalbuminuria ( = 0.034; OR = 1.04; 95%CI = 1.003-1.09) and the number of risk factors ( = 0.006; OR = 2.15; 95% CI = 1.24-3.73) with independent and significant impact on the occurrence of carotid plaque. Our results may indicate an association of microalbuminuria with the presence of carotid atherosclerotic plaque; in addition, microalbuminuria and the number of risk factors appear to be possible predictors of the carotid plaque occurrence. Monitoring microalbuminuria may improve the personalized cardiovascular risk assessment in nondiabetic, low-to-moderate cardiovascular risk individuals with or without hypertension.
PubMed: 34574057
DOI: 10.3390/diagnostics11091716 -
Cardiovascular Endocrinology &... Dec 2021The ankle-brachial index (ABI) is a fast, simple, noninvasive method that provides accurate results in the early diagnosis of peripheral artery disease. Microalbuminuria...
UNLABELLED
The ankle-brachial index (ABI) is a fast, simple, noninvasive method that provides accurate results in the early diagnosis of peripheral artery disease. Microalbuminuria is considered a predictor of renal and cardiovascular complications in patients with diabetes. This study was conducted to determine the correlation between ABI and microalbuminuria with certain risk factors in patients with type 2 diabetes.
SUBJECTS AND RESEARCH METHODS
A cross-sectional descriptive study was performed on 62 inpatients with type 2 diabetes. All patients were measured for ABI as well as microalbuminuria, HbA1c, glucose and lipidemia in the blood.
RESULTS
The study results showed that in patients with dyslipidemia, the risk of having microalbuminuria (+) increased 5.7 times and ABI ≤0.90 increased 8.6 times ( = 0.004 and 0.021, respectively). Fasting blood glucose >7.2 mmol/L had 5.7 times higher microalbuminuria (+) risk and 8.6 times higher ABI ≤0.90 ( = 0.004 and 0.021, respectively). Patients with HbA1c ≥7% were 2.9 times more likely to have microalbuminuria (+) and ABI ≤0.90 ( = 0.043 and 0.048, respectively).
CONCLUSIONS
Peripheral vascular disease risk factors such as hypertension, dyslipidemia and waist circumference and the effectiveness of fasting blood glucose and HbA1c control increased the risk of high microalbuminuria and ABI in patients with type 2 diabetes.
PubMed: 34765891
DOI: 10.1097/XCE.0000000000000251 -
Journal of Clinical Medicine Research Mar 2021It was reported that microalbuminuria and a decline in renal function were associated with cardiovascular disease (CVD) mortality and renal events and prognostic serious...
BACKGROUND
It was reported that microalbuminuria and a decline in renal function were associated with cardiovascular disease (CVD) mortality and renal events and prognostic serious complications. Dietary factors and nutrients affecting microalbuminuria in type 2 diabetes remain unclear, and accordingly we conducted a cross-sectional study on the possible relevance of dietary factors to urinary albumin excretion in patients with type 2 diabetes.
METHODS
Forty-two patients with type 2 diabetes participated in this study, and these subjects were categorized into patients without microalbuminuria group with urine albumin-to-creatinine ratio (ACR) of less than 30 mg/g Cr (n = 29) and a microalbuminuria group with ACR of 30 - 299 mg/g Cr (n = 13). ACR levels were measured using spot urine samples. At the time of examination, body mass index (BMI) and systolic and diastolic blood pressures were measured and recorded. We performed sampling fasting-blood and spot urine and conducted a food frequency questionnaire based on food groups to examine dietary habits for the past 1 - 2 months.
RESULTS
There were no significant differences in sex, age, duration, BMI, blood pressures, biochemical data, and the median of daily intakes of energy and macronutrients between patients without microalbuminuria and microalbuminuria groups. In the intake of 17 food groups per day, fruits were significantly lower in the microalbuminuria group than in patients without microalbuminuria group (the median was 38 g vs. 120 g/day, P < 0.05), but intakes of other food groups were not significantly different between the two groups. Moreover, we examined a model of partial correlation between ACR to the intake of fruits, adjusted by age, sex, glycated hemoglobin and BMI. This partial correlation was insignificantly seen but close to a significant level (partial correlation coefficient: -0.270, P = 0.102).
CONCLUSIONS
These results suggest that the intake of fruits may be inversely associated with microalbuminuria in Japanese type 2 diabetic patients. It would be necessary to investigate the exact types and amounts of fruits to be consumed to address microalbuminuria.
PubMed: 33854654
DOI: 10.14740/jocmr4440