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British Journal of Haematology Jun 2022
Topics: Adult; Albuminuria; Anemia, Sickle Cell; Benzaldehydes; Humans; Pyrazines; Pyrazoles
PubMed: 35156191
DOI: 10.1111/bjh.18076 -
American Journal of Kidney Diseases :... Aug 2008Dementia is associated with microvascular disease of the retina. In this study, we examine whether cognitive status (normal cognition, mild cognitive impairment, and... (Comparative Study)
Comparative Study
BACKGROUND
Dementia is associated with microvascular disease of the retina. In this study, we examine whether cognitive status (normal cognition, mild cognitive impairment, and dementia) is associated with albuminuria, a microvascular disorder of the kidney.
STUDY DESIGN
Cross-sectional analysis.
SETTING & PARTICIPANTS
2,316 participants from the Cardiovascular Health Cognition Study who underwent brain magnetic resonance imaging and testing for albuminuria.
PREDICTOR
Doubling of albuminuria.
OUTCOME
Dementia defined according to neuropsychological and clinical evaluation.
MEASUREMENTS
Multinomial logistic modeling was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of dementia and mild cognitive impairment with doubling of albuminuria compared with the odds with normal cognition.
RESULTS
283 participants (12.2%) had dementia, 344 (14.9%) had mild cognitive impairment, and 1,689 (72.9%) had normal cognition. Compared with participants with normal cognition, doubling of albuminuria was associated with increased odds of dementia (OR, 1.22; 95% CI, 1.15 to 1.29). Adjustment for prevalent cardiovascular disease and cardiovascular risk factors, lipid levels, C-reactive protein level, estimated glomerular filtration rate, and apolipoprotein E-4 genotype attenuated this association, but it remained statistically significant (OR, 1.12; 95% CI, 1.03 to 1.22). Mild cognitive impairment was associated with albuminuria on unadjusted analysis, but not with adjustment for other factors.
LIMITATIONS
Results are cross-sectional; causality cannot be imputed.
CONCLUSIONS
The odds of dementia increased in the presence of albuminuria. These findings suggest a role of shared susceptibility for microvascular disease in the brain and kidney in older adults.
Topics: Age Factors; Aged; Aged, 80 and over; Albuminuria; Brain; Cognition; Cross-Sectional Studies; Dementia; Female; Humans; Incidence; Magnetic Resonance Imaging; Male; Odds Ratio; Population Surveillance; Prognosis; Retrospective Studies; Risk Factors
PubMed: 18468749
DOI: 10.1053/j.ajkd.2007.12.044 -
Pediatric Nephrology (Berlin, Germany) Aug 2023Mildly increased albuminuria is common in the general adult population and is a strong predictor for cardiovascular events, even in otherwise healthy individuals. The...
BACKGROUND
Mildly increased albuminuria is common in the general adult population and is a strong predictor for cardiovascular events, even in otherwise healthy individuals. The underlying pathophysiological process could be endothelial dysfunction. Previously, we reported that increased albuminuria can also be found in 2-year-olds from the general population. We hypothesized that some individuals have constitutionally higher levels of albuminuria, possibly as an expression of early or inborn endothelial dysfunction. The aim of this study is to evaluate longitudinal persistence of albuminuria from infancy into school age.
METHODS
In the population-based GECKO (Groningen Expert Center for Kids with Obesity) cohort, urine was collected from 816 children at the age of 2 years as well as 12 years (random urine and first morning void urine, respectively). We evaluated prevalence and persistence of increased albuminuria (U ≥ 3 mg/mmol) at the two time points.
RESULTS
The prevalence of U ≥ 3 mg/mmol at 2 and 12 years of age was 31.9% (95% CI 28.7-35.2) and 3.1% (95% CI 2.0-4.5), respectively. U < 3 mg/mmol at both 2 and 12 years of age was present in 540 children (66.2%). Only 9 children (3.5%) of the 260 children with an U ≥ 3 mg/mmol at 2 years had an U ≥ 3 mg/mmol at 12 years (p < 0.001).
CONCLUSION
Albuminuria in 2-year-olds does largely not persist until the age of 12, indicating that albuminuria at 2 years of age is not a marker for constitutional endothelial dysfunction in this cohort. A higher resolution version of the Graphical abstract is available as Supplementary information.
