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Cureus Oct 2023Laurence-Moon-Bardet Biedl syndrome (LMBBS) is a rare autosomal recessive genetic disorder that is most frequently found in children born from consanguineous marriages....
Laurence-Moon-Bardet Biedl syndrome (LMBBS) is a rare autosomal recessive genetic disorder that is most frequently found in children born from consanguineous marriages. The most prominent clinical characteristics of this syndrome include rod and cone dystrophy, nystagmus, central obesity, polydactyly, hypogonadism in males, renal anomalies, developmental delay, ataxia, speech difficulties, and poor coordination. In this report, we describe the case of a 31-year-old male who had the classical clinical features of LMBBS like developmental delay, retinitis pigmentosa, nystagmus, obesity, hypogonadism, and central obesity, presenting with abdominal pain associated with vomiting and tenderness in the right lower quadrant. The patient was diagnosed with cholelithiasis. This case report emphasizes the atypical complication of cholelithiasis due to the underlying syndrome and the need for further research in this area.
PubMed: 38021809
DOI: 10.7759/cureus.47316 -
Indian Journal of Ophthalmology Aug 2023Vascular endothelial growth factor inhibitors (anti-VEGF) have been shown to be effective in the treatment of diabetic macular edema. However, there is little...
PURPOSE
Vascular endothelial growth factor inhibitors (anti-VEGF) have been shown to be effective in the treatment of diabetic macular edema. However, there is little information about the systemic effects of intraocular administration of anti-VEGF drugs in patients with coexistent diabetic nephropathy because it can produce adverse renal effects.
METHODS
This retrospective cohort study analyzed the effect of intravitreal anti-VEGF drugs (bevacizumab, ranibizumab, or aflibercept) on eFGR and microalbuminuria (MicA) in patients with diabetic macular edema and nonproliferative retinopathy without chronic kidney disease (CKD).
RESULTS
Sixty-six patients were included, 54.5% male and 45.5% female, with a mean age of 66.70 ± 11.6 years. The mean follow-up of patients with antiangiogenic treatment was 42.5 ± 28.07 months, and the mean number of injections was 10.91 ± 7.54. In 12.1% of the cases, there was a worsening of the glomerular filtration rate (eFGR) and a 19.7% worsening of the microalbuminuria (MicA). The number of injections was not related to the worsening of the eFGR (P = 0.74) or the MicA (P = 0.239). No relationship was found between the type of drug and the deterioration of the GFR (P = 0.689) or the MicA (P = 0.53).
CONCLUSIONS
Based on the results, there is a small proportion of patients with increase in MicA and the decrease in eFGR after anti-VEGF therapy, and these was no associated with the number of injection or the drug type. Ophthalmologists should be aware of renal damage in order to do a close monitoring of renal function and proteinuria after intravitreal administration of anti-VEGF mainly in hypertensive patients.
Topics: Humans; Male; Female; Middle Aged; Aged; Macular Edema; Diabetic Retinopathy; Angiogenesis Inhibitors; Vascular Endothelial Growth Factor A; Retrospective Studies; Ranibizumab; Bevacizumab; Intravitreal Injections; Kidney; Recombinant Fusion Proteins; Diabetes Mellitus
PubMed: 37530286
DOI: 10.4103/IJO.IJO_44_23 -
Journal of Pediatric Intensive Care Dec 2022The aim of this study is to assess the accuracy of microalbuminuria (MA) to predict the mortality in pediatric intensive care unit (PICU). Between December 2014 and...
The aim of this study is to assess the accuracy of microalbuminuria (MA) to predict the mortality in pediatric intensive care unit (PICU). Between December 2014 and November 2015, 250 patients who were 1 month to 18 years old monitored at least 24 hours in PICU and met study criteria were included. Spot urine samples were measured for microalbuminuria. Pediatric Risk of Mortality III-24 and Pediatric Multiple Organ Dysfunction scores were calculated by using the worst parameters in first 24 hours. The collected data were analyzed with statistical methods and compared with mortality scoring systems and observed mortality. MA values were significantly higher in nonsurvivors than the average of the survivors (18 vs. 48 mg/g, < 0.05). The receiver operating characteristics curve analysis showed that the areas under the curves for MA was 0.81 at a cut-off value of 32 mg/g, MA measured in 24 hours of admission to PICU may be able to discriminate between patients a with sensitivity of 85.2, specificity of 70.8%, positive predictive value of 31.5%, and negative predictive value of 96.8%. MA is a useful tool to predict mortality in PICU.
