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Kidney International. Supplement Jul 1999Some patients with essential hypertension manifest greater than normal urinary albumin excretion (UAE). A few retrospective studies have suggested that there is an... (Review)
Review
BACKGROUND
Some patients with essential hypertension manifest greater than normal urinary albumin excretion (UAE). A few retrospective studies have suggested that there is an association between microalbuminuria and cardiovascular risk. The reasons for this association are not well established, and they are the object of this review.
RESULTS
We found that hypertensive patients with microalbuminuria manifest greater levels of blood pressure, particularly at night. Serum levels of cholesterol, triglycerides, and uric acid in patients with microalbuminuria were higher than levels in those with normal UAE, whereas levels of high-density lipoprotein cholesterol in patients with microalbuminuria were lower than levels in patients with normal UAE. Patients with microalbuminuria manifest a greater incidence of insulin resistance, and thicker carotid arteries. After a follow-up of seven years we observed that 12 cardiovascular events occurred among 54 (21.3%) patients with microalbuminuria, and only two such events among 87 patients with normal UAE (P < 0.0002). Stepwise logistical regression analysis showed that UAE, cholesterol level and diastolic blood pressure were independent predictors of the cardiovascular outcome. The rate of clearance of creatinine from patients with microalbuminuria decreased more than did that from those with normal urinary albumin excretion.
CONCLUSIONS
These studies suggest that hypertensive individuals with microalbuminuria manifest a variety of biochemical and hormonal derangements with pathogenic potential, which result in greater incidence of cardiovascular events and a greater decline in renal function than do patients with normal UAE.
Topics: Albuminuria; Blood Pressure; Humans; Hyperlipidemias; Hypertension
PubMed: 10412727
DOI: No ID Found -
American Journal of Nephrology 2013Microalbuminuria is a marker for early kidney disease and cardiovascular risk. The purposes of this study were to determine the prevalence of microalbuminuria in an...
BACKGROUND/AIMS
Microalbuminuria is a marker for early kidney disease and cardiovascular risk. The purposes of this study were to determine the prevalence of microalbuminuria in an HIV-infected clinic population, to test the predictive value of a single urine albumin/creatinine ratio (ACR) to identify persistent microalbuminuria and to examine covariates of microalbuminuria.
METHODS
We conducted a prospective cohort study of HIV-infected subjects (n = 182) without proteinuria (urine protein/creatinine ratio ≥0.5 g/g), elevated serum creatinine, diabetes, or chronic inflammatory conditions. Subjects completed three research visits within 9 months. Microalbuminuria was defined as the geometric mean ACR of 25-355 mg/g for females and 17-250 mg/g for males.
RESULTS
The prevalence of microalbuminuria was 14%. The negative predictive value of a single urine ACR determination was 98%, whereas the positive predictive value was only 74%. Microalbuminuria was similar among Black (15%) and non-Black (14%) subjects (p = 0.8). Subjects with microalbuminuria were more likely to have hypertension (p = 0.02) and metabolic syndrome (p = 0.03). While duration of HIV infection and the level of HIV viremia were similar between groups, those with microalbuminuria were more likely to have a CD4 count <200 cells/μl (p = 0.0003). In a multivariate logistic regression analysis, the only significant independent predictors of microalbuminuria were low CD4 count (p = 0.018) and current ritonavir exposure (p = 0.04).
CONCLUSION
The prevalence of microalbuminuria in an HIV-infected clinic population was similar to earlier reports, and was associated with hypertension and impaired immune function. A single normal ACR determination effectively excludes microalbuminuria, whereas an elevated ACR requires confirmation.