Topics: Child; Adult; Humans; Infant; Child, Preschool; Albuminuria; Creatinine; Obesity
PubMed: 36705757
DOI: 10.1007/s00467-022-05850-5 -
BMJ Open Diabetes Research & Care Jul 2022Albuminuria is useful for early screening and diagnosis of kidney impairment, especially in people with pre-diabetes or type 2 diabetes (T2D), which is the leading cause... (Review)
Review
Albuminuria is useful for early screening and diagnosis of kidney impairment, especially in people with pre-diabetes or type 2 diabetes (T2D), which is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD), associated with increased mortality, poor cardiovascular outcomes, and high economic burden. Identifying patients with CKD who are most likely to progress to ESKD permits timely implementation of appropriate interventions. The early stages of CKD are asymptomatic, which means identification of CKD relies on routine assessment of kidney damage and function. Both albuminuria and estimated glomerular filtration rate are measures of kidney function. This review discusses albuminuria as a marker of kidney damage and cardiorenal risk, highlights the importance of early screening and routine testing for albuminuria in people with T2D, and provides new insights on the optimum management of CKD in T2D using albuminuria as a target in a proposed algorithm. Elevated urine albumin can be used to detect CKD in people with T2D and monitor its progression; however, obstacles preventing early detection exist, including lack of awareness of CKD in the general population, poor adherence to clinical guidelines, and country-level variations in screening and treatment incentives. With albuminuria being used as an entry criterion and a surrogate endpoint for kidney failure in clinical trials, and with novel treatment interventions available to prevent CKD progression, there is an urgent need for early screening and diagnosis of kidney function decline in people with T2D or pre-diabetes.
Topics: Albuminuria; Biomarkers; Diabetes Mellitus, Type 2; Glomerular Filtration Rate; Humans; Kidney Failure, Chronic; Prediabetic State; Renal Insufficiency, Chronic
PubMed: 35790319
DOI: 10.1136/bmjdrc-2022-002806 -
Clinical Journal of the American... Nov 2013Diabetes mellitus is associated with increased risk of cognitive impairment. This study examines whether microvascular disease, as measured by albuminuria and decline in... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND AND OBJECTIVES
Diabetes mellitus is associated with increased risk of cognitive impairment. This study examines whether microvascular disease, as measured by albuminuria and decline in estimated GFR (eGFR), is associated with cognitive decline during 3.3 years of follow-up in individuals with diabetes with a normal baseline eGFR (approximately 90 ml/min per 1.73 m(2)).
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
Participants were from the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes study (N=2977; mean age 62.5 ± 5.8 years; recruitment from August 2003 to December 2005, followed through June 2009), which examined the association of intensive versus standard glucose control on cognitive function. Participants underwent three neuropsychologic tests at baseline, 20 months, and 40 months. Tests included information processing speed, verbal memory, and executive function. Mixed-effects models were used to assess the association of albuminuria and eGFR on the percentage decline in each test.
RESULTS
Participants with albuminuria at baseline and follow-up (persistent albuminuria) (-5.8% [95% confidence interval (CI), -7.3 to -4.2]) and participants with albuminuria at follow-up but none at baseline (progressive albuminuria) (-4.1% [95% CI, -5.6 to -2.7]) had greater percentage declines on information processing speed than participants without albuminuria at baseline and at follow-up (no albuminuria) (-2.6% [95% CI, -3.4 to -1.9]) (P=0.001 and P=0.10, respectively). There were borderline percentage changes in the test of verbal memory (4.8% [95% CI, 2.4 to 7.1] and 4.7% [95% CI, 2.5 to 7.0] versus 7.1% [95% CI, 6.0 to 8.3]; P=0.11 and P=0.08, respectively). On logistic regression analysis, persistent albuminuria (odds ratio, 1.37 [95% CI, 1.09 to 1.72]) and progressive albuminuria (odds ratio, 1.25 [95% CI, 1.02 to 1.56]) were associated with a ≥ 5% decline in information processing speed scores but not with verbal memory or executive function performance. A 1 ml/min per 1.73 m(2) per year eGFR decline had a borderline association with decline in tests of cognitive function.
CONCLUSIONS
Persistent albuminuria and progressive albuminuria are associated with a decline in cognitive function in relatively young individuals with diabetes with unimpaired eGFR. These findings do not rule out the possibility of other processes causing cognitive decline.
