Urinary microalbumin(mALB)serves as an exceptionally sensitive indicator for the early detection of kidney damage,playing a pivotal role in identifying chronic renal failure and kidney lesions in individuals.Neverthel...Urinary microalbumin(mALB)serves as an exceptionally sensitive indicator for the early detection of kidney damage,playing a pivotal role in identifying chronic renal failure and kidney lesions in individuals.Nevertheless,the currentfluores-cent methodologies for point-of-care(POC)diagnosis of mALB in real urine still exhibit suboptimal performance.Herein,the development and synthesis of QM-N2,an albumin-activated near-infrared(NIR)aggregation-induced emission(AIE)fluorescent probe,are presented.The strategic incorporation and positioning of quaternary ammonium salts within the quinoline-malononitrile(QM)scaffold sig-nificantly influence solubility and luminescence characteristics.Specifically,the quaternary ammonium salt-free variant,QM-OH,and the quaternary ammonium salt integrated at the donor function group(DFG)site,QM-N1,display limited solubility in aqueous solutions while demonstrating a distinctfluorescence signal.Conversely,the incorporation of quaternary ammonium salt at the conformational functional group(CFG)site in QM-N2 imparts superior dispersibility in water and reduces the initialfluorescence.Furthermore,the integration of a well-defined D-π-A struc-ture within QM-N2 enables itself with near-infrared emission,which is crucial for mitigating interference from autofluorescence present in urine samples.Upon inter-action with albumin,QM-N2 forms a tight bond with the IIA site of the subdomain of human serum albumin(HSA),inducing alterations in protein configuration and constraining the intrinsic motion offluorescent molecules.This interaction inducesfluorescence,facilitating the sensitive detection of trace albumin.Ultimately,QM-N2 is applied for POC testing of mALB using portable equipment,particularly in the diagnosis of mALB-related diseases,notably chronic renal failure.This positioning underscores its potential as an ideal candidate for self-health measurement at home or in community hospitals.展开更多
AIM:To investigate the relationship between Helicobacter pylori(H.pylori) seropositivity and the presence of microalbuminuria.METHODS:Between December 2003 and February 2010,asymptomatic individuals who visited the Se...AIM:To investigate the relationship between Helicobacter pylori(H.pylori) seropositivity and the presence of microalbuminuria.METHODS:Between December 2003 and February 2010,asymptomatic individuals who visited the Seoul National University Healthcare System Gangnam Center for a routine check-up and underwent tests for H.pylori immunoglobulin G antibodies and urinary albumin to creatinine ratio(UACR) were included.All study subjects completed a structured questionnaire,anthropometric measurements and laboratory tests.Anti-H.pylori immunoglobulin G was identified using an enzyme-linked immunosorbent assay kit.A random single-void urine sample,collected using a clean-catch technique,was obtained to determine the UACR.The presence of microalbuminuria was defined as a UACR from 30 to 300 μg/mg.The presence of diabetes mellitus(DM) was defined as either a fasting serum glucose level greater than or equal to 126 mg/dL or taking anti-diabetic medication.Multiple logistic regression analysis was performed to identify the risk factors.The dependent variable was microalbuminuria,and the independent variables were the other study variables.RESULTS:A total of 2716 subjects(male,71.8%;mean age,54.9 years) were included.Among them,224 subjects(8.2%) had microalbuminuria and 324 subjects(11.9%) had been diagnosed with DM.Subjects with microalbuminuria had a significantly higher H.pylori seropositivity rate than subjects without microalbuminuria(60.7% vs 52.8%,P = 0.024).Multivariate analysis after adjustment for age,body mass index(BMI),waist circumference,and glucose and triglyceride levels showed that H.pylori seropositivity was significantly associated with microalbuminuria [odds ratio(OR),1.40,95% CI,1.05-1.89,P = 0.024].After the data were stratified into cohorts by glucose levels(≤ 100 mg/dL,100 mg/dL < glucose < 126 mg/dL,and ≥ 126 mg/dL or history of DM),H.pylori seropositivity was found to be significantly associated with microalbuminuria in diabetic subjects after adjusting for age,BMI and serum creatinine level(OR,2.21,95% CI,1.20-4.08,P = 0.011).In addition,the subjects were divided into five groups.Those without microalbuminuria(an UACR of < 30 μg/mg) were divided into four groups in accordance with their UACR values,and subjects with microalbuminuria comprised their own group.Notably,H.pylori seropositivity gradually increased with an increase in UACR(P = 0.001) and was highest in subjects with microalbuminuria(OR,2.41,95% CI,1.14-5.11).This suggests that H.pylori seropositivity is positively associated with microalbuminuria in diabetic subjects.CONCLUSION:H.pylori seropositivity was independently associated with microalbuminuria,and the prevalence of H.pylori seropositivity was associated with the severity of UACR in diabetic subjects.展开更多