Topics: Adult; Albuminuria; Female; HIV Infections; Humans; Logistic Models; Male; Middle Aged; Predictive Value of Tests; Prevalence; Prospective Studies; United States
PubMed: 23615312
DOI: 10.1159/000350384 -
Diabetologia May 2008Microalbuminuria is an important risk factor for cardiovascular disease and progressive renal impairment. This holds true in the general population and particularly in... (Review)
Review
Microalbuminuria is an important risk factor for cardiovascular disease and progressive renal impairment. This holds true in the general population and particularly in those with diabetes, in whom it is common and marks out those likely to develop macrovascular disease and progressive renal impairment. Understanding the pathophysiological mechanisms through which microalbuminuria occurs holds the key to designing therapies to arrest its development and prevent these later manifestations. Microalbuminuria arises from the increased passage of albumin through the glomerular filtration barrier. This requires ultrastructural changes rather than alterations in glomerular pressure or filtration rate alone. Compromise of selective glomerular permeability can be confirmed in early diabetic nephropathy but does not correlate well with reported glomerular structural changes. The loss of systemic endothelial glycocalyx--a protein-rich surface layer on the endothelium--in diabetes suggests that damage to this layer represents this missing link. The epidemiology of microalbuminuria reveals a close association with systemic endothelial dysfunction and with vascular disease, also implicating glomerular endothelial dysfunction in microalbuminuria. Our understanding of the metabolic and hormonal sequelae of hyperglycaemia is increasing, and we consider these in the context of damage to the glomerular filtration barrier. Reactive oxygen species, inflammatory cytokines and growth factors are key players in this respect. Taken together with the above observations and the presence of generalised endothelial dysfunction, these considerations lead to the conclusion that glomerular endothelial dysfunction, and in particular damage to its glycocalyx, represents the most likely initiating step in diabetic microalbuminuria.
Topics: Albuminuria; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Diabetic Nephropathies; Endothelial Cells; Glomerular Filtration Rate; Humans; Hypoglycemia; Kidney Glomerulus; Risk Factors; Serum Albumin
PubMed: 18347777
DOI: 10.1007/s00125-008-0961-8 -
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 -
Frontiers in Cardiovascular Medicine 2022The impact of elevated resting heart rate on early-stage renal dysfunction, manifesting as microalbuminuria, in hypertension is unclear. This study aimed to analyze the...
BACKGROUND
The impact of elevated resting heart rate on early-stage renal dysfunction, manifesting as microalbuminuria, in hypertension is unclear. This study aimed to analyze the association between resting heart rate and microalbuminuria in patients with hypertension according to their blood pressure status. In addition, the effect of antihypertensive agents on this relationship was evaluated.
METHODS AND RESULTS
We searched the National Health and Nutrition Examination Survey for eligible participants from 2009 to 2018. Data on key parameters such as age, sex, blood pressure, heart rate, albumin creatinine ratio, and medication were collected for analysis. Subsequently, participants were classified according to the heart rate quartile and blood pressure status for subgroups assessment. A total of 5,692 participants were enrolled in this study. After adjusting the confounding factors, there was a linear association between resting heart rate and microalbuminuria in patients with hypertension (OR 1.184 [per 1 SD]; 95% CI: 1.101, 1.274; < 0.001). However, the association between elevated resting heart rate and microalbuminuria was not significant in patients with uncontrolled hypertension (OR 1.092 [per 1 SD]; 95% CI: 0.935, 1.275; = 0.269). The OR of the indirect effect of β-blockers on the risk of microalbuminuria incidence through heart rate was 0.926 (95% CI: 0.895, 0.956), while the direct effect was 1.374 (95% CI: 1.138, 1.662, = 0.010). Similarly, dihydropyridine calcium channel blockers were associated with a higher prevalence of microalbuminuria (OR 1.300, 95% CI: 1.058, 1.597, = 0.013), but the association between non-dihydropyridine calcium channel blockers and microalbuminuria was not significant (OR 1.207, 95% CI: 0.737, 1.978, = 0.454).
CONCLUSION
Elevated resting heart rate is associated with a high risk of microalbuminuria in untreated patients and patients with controlled hypertension. Although there is a linear association between heart rate and microalbuminuria, the use of β-blockers exhibits a significantly increase in the prevalence of microalbuminuria in hypertension. Likewise, dihydropyridine calcium channel blockers may increase the risk of microalbuminuria in hypertension.
PubMed: 35498047
DOI: 10.3389/fcvm.2022.739113 -
Cureus Feb 2022Diabetic ocular disease is a leading cause of blindness today. The most common microvascular complications of diabetes are diabetic retinopathy and diabetic nephropathy....