Topics: Aged; Albuminuria; Cognition; Cognition Disorders; Diabetic Nephropathies; Disease Progression; Executive Function; Female; Glomerular Filtration Rate; Humans; Kidney; Logistic Models; Male; Memory; Middle Aged; Neuropsychological Tests; Odds Ratio; Prospective Studies; Risk Factors; Time Factors
PubMed: 23990163
DOI: 10.2215/CJN.11321112 -
Sao Paulo Medical Journal = Revista... 2022Albuminuria is a risk factor for microvascular and macrovascular complications in the diabetic population. However, few studies have correlated poor glycemic control and...
BACKGROUND
Albuminuria is a risk factor for microvascular and macrovascular complications in the diabetic population. However, few studies have correlated poor glycemic control and albuminuria prevalence in Hispanic populations.
OBJECTIVE
To evaluate the association between glycemic control and albuminuria among Peruvian adults with type 2 diabetes mellitus (T2DM).
DESIGN AND SETTING
Cross-sectional analytical study among adults with T2DM in Lima, Peru.
METHODS
We included adults over 18 years old who were in a clinical follow-up program at a private clinic in Lima in 2018. Poor glycemic control was defined as a serum value of glycosylated hemoglobin A1C (HbA1C) ≥ 7%. Albuminuria was defined as albumin values > 30 mg/dl in the first morning urine. We generated generalized linear regression models from the Poisson family with robust variance. We calculated the crude and adjusted prevalence ratios (PRs) with their 95% confidence interval (CI).
RESULTS
We analyzed 907 participants of median age 58 years (interquartile range, IQR 49 to 66), and 62.8% were males. The prevalence of poor glycemic control was 39.8%, and the prevalence of albuminuria was 22.7%. The prevalences of albuminuria in groups with poor glycemic control and adequate glycemic control were 32.7% and 16.1%, respectively. In the adjusted regression analysis, we found a statistically significant association between poor glycemic control and albuminuria (annual percentage rate, aPR = 1.70; 95% CI: 1.28-2.27).
CONCLUSIONS
The prevalence of poor glycemic control and albuminuria was high in our study population. Moreover, Peruvian T2DM adults with poor glycemic control were more likely to have albuminuria.
Topics: Adult; Male; Humans; Middle Aged; Adolescent; Female; Albuminuria; Diabetes Mellitus, Type 2; Peru; Glycemic Control; Cross-Sectional Studies; Glycated Hemoglobin; Blood Glucose
PubMed: 35858014
DOI: 10.1590/1516-3180.2021.0448.R2.07022022 -
Cleveland Clinic Journal of Medicine Jan 2014Albuminuria is common. Traditionally considered a precursor to diabetic nephropathy, it has now been directly linked to adverse cardiovascular outcomes and death,... (Review)
Review
Albuminuria is common. Traditionally considered a precursor to diabetic nephropathy, it has now been directly linked to adverse cardiovascular outcomes and death, independent of other risk factors. In this review, we compare the measures of albuminuria, examine the evidence linking it to renal failure, cardiovascular disease, and death, and provide recommendations for its testing and management.
Topics: Albuminuria; Biomarkers; Cardiovascular Diseases; Creatinine; Glomerular Filtration Rate; Humans; Practice Guidelines as Topic; Prognosis; Proteinuria; Renal Insufficiency, Chronic
PubMed: 24391106
DOI: 10.3949/ccjm.81a.13040 -
Cellular Physiology and Biochemistry :... 2018Transcytosis is an important intracellular transport process by which multicellular organisms selectively move cargoes from apical to basolateral membranes without... (Review)
Review
Transcytosis is an important intracellular transport process by which multicellular organisms selectively move cargoes from apical to basolateral membranes without disrupting cellular homeostasis. In kidney, macromolecular components in the serum, such as albumin, low-density lipoprotein and immunoglobulins, pass through the glomerular filtration barrier (GFB) and proximal tubular cells (PTCs) by transcytosis. Protein transcytosis plays a vital role in the pathology of albuminuria, which causes progressive destruction of the GFB structure and function. However, the pathophysiological consequences of protein transcytosis in the kidney remain largely unknown. This article summarizes recent researches on the regulation of albumin transcytosis across the GFB and PTCs in both physiological and pathological conditions. Understanding the mechanism of albumin transcytosis may reveal potential therapeutic targets for prevention or alleviation of the pathological consequences of albuminuria.