BACKGROUND： Microalbuminuria （MAU） is a key component of metabolic syndrome （MetS） and is an early sign of diabetic nephropathy as well. Although routine Western medicine treatments are given to MetS patients to ...BACKGROUND： Microalbuminuria （MAU） is a key component of metabolic syndrome （MetS） and is an early sign of diabetic nephropathy as well. Although routine Western medicine treatments are given to MetS patients to control high blood pressure, hyperglycemia and dyslipidemia, some patients still experience progressive renal lesions and it is necessary to modify and improve the treatment strategy for MetS patients. OBJECTIVE： To investigate the efficacy of Yiqi Huaju Qingli Herb Formula, a compound traditional Chinese herbal medicine, in MetS patients with MAU when it is combined with routine Western medicine treatment. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： Sixty patients with MetS were randomized into the Chinese herbal formula group （CHF, Yiqi Huaju Qingli formula treatment in combination with Western medicine） and control group （placebo in combination with Western medicine）. All treatments were administered for 12 weeks. MAIN OUTCOME MEASURES： Urinary microalbumin （MA）, urinary albumin-to-creatinine ratio （UACR）, 24-hour total urine protein （24-hTP）, body mass index （BMI）, waist circumference （WC）, waist-to-hip ratio （WHR）, fasting plasma glucose （FPG）, 2-hour postprandial plasma glucose （2-hPPG）, glycosylated hemoglobin （HbAlc）, homeostasis model assessment for insulin resistance （HOMA-IR）, blood lipid profile and blood pressure were observed. RESULTS： Compared with the control group, CHF treatment significantly decreased BMI （P〈0.05）, WC （P〈0.01） and WHR （P〈0.01）. Both groups had significant decreases in FPG, 2-hPPG, HbAlc, HOMA-IR, MA, and UACR, with CHF treatment showing better effects on these parameters compared with the control treatment （P〈0.05）. Both treatments significantly reduced the levels of total cholesterol, low-density lipoprotein cholesterol and triacylglycerol （TAG）, and a greater reduction in TAG was observed with CHF treatment （P〈0.05）. The level of high-density lipoprotein cholesterol did not change in the control group after treatment （P〉0.05）, whereas it significantly increased with CHF treatment （P〈0.01）. Compared with before the treatment, significant decreases in systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were observed in both groups （P〈0.01）. However, there was no significant difference between the two groups （P〉0.05）. CONCLUSION： Combined treatment ofYiqi Huaju Qingli Formula and Western medicine significantly alleviated MAU, which may correlate with the improvement of insulin sensitivity and glucose and lipid metabolism. TRIAL REGISTRATION IDENTIFIER： This trial was registered in the Chinese Clinical Trial Registry with the identifier ChiCTR-TRC-11001633.展开更多
Childhood obesity represents a complex disease with a well-known cardiometabolic burden including fatty liver,type 2 diabetes,metabolic syndrome,and cardiovascular disease.From a pathogenic point of view,insulin resis...Childhood obesity represents a complex disease with a well-known cardiometabolic burden including fatty liver,type 2 diabetes,metabolic syndrome,and cardiovascular disease.From a pathogenic point of view,insulin resistance(IR)represents the key factor underlying the spectrum of these obesity consequences.As observed in adults,recent data supported the occurrence of microalbuminuria(MA)as marker of early kidney dysfunction and its potential link with cardiometabolic factors also in children with obesity.In fact,a well-documented pathophysiological hypothesis both in adults and children supported an intimate correlation with the major feature of obesity such as IR through the influence of insulin on renal hemodynamics.Based on the clinical and prognostic relevance of this relationship in daily practice(including an increased risk of chronic kidney disease development overtime),more scientific attention needs to be paid to the evaluation of early kidney damage in children with obesity.In this paper,we attempt to address three debated questions regarding the intriguing liaison between IR and MA in children with obesity:(1)What is the prevalence of pediatric MA?(2)What is the state of art of MA in children with obesity?and(3)Is there a link between IR and MA in children with obesity?展开更多