PubMed: 36388068
DOI: 10.1055/s-0041-1726278 -
Diabetes, Metabolic Syndrome and... 2021Neck circumference (NC) represents the subcutaneous fat deposition in the neck and is an effective indicator for evaluating metabolic disorders, such as metabolic...
OBJECTIVE
Neck circumference (NC) represents the subcutaneous fat deposition in the neck and is an effective indicator for evaluating metabolic disorders, such as metabolic syndrome, subclinical atherosclerosis, and non-alcoholic fatty liver disease. Microalbuminuria (MAU) is regarded as a potential sign of systemic endothelial dysfunction and microvascular abnormalities. The aim of this study was to elucidate the association of NC with urine albumin-to-creatinine ratio (UACR) and MAU.
METHODS
A total of 1882 Shanghai community residents were enrolled (816 men and 1066 women), with age ranging from 40 to 80 years. Anthropometric parameters, including NC, and biochemical indices were measured. MAU was determined if 30 mg/g ≤ UACR < 300 mg/g. An elevated NC was defined as NC ≥ 38.5 cm for men and NC ≥ 34.5 cm for women.
RESULTS
Individuals with an elevated NC had significantly higher prevalence of MAU and UACR values than those with normal NC in both men and women (all < 0.05). The logistic regression analysis showed that there were significant and positive associations between elevated NC and the increasing risk of MAU after adjusting for lipid profile and glycemic indices ( = 0.007 for men and = 0.009 for women). After further adjusting for blood pressure, elevated NC caused an 69.3% additional risk of MAU in men ( = 0.037) and the positive correlation in women disappeared ( = 0.131).
CONCLUSION
There was an independent and positive association between elevated NC and the risk of MAU in men in the Chinese community population.
CHINESE CLINICAL TRIAL REGISTRY WWWCHICTRORGCN REGISTRATION NUMBER
ChiCTR1900024011.
PubMed: 34093027
DOI: 10.2147/DMSO.S313202 -
Diabetes, Metabolic Syndrome and... 2023Microalbuminuria (MAU) is considered the earliest sign of diabetic nephropathy among diabetes patients. In order to effectively manage diabetic nephropathy and its... (Review)
Review
BACKGROUND
Microalbuminuria (MAU) is considered the earliest sign of diabetic nephropathy among diabetes patients. In order to effectively manage diabetic nephropathy and its consequences early, detection of microalbuminuria as soon as possible, especially for diabetes patients, is critical. Therefore, the present study aimed to determine the pooled prevalence of microalbuminuria among diabetes patients in Africa.
METHODS
Electronic databases such as Google Scholar, PubMed, African Journals Online, Web of Science, Cochrane Library, EMBASE, and ResearchGate were searched for articles and grey literature. The STATA version 14 software was used to conduct the meta-analysis. I and Cochran's Q test were employed to assess the presence of heterogeneity between studies. Due to the presence of heterogeneity, a random effect model was used. The publication bias was assessed using the symmetry of the funnel plot and Egger's test statistics. Moreover, subgroup analysis, trim and fill analysis, and sensitivity analysis were also done.
RESULTS
The overall pooled prevalence of microalbuminuria among diabetes patients in Africa was 37.11% (95% CI 31.27-42.95). Substantial heterogeneity was observed between studies, with I values of 94.7%. Moreover, this meta-analysis showed that the pooled estimate of microalbuminuria among type 1 and type 2 diabetes patients was 35.34% (95% CI: 23.89-46.80, I=94.2), and 40.24% (95% CI: 32.0-48.47, I=94.9) respectively. MAU, on the other hand, was more common in people with diabetes for more than 5 years 38.73% (95% CI: 29.34-48.13) than in people with diabetes for less than 5 years 31.48% (95% CI: 18.73-44.23).
CONCLUSION
This systematic review and meta-analysis found a high prevalence of microalbuminuria among diabetes patients. As a result, early detection of microalbuminuria is critical for preventing and treating microvascular complications such as diabetic nephropathy and the onset of end-stage renal disease.