BACKGROUND
Diabetic ocular disease is a leading cause of blindness today. The most common microvascular complications of diabetes are diabetic retinopathy and diabetic nephropathy. Multiple risk factors like the duration of the disease, age of the patient, high blood pressure, pregnancy, blood glucose control, and nephropathy have been studied to be associated with the development and progression of diabetic microangiopathy. However, the association of albuminuria has still not been studied in detail, especially in type-II diabetes mellitus.
AIM
The primary objective of our study is to quantify the relationship between diabetic retinopathy and urine albumin excretion and to correlate the urinary albumin excretion (normoalbuminuria, microalbuminuria, macroalbuminuria) with the severity and grade (mild, moderate, severe non-proliferative diabetic retinopathy [NPDR] or proliferative diabetic retinopathy [PDR]) of diabetic retinopathy.
METHODS
In this cross-sectional study, 250 patients with type-II diabetes above 40 years of age attending the ophthalmic outpatient department (OPD), Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar in India between September 2019 and September 2021 were subjected to a detailed evaluation of history and a thorough ocular examination. Besides, a blood sugar estimation and urine albumin levels were documented. The grade of diabetic retinopathy was correlated with albumin levels.
RESULTS
The duration of diagnosis of diabetes ranged from 1-25 years. The association between the grade of diabetic retinopathy and the duration since diagnosis was significant. Sixty-nine percent of the cases were hypertensives, and 66.7% of hypertensives had diabetic retinopathy. In patients without retinopathy, 83.03% had normoalbuminuria levels, and 16.96% had microalbuminuria. In the mild NPDR group, 37.94% of cases had normoalbuminuria, and 62.06% had microalbuminuria. In the moderate NPDR group, 11.1% of cases had normoalbuminuria, and 88.8% had microalbuminuria. In the severe NPDR group, 57.14% of cases had microalbuminuria, while 42.86% had macroalbuminuria. In the very severe NPDR group, 42.86% of cases had microalbuminuria, and 57.14% had macroalbuminuria. In the PDR group, only 6.6% of cases had microalbuminuria, and the rest, 93.3%, had macroalbuminuria.
CONCLUSION
This study concluded that there is a definite association between albuminuria and severe diabetic retinopathy in type-II diabetes. Microalbuminuria was a finding associated with all grades of retinopathy with skewing towards the lower grades of diabetic retinopathy; a proportion of diabetics without retinopathy also had microalbuminuria, while macroalbuminuria was associated only with those patients who had either severe NPDR, very severe NPDR, or PDR.
PubMed: 35155044
DOI: 10.7759/cureus.21927 -
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 -
PloS One 2023The association between microalbuminuria and cardiovascular disease (CVD) is accumulating in various patient populations. However, when stratified by sex, the...
INTRODUCTION
The association between microalbuminuria and cardiovascular disease (CVD) is accumulating in various patient populations. However, when stratified by sex, the relationship between microalbuminuria and CVD remains unclear.
METHOD
We obtained data from the 2011-2014 and 2019-2020 Korea National Health and Nutrition Examination Survey (KNHANES). Microalbuminuria was measured based on spot urine albumin-creatinine ratio (UACR). The Framingham risk score (FRS) model was implemented to evaluate the CVD risk. Linear and logistic regression models were used to identify the associations of microalbuminuria status with cardiometabolic predictors and CVD status determined by the FRS score.
RESULTS
Among 19,340 representative Korean participants, the (UACR) in Korean women and men with history of CVD was higher than in those without history of CVD. Among patients without history of CVD, multivariate regression analysis showed that a high UACR was related to older age, lower high-density lipoprotein cholesterol level, higher total cholesterol level, higher systolic blood pressure, higher prevalence of current smoking, higher prevalence of diabetes, and higher anti-hypertensive medication use in both women and men. The UACR showed a positive linear correlation with the Framingham risk score in both women and men.
CONCLUSION
The presence of microalbuminuria was significantly associated with the cardiometabolic risk factors and the increased risk of CVD evaluated by FRS model in both women and men in a nationally representative sample of Korea.