Objective To investigate the therapeutic effect of intensive glycemic control on patients with early diabetic nephropathy. Methods A total of 41 type 2 diabetes patients who developed microalbuminuria were divided int...Objective To investigate the therapeutic effect of intensive glycemic control on patients with early diabetic nephropathy. Methods A total of 41 type 2 diabetes patients who developed microalbuminuria were divided into two groups randomly. Patients in Group A received intensive glycemic control and the blood glucose in Group B was regularly controlled. Glycemic monitoring and control were followed for 12 weeks to observe the changes of microalbuminuria in both groups; meanwhile the levels of serum lipids and coagulation indices were also recorded. Results The urine albumin excretion rate (UAER) in Group A decreased significantly from (47.91±13.86)mg/24h to (35.31±14.56)mg/24h after 12 weeks (P<0.05),and this decrease was significantly greater than that in Group B. However,Group B had no significant difference in UAER decrease [(48.93±13.32)mg/24h to (40.48±19.62)mg/24h,P>0.05]. The decrease of triglyceride (TG) and low-density lipoprotein cholesterol (LDL cholesterol),and the increase of high-density lipoprotein cholesterol (HDL cholesterol) showed no significant differences (P>0.05). And the level of plasma fibrinogen (FIB) showed no significant decrease after 12 weeks,either (P>0.05). Conclusion Intensive glycemic control reduces the level of microalbuminuria and may ameliorate the progression of early diabetic nephropathy.展开更多
Objective To investigate the urinary endothelin-1 (ET-l ) excretion and urinary sodium excretion, microalbuminuria and ambulatory blood pressure(ABP) in salt-sensitive(SS) hypertension patients. Methods Twen- ty-one c...Objective To investigate the urinary endothelin-1 (ET-l ) excretion and urinary sodium excretion, microalbuminuria and ambulatory blood pressure(ABP) in salt-sensitive(SS) hypertension patients. Methods Twen- ty-one cases of normotensive subjects and 32 cases of uncomplicated hypertensive patients were recruited in this study. Salt sensitivity was determined by acute venous saline loading test. Before saline loading, 24-hour ABP mea- surements were performed. Urine samples were collected to assay ET-1,urinary sodium excretion and urinary albumin excretion(UAF). Results Compared to slat-resistant(SR) subgroup, SS showed low urinary ET-1 excretion in nor- motensive group (P<0.05) or hypertensive group (P<0.01),regardless or saline loading or not. The nighttime MAP of SS was higher than SR subgroup in normotensive or hypertensive group. Urinary sodium excretion during 4h of saline loading was significantly lower in SS than that in SR hypertensive patients (P<0.05). Twenty-four-hour UAE of SS patients was higher than SR group (P<0.01). Results of further correlation analysis indicated that the urinary ET-1 excretion was positively related to urinary sodium content and negatively to ABP and UAE. Conclusion Uri- nary ET-1 is low in SS normotensives or hypertension patients,which may play a role in renal sodium retention and renal impairment or SS hypertension patients.展开更多
Objective: To develop and validate a prognostic scoring scheme for the prediction of microalbuminuria in type 2 diabetic patients of Thai descent. Methods: The clinical information from type 2 diabetic patients who we...Objective: To develop and validate a prognostic scoring scheme for the prediction of microalbuminuria in type 2 diabetic patients of Thai descent. Methods: The clinical information from type 2 diabetic patients who were treated at community hospitals was used to develop a prediction model (derivation set). The model evaluated at a tertiary hospital (validation set). A stepwise logistic regression model was used to identify the independent risk variables from the derivation set and a simple point scoring system was derived from the beta-coefficients. The risk scoring scheme was validated by the validation set. Results: The risk scoring scheme is based on six risk predictors: the duration of diabetes, age at the onset of diabetes, systolic blood pressure, low density lipoprotein levels, creatinine levels, and alcohol consumption. The total score ranged from 0 to 11.5. The likelihood of microalbuminuria in patients with low risk (scores ≤ 2) was 0.28, with moderate risk (scores 2.5 to 5.5) was 0.86, and high risk (scores ≥ 6) was 7.36. The area under the ROC curve of the derivation set and validation set were 0.768 (95% CI 0.73 - 0.81) and 0.758 (95% CI 0.70 - 0.80), respectively. Conclusion: Our scoring system is a simple and reasonably accurate method for predicting the future presence of microalbuminuria in type 2 diabetic patients.展开更多