PubMed: 37457109
DOI: 10.2147/DMSO.S409483 -
Scientific Reports Mar 2023The aim of the present study was to investigate the effect of linagliptin on microalbuminuria in patients with diabetic nephropathy (DN). The present double-blind... (Randomized Controlled Trial)
Randomized Controlled Trial
The aim of the present study was to investigate the effect of linagliptin on microalbuminuria in patients with diabetic nephropathy (DN). The present double-blind randomized placebo-controlled clinical trial was performed on 92 patients with DN who were divided into two groups. The intervention and control groups received linagliptin 5 mg and placebo for 24 weeks, respectively. Blood pressure, lipid profile, liver enzymes, fasting plasma glucose (FPG), and urine albumin-creatinine ratio (UACR) were assessed and recorded before, 12 weeks, and 24 weeks after the beginning of the intervention. The mean value of UACR decrease was significant over time in both groups, with higher decrease in linagliptin group, however, the differences between two groups were not, statistically significant (P > 0.05). However, the percentage of improvement in microalbuminuria (UACR < 30 mg/g) in the linagliptin group was significantly higher than that of the control group during 24 weeks of intervention (68.3% vs. 25%; P-value < 0.001). There was no statistically significant difference in the mean value of the UACR and other parameters between linagliptin treated and placebo treated patients with diabetic nephropathy. Further studies, with longer periods of follow-up are suggested to examine these patients' renal outcomes.
Topics: Humans; Albuminuria; Diabetes Mellitus; Diabetic Nephropathies; Kidney; Linagliptin
PubMed: 36859710
DOI: 10.1038/s41598-023-30643-7 -
Middle East Journal of Digestive... Jan 2020BACKGROUND Introducing a non-invasive method for determining disease activity is important in patients with ulcerative colitis (UC). So in this study, we aimed to assess...
BACKGROUND Introducing a non-invasive method for determining disease activity is important in patients with ulcerative colitis (UC). So in this study, we aimed to assess the association between disease activity index and microalbuminuria in patients with UC. METHODS In the present cross-sectional study, 84 patients with UC were selected. The disease activity was calculated by the partial Mayo clinic score. Microalbuminuria was assessed using the immunoturbidimetric method in a first-voided sample in the morning in two consecutive days and the mean of these two measurements was reported as urinary microalbumin level. Serum C reactive protein (CRP), erythrocyte sedimentation rate (ESR), and fecal calprotectin were measured respectively using conventional turbidimetric immunoassay, Westergren method, and ELISA methods. RESULTS The mean age of the participants was 40.01 ± 12.85 years, 60.8% of them were female and 53.5% had microalbuminuria. The frequency of microalbuminuria was significantly higher in patients with active compared with inactive inflammatory bowel disease (IBD). There were significant differences between the patients with active and inactive disease regarding CRP, ESR, and calprotectin ( < 0.001). Moreover, there was a strong correlation between microalbuminuria and CRP (r = 0.89, < 0.001), ESR (r = 0.92, < 0.001), and calprotectin (r = 0.91, < 0.001). CONCLUSION Microalbuminuria could be used as a non-invasive marker of disease activity in patients with UC.
PubMed: 32082519
DOI: 10.15171/mejdd.2020.161 -
Clinical Journal of the American... Nov 2022
Topics: Humans; Glucosides; Benzhydryl Compounds; Diabetes Mellitus, Type 2
PubMed: 36344217
DOI: 10.2215/CJN.07290622 -
Cureus Dec 2020The presence of albumin in the urine is a marker of glomerular involvement in type 2 diabetes mellitus (T2DM), depicting diabetic nephropathy. Strict glycemic control...
OBJECTIVE
The presence of albumin in the urine is a marker of glomerular involvement in type 2 diabetes mellitus (T2DM), depicting diabetic nephropathy. Strict glycemic control can prevent and delay the occurrence of microalbuminuria and other diabetic complications. Therefore, we conducted a study to report the prevalence of microalbuminuria in type 2 diabetics along with its association with diabetic control.
METHODS
A total of 133 patients with T2DM were consecutively included and their co-morbidities, body mass index, mode of treatment of diabetes (oral hypoglycemic drugs and/or insulin), duration since diagnosis of T2DM, and hemoglobin A1c (HbA1c) levels were recorded. A morning, mid-stream urine sample was collected and a urine spot for albumin:creatinine ratio (UACR) was assessed. Descriptive and analytic statistics were drawn with different variables and UACR values.
RESULTS
The mean age of the participants was 54.5 ± 10.3 years which included 60.9% males and 39.1% females. The overall incidence of diabetic nephropathy was 30.1%, with 25.6% having microalbuminuria and 4.5% having macroalbuminuria. Pearson correlation test was used to compare UACR and duration of diabetes (p=0.034) and HbA1c (p=0.001).
CONCLUSION
UACR was higher in patients with uncontrolled T2DM (in terms of higher HbA1c value) and with a longer duration since diagnosis. We recommend that UACR should be inculcated in routine practice, annually, for all patients with T2DM for gauging the development of underlying renal involvement and prompt management.
PubMed: 33520516
DOI: 10.7759/cureus.12318 -
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