Topics: Albuminuria; Animals; Glomerular Filtration Barrier; Humans; Kidney Tubules, Proximal; Transcytosis
PubMed: 29913460
DOI: 10.1159/000490223 -
Blood Purification 2019Compared to the past, patients with sickle cell disease (SCD) currently live longer due to improvements in diagnosis and comprehensive care. Due to these advances,... (Review)
Review
BACKGROUND
Compared to the past, patients with sickle cell disease (SCD) currently live longer due to improvements in diagnosis and comprehensive care. Due to these advances, long-term chronic complications pose a greater challenge in the management of patients with SCD. In particular, sickle cell nephropathy (SCN) is associated with significant morbidity and mortality across all age groups. Furthermore, SCN is an understudied condition with relatively few symptoms and therefore requires close surveillance. In this review, we sought to explore the epidemiology, natural history, and treatment options for SCN with an emphasis on the pediatric population.
SUMMARY
SCN invariably begins in childhood with evidence of structural changes detected as early as infancy. These indolent changes can progress undetected to advanced chronic kidney disease by late adolescence or early adulthood. The risk factors for progression are not well defined, but significant albuminuria (which is also the most common presentation in childhood) is a key factor in progression. One of the main challenges in understanding SCN in children is the poor correlation between estimated and measured glomerular filtration rates. Another challenge is the lack of large-scale longitudinal studies that track the clinical outcomes of pediatric patients over time. Several studies aim to identify early biomarkers of SCN in children, as albuminuria presents only following significant chronic damage. The utility of angiotensin converting enzyme inhibitors and hydroxyurea in treating albuminuria is addressed here as well as novel treatments that may be of benefit.
Topics: Adolescent; Adult; Albuminuria; Anemia, Sickle Cell; Angiotensin-Converting Enzyme Inhibitors; Biomarkers; Child; Child, Preschool; Female; Humans; Hydroxyurea; Infant; Kidney Diseases; Male
PubMed: 30517931
DOI: 10.1159/000494581 -
Journal of Clinical Hypertension... Dec 2023Normoalbuminuria has recently been associated with increased cardiovascular risk, and vascular aging is proposed as the early manifestation of cardiovascular disease....
Normoalbuminuria has recently been associated with increased cardiovascular risk, and vascular aging is proposed as the early manifestation of cardiovascular disease. Here, the authors aimed to examine the association of high-normal albuminuria and vascular aging in a Chinese cohort. From our previously established cohort, 1942 participants with estimated glomerular filtration rate ≥60 mL/min/1.73 m or urinary albumin-creatinine ratio (UACR) <30 mg/g were enrolled. Brachial-ankle pulse wave velocity (baPWV) ≥1400 cm/s and/or carotid intima-media thickness (CIMT) ≥0.9 mm were used as indicators of vascular aging. Multivariate regression and receiving operating characteristic curve analysis were performed to examine the relationship between continuous and categorical UACR with vascular aging. We found an average UACR value of 8.08 (5.45-12.52) mg/g in this study. BaPWV and CIMT demonstrated positive correlations with lg-UACR (p < .05). High-normal albuminuria (10-29 mg/g) was significantly associated with the presence of vascular aging after adjusting for multiple cardiovascular confounders (OR = 1.540, 95% CI = 1.203-1.972, p = .001). In addition, a lg-UACR cutoff point of 0.918 lg(mg/g) (equal to UACR of 8.285 mg/g) was significantly associated with the presence of vascular aging and its components for all participants and those without hypertension or diabetes and without medication (p < .05). Briefly, high-normal albuminuria was significantly associated with vascular aging in this sample of Chinese adults. These findings implied the warning of elevated UACR even within normal range in clinical practice and the importance of UACR screening in normoalbuminuria for early detection and prevention of cardiovascular disease in otherwise healthy participants.
Topics: Adult; Humans; Adolescent; Hypertension; Carotid Intima-Media Thickness; Cardiovascular Diseases; Risk Factors; Ankle Brachial Index; Albuminuria; Creatinine; Pulse Wave Analysis; Glomerular Filtration Rate; Aging
PubMed: 37966821
DOI: 10.1111/jch.14749