Objectives: This study proposes to evaluate risk factors for kidney disease in HIV patients treated chronically and correlate with microalbuminuria measurements. Methods: Review charts and analyses of microalbuminuria...Objectives: This study proposes to evaluate risk factors for kidney disease in HIV patients treated chronically and correlate with microalbuminuria measurements. Methods: Review charts and analyses of microalbuminuria in subgroup of HIV patients treated at Ceara/Brazil. Results: 149 patients, 69.1% male, mean 38.5 years old, infection mean 86.8 months. Mean Creatinine Clearance 110.2%, Creatinine 0.97, Urea 27.76 mg/dl, CD4+ 600.37 cels/mm3 and detectable viral load 530.59 copies with 61.7% undetectable. Mean Dosages of microalbuminuria/24h 147, 46 ± 820, 45 (N = 48) and microalbuminuria (mg/dl) 32.05 ± 85.25 (N = 43). Kidney Diseases Classification analyses evidenced 6.4% patients in stages ≥3 and 6.2% presented altered Microalbuminuria/24h. Patients using Tenofovir (TDF) 27.27% had Stage 2 and protease inhibitors (PI) had 4.1% in Stage 3. Proteinuria was observed in 5% stage ≥3. Association PI/TDF had 4.1% in Stage 3. No statistical difference between CD4 > or 3 and microalbuminuria/24h > 300 mg (p = 0.69);detectable/undetectable viral load and microalbuminuria/24h (p = 0.63) or stage ≥3 (p = 0.17);relation to Diabetes or arterial hypertension and microalbuminuria 24 h (p = 0.5 and p = 0.21);relation stage ≥3 and microalbuminuria/24h (p = 0.33);relation HIV diagnoses >/< 60 months and stage ≥3 (p = 0.51);or microalbuminuria/24h and TDF (p = 0.4), PI (p = 1), TDF/PI (p = 0.69), Atazanavir (p = 0.4) or Lopinavir/r (p = 1) regimens. There was statistical significance comparing age > or or < 50 years and microalbuminuria/24h (p = 0.55) or microalbuminuria mg/d (p = 0.32). Relating comorbidities risk (Diabetes Mellitus plus Systemic Arterial Hypertension) to Kidney Diseases, it was found that 55.5% patients in Stage 3 or above with comorbidities compared with 15% with comorbidities in lower stages (P = 0.005). Nevertheless, comorbidities presence was not associated with microalbuminuria (p = 0.08). Conclusion: Kidney disease is a real risk for HIV patients and stages ≥3 have to be early detected. Microalbuminuria dosage did not demonstrate more sensibility than proteinuria to early diagnoses, even related to antiretroviral drugs. Major risk factor for kidney damage evidenced to be older than 50 years and there was no protective effect from CD4 or undetectable viral load.展开更多
Background: Microalbuminuria is often the first sign of renal involvement predicting overt nephropathy. For this reason, monitoring microalbuminuria and other risk factors associated with this condition is important t...Background: Microalbuminuria is often the first sign of renal involvement predicting overt nephropathy. For this reason, monitoring microalbuminuria and other risk factors associated with this condition is important to take measures to prevent or postpone overt nephropathy. This study aimed to investigate the prevalence of microalbuminuria in type 2 diabetes patients attending three diabetes centers in Tirana city. Patients and Methods: Two hundred and twenty patients with type 2 diabetes attending diabetes centers in Tirana were recruited in this crosssectional study. Medical records were used to collect data on duration of diabetes, waist circumference, history of hypertension, smoking. Blood samples were drawn after 12 h overnight fasting to measure glycosylated hemoglobin (HbA1c), serum cholesterol, triglyceride and creatinine. Microalbuminuria was assessed using dipstick kits in early morning urine samples. Results: The prevalence of normoalbuminuria was 58.3%, microalbuminuria 38.6% and macroalbuminuria 3.1%. Systolic and diastolic blood pressure (p p < 0.01) and fasting plasma glucose (p moalbuminuric subjects. Multiple logistic regression analysis using microalbuminuria as the dependent variable in males shows that independent risk factors for diabetes patients with microalbuminuria were duration of diabetes, systolic blood pressure and waist circumference. We found that the OR for microalbuminuria became statistically significantly increased only at 16 years after the diagnosis of type 2 diabetes. At this time, 43.7% of patients had microalbuminuria. Conclusions: We found a high proportion of type 2 diabetes patients with microalbuminuria which raises implications for health policy inAlbania. This calls for early detection and good control of diabetes to reduce the burden of diabetic kidney disease in the future. Screening programs and optimized control of modifiable risk factors are needed to reduce the risk of diabetic nephropathy.展开更多