Topics: Male; Humans; Female; Cardiovascular Diseases; Creatinine; Nutrition Surveys; Risk Factors; Cholesterol; Albumins; Albuminuria
PubMed: 36943853
DOI: 10.1371/journal.pone.0283083 -
Integrated Blood Pressure Control 2021The causal relationship between systemic arterial hypertension and target organ damage (TOD) is well known, as well as the association with cardiovascular risk factors...
BACKGROUND
The causal relationship between systemic arterial hypertension and target organ damage (TOD) is well known, as well as the association with cardiovascular risk factors (CV). Ambulatory blood pressure monitoring (ABPM) is important in monitoring hypertension and assessing the risk of TOD.
OBJECTIVE
To evaluate the relationship between blood pressure (BP) and clinical and biochemical parameters in the development of TOD in hypertensive patients.
METHODS
This was a retrospective cohort study with 162 hypertensive patients followed for an average period of 13 years. The TOD investigated were left ventricular hypertrophy (LVH), microalbuminuria, coronary artery disease (CAD) and stroke. Blood pressure was assessed by ABPM and LVH using echocardiogram and electrocardiogram, respectively. Biochemical-metabolic tests and 24-hour microalbuminuria were performed at baseline and follow-up. The P-value <0.05 was considered significant.
RESULTS
The average age was 69±11.8 years, with a predominance of women (64.8%), white ethnicity (79.6%) and diabetics (78.4%). ABPM showed a significant reduction in BP values during follow-up, although without association with TOD (microalbuminuria, stroke, and CAD), except for LVH that showed a correlation with sleep BP ≥120/70 mmHg (P=0.044). The most frequent TODs were LVH (29.6%), microalbuminuria (26.5%), CAD (19.8%) and stroke (17.3%). In the follow-up, there was an association between LVH and diabetes; microalbuminuria was associated with diabetes and triglycerides; stroke was associated with HDL-cholesterol (HDL-c), microalbuminuria and carotid disease. CAD showed a relationship with age and HDL-c.
CONCLUSION
Predictive factors for TOD are age, microalbuminuria, diabetes, HDL-c, triglycerides and carotid disease. Nocturnal BP is correlated with LVH. The absence of a relationship between ABPM and other TODs can be explained by the use of effective drugs, improvement of metabolic and blood pressure parameters.
PubMed: 34429649
DOI: 10.2147/IBPC.S324151 -
Kidney International Jul 2014The concept of microalbuminuria has been central to the development of clinical practice and research in the area of diabetic kidney disease (DKD). However, in recent... (Review)
Review
The concept of microalbuminuria has been central to the development of clinical practice and research in the area of diabetic kidney disease (DKD). However, in recent times, the value of a paradigm of DKD based solely on microalbuminuria has been questioned. Although both the absolute level and rate of change of microalbuminuria are linked to the development and progression of DKD, microalbuminuria on its own lacks the necessary sensitivity or specificity to accurately predict kidney outcomes for people with diabetes. The development of microalbumiuria can no longer be viewed as a committed and irreversible stage of DKD, as spontaneous remission is now reported as a common occurrence. In addition, the absence of microalbuminuria or its progression to proteinuria does not signify that an individual patient is safe from a progressive decline in glomerular filtration rate (GFR). Furthermore, although reductions in albuminuria within the microalbuminuric range can be linked to a slower GFR decline in observational studies, this relationship has not been robustly demonstrated in intervention studies. Conclusions regarding the kidney health of individuals with diabetes will continue to be flawed if an inappropriate emphasis is placed on the presence or absence of albuminuria or changes in albuminuria within the microalbuminuric range. This has important implications in terms of undermining the value of microalbuminuria as a surrogate renal end point for intervention trials. There is a need to develop broader models of progressive DKD that include novel pathways and risk markers apart from those related to the traditional 'albuminuric pathway' to renal impairment.
Topics: Albuminuria; Biomarkers; Diabetic Nephropathies; Disease Progression; Glomerular Filtration Rate; Humans; Kidney; Prognosis; Risk Factors
PubMed: 24717301
DOI: 10.1038/ki.2014.98