Diabetes mellitus is a disease of great frequency and is a major public health problem. Several complications can occur during the course of diabetes such as diabetic nephropathy, which starts with microalbuminuria in...Diabetes mellitus is a disease of great frequency and is a major public health problem. Several complications can occur during the course of diabetes such as diabetic nephropathy, which starts with microalbuminuria in diabetic patients. This was a cross-sectional and analytical study which took place from 23 September to 23 December 2021 in the Endocrinology-Metabolism-Nutrition Department of the CNHU-HKM of Cotonou, Benin. We carried out an exhaustive census of the patients. Type 2 diabetic patients were included in the study, and 24-hour microalbumunuria, fundus examination and assessment of complications were performed. We identified 145 type 2 diabetic patients of whom 44 had positive microalbuminuria, i.e. a prevalence of 30.3%. There were 61 men and 84 women with a sex ratio of 0.72. The mean age was 59 years with extremes of 26 and 85 years. The complications identified in diabetics with positive microalbuminuria were Neuropathy (43.2%), Nephropathy (22.7%) and Retinopathy (20.5%). Factors associated with microalbuminuria in diabetics were: age, occupation, hypertension, diabetes imbalance, erectile dysfunction. Conclusion: Microalbuminuria is common in type 2 diabetes. It should be managed early to slow the progression of kidney disease to the end stage.展开更多
Microalbuminuria in adults has been found to be an early indicator of both renal and systemic vascular disease, as well as significant cardiovascular risk predictor and therapeutic marker. Its role in essential hypert...Microalbuminuria in adults has been found to be an early indicator of both renal and systemic vascular disease, as well as significant cardiovascular risk predictor and therapeutic marker. Its role in essential hypertension in adults has also been well established. As diseases like hypertension and obesity have their roots in childhood and are already present in children, influencing the morbidity in adulthood, the role of microalbuminuria has been extensively investigated in children as well. Most investigations have been performed in diabetic children, confirming its clinical significance. There is also enough evidence to suggest that microalbuminuria in obese children should be taken as seriously as in children with diabetes. In children with hypertension rare studies also indicate that its presence identifies hypertensive children with higher risk, although the exact role has to be confirmed in prospective and larger studies. The mechanisms of microalbuminuria onset could be the result of renal damage secondary to hypertension or underlying renal and systemic endothelial dysfunction. Evidence from small intervention studies in children with microalbuminuria also suggests that early intervention with antihypertensive drugs is likely to be beneficial, pointing out the role of microalbuminuria as a therapeutic marker in children too. In addition, we have to stress the importance of follow-up of children with microalbuminuria, confirmation of its persistence and identification of progression. However, longitudinal prospective studies in children, investigating its future cardiovascular risk, are still lacking.展开更多
Microalbuminuria (MAU) is a predictor of cardiovascular mortality in patients with diabetes mellitus (DM) and hypertension (HTN) and also in an unselected population. The American Diabetes Association (ADA) and the Na...Microalbuminuria (MAU) is a predictor of cardiovascular mortality in patients with diabetes mellitus (DM) and hypertension (HTN) and also in an unselected population. The American Diabetes Association (ADA) and the National Kidney Foundation (NKF) define MAU as an albumin/creatinine ratio (ACR) between 30 and 300 μg/mg in both men and women. Aim: To evaluate the possible relationship among MAU, HTN and gender and ethnicity in Brazilian nondiabetic primary hypertensive patients. Design: Population-based study. Participants: Ninety-eight men and women, seventy-two black and twenty-six white nondiabetic primary hypertensive patients aged 20 years or older were selected. Forty healthy individuals, paired according to age, gender, and ethnics were used as controls. Methods: Early-morning midstream urine was used. Urinary albumin was spectrophotometrically measured with Coomassie Brillant Blue G-250. Creatinine was determined by a method based on Jaffe’s reaction. ACR (μg albumin/mg creatinine) was calculated. Data are expressed as medians. Results: ACR level was significantly higher in 98 hypertensive patients (38.00) than in 40 control individuals (23.00) (P < 0.001). ACR level was significantly higher in 48 hypertensive male (46.00) than in 50 hypertensive female (34.00) (P = 0.008). No significant effect of ethnicity on ACR levels between 26 hypertensive Whites (35.50) and 72 hypertensive Blacks (38.00) was observed (P = 0.978). Conclusions: The ACR level, significantly higher in hypertensive patients than in control individuals, supports data from the literature. To our knowledge, this is the first study demonstrating that the ACR level is significantly higher in men than in women. The lack of an ethnicity effect supports what was already asserted, namely, that in Brazil, at an individual level, color, as determined by physical evaluation, is a poor predictor of genomic African ancestry, as estimated by molecular markers.展开更多
BACKGROUND Type 2 diabetes mellitus(T2DM)often leads to vascular complications,such as albuminuria.The role of insulin autoantibodies(IAA)and their interaction with D-dimer in this context remains unclear.AIM To inves...BACKGROUND Type 2 diabetes mellitus(T2DM)often leads to vascular complications,such as albuminuria.The role of insulin autoantibodies(IAA)and their interaction with D-dimer in this context remains unclear.AIM To investigate the characteristics of IAA and its effect on albuminuria in T2DM patients.METHODS We retrospectively analyzed clinical data from 115 T2DM patients with positive IAA induced by exogenous insulin,and 115 age-and sex-matched IAA-negative T2DM patients as controls.Propensity scores were calculated using multivariate logistic regression.Key variables were selected using the least absolute shrinkage and selection operator(LASSO)algorithm.We constructed a prediction model and analyzed the association between IAA and albuminuria based on demographic and laboratory parameters.RESULTS The IAA-positive group had significantly higher D-dimer levels[0.30(0.19-0.55)mg/L vs 0.21(0.19-0.33)mg/L,P=0.008]and plasma insulin levels[39.1(12.0-102.7)μU/mL vs 9.8(5.5-17.6)μU/mL,P<0.001]compared to the IAA-negative group.Increases in the insulin dose per weight ratio,diabetes duration,and urinary albumin-to-creatinine ratio(UACR)were observed but did not reach statistical significance.The LASSO model identified plasma insulin and D-dimer as key factors with larger coefficients.D-dimer was significantly associated with UACR in the total and IAA-positive groups but not in the IAA-negative group.The odds ratio for D-dimer elevation(>0.5 g/L)was 2.88(95%confidence interval:1.17-7.07)in the IAA-positive group(P interaction<0.05).CONCLUSION D-dimer elevation is an independent risk factor for abnormal albuminuria and interacts with IAA in the development of abnormal albuminuria in T2DM patients.展开更多
This work aims to estimate the value of diffusion weighted imaging （DWI） and diffusion tensor imaging （DTI） in detecting early-stage kidney injury in type 2 diabetic patients with normoalbuminuria （NAU） versus m...This work aims to estimate the value of diffusion weighted imaging （DWI） and diffusion tensor imaging （DTI） in detecting early-stage kidney injury in type 2 diabetic patients with normoalbuminuria （NAU） versus microalbuminuria （MAU） prospectively. A total of 30 T2DM patients with normal kidney function were recruited and assigned to the NAU group （n = 14） or MAU group （n = 16） according to 8 h overnight urinary albuminuria excretion rate （AER） results. A contemporary cohort of health check-up recipients were included as controls （n = 12）. DWI and DTI scans were performed on bilateral kidney using SE single-shot EPI, and apparent diffusion coefficient （ADC） and fractional anisotropy （FA） of the renal parenchyma was determined from ADC and FA maps of the three groups. ADC and FA values were compared among the three groups. According to DWI with a b value of 400 s/mm^2, the MAU and NAU groups showed significantly lowered mean ADC values compared with the healthy controls （P 〈 0.01）. The mean ADC in the MAU group [（2.22± 0.07） × 10^-3 mm^2/s] was slightly lower than that of the NAU group [（2.31 ± 0.22） × 10^- 3 mm^2/s], but this difference was not statistically significant （P 〉 0.05）. The FAvalue in the MAU group was higher than that in the control group （0.45 ± 0.07 vs. 0.3±0.03, P = 0.004） but did not differ from that in the NAU group （0.42 ± 0.03） （P 〉 0.05）. ADC and FA values may be more sensitive than urine AER in reflecting early-stage kidney injury and, hence, may facilitate earlier detection and quantitative evaluation of kidney injury in T2DM patients. Combined evaluation of ADC and FA values may provide a better quantitative approach for identifying diabetic nephropathy at early disease stages.展开更多
Background There is significant evidence showing that microalbuminuria and arterial compliance are sensitive markers for early cardiovascular diseases. However, whether microalbuminuria is associated with reduced arte...Background There is significant evidence showing that microalbuminuria and arterial compliance are sensitive markers for early cardiovascular diseases. However, whether microalbuminuria is associated with reduced arterial compliance in Chinese metabolic syndrome （MS） patients remains unknown. Methods According to the definition of MS proposed by ATPⅢ in 2001, USA, subjects （n=362） were divided into three groups according to the number of risk factors： group 1 （control）, group 2 （medium, 〈 3 risk factors） and group 3 （MS, ≥ 3 risk factors）. Both large artery compliance （C1） and small artery compliance （C2） were measured with the CVProfilor DO-2020 Cardiovascular Profiling System, and microalbuminuria was evaluated with the ratio of albumin to urine creatinine. Results （1） As C1 and C2 levels elasticity decreased, albumin creatinine ratio （ACR） and the prevalence of microalbuminuria increased within those groups with MS risk factors. C1 and C2 were negatively correlated with the ranking of MS risk factors, ACR was positively correlated with the ranking of MS risk factors （all P〈0.05）. （2） Subjects were also categorized into a microalbuminuria group and a normal group, C1 and C2 in the microalbuminuria group were lower than in the normal group. （3） Multivariate regression analysis showed that increased systolic blood pressure （SBP） and reduced arterial compliance were the main risk factors for microalbuminuria in the MS group. Conclusions The risk of developing microalbuminuria was higher in the subjects with multiple metabolic abnormalities. Increased systolic blood pressure and reduced arterial compliance may be the main predictors for microalbuminuria in MS.展开更多
Background Microalbuminuria （MAU） and ambulatory arterial stiffness index （AASI） may predict cardiovascular events and death. However, there is little information about the correlation between the two parameters i...Background Microalbuminuria （MAU） and ambulatory arterial stiffness index （AASI） may predict cardiovascular events and death. However, there is little information about the correlation between the two parameters in patients with type 2 diabetes mellitus （T2DM）. Therefore, we examined the association of MAU with 24-hour AASI in patients with T2DM. Methods A total of 189 patients with 24-hour ambulatory blood pressure monitoring （24h-ABPM） who were hospitalized from January 2011 to January 2017 were selected. 136 patients without hypertension were screened. The subjects were divided into two groups according to urinary albumin-to-creatinine ratio （uACR）. MAU group was defined as uACR of 30-299 mg/g （n=69）, NMAU group was defined as uACR 〈30 mg/g （n=67）. AASI was calculated as 1 minus the regression slope of diastolic blood pressure （DBP） value vs. systolic blood pressure （SBP） value according to ABPM. The differences of clinical and bio- chemical indicators between the two groups were determined. The correlation between AASI and MAU was analyzed by unconditional forward stepwise logistic regression. Results Patients with MAU had significantly higher level of diabetic duration, TC, LDL-C, Scr, AASI and lower eGFR than NMAU group （P〈0.05）. Using MAU as the dependent variable （ 1 with MAU and 0 without MAU）, LDL-C, decreased eGFR, AASI were independent risk factors of MAU in patients with T2DM. The ROC curve of AASI in predicting the risk of MAU showed when AASI was 0.48, the area under the curve was the largest 0.659（95 % CI 0.568-0.750, P=0.001）. The sensitivity was 71.0% and the specificity was 56.7%. Conclusions Patients with MAU have higher AASI than patients without MAU. As a new index of arterial stiffness, AASI is associated with MAU, and could inde- pendently predict MAU in patients with T2DM.展开更多
基金National Key Research and Development Program of China,Grant/Award Number:2021YFA0910000NSFC,Grant/Award Numbers:22222803,91959202,21974047+1 种基金China Postdoctoral Science Foundation,Grant/Award Number:2022M72142Shanghai Municipal Science and Technology Major Project,Grant/Award Number:2018SHZDZX03。
文摘Urinary microalbumin(mALB)serves as an exceptionally sensitive indicator for the early detection of kidney damage,playing a pivotal role in identifying chronic renal failure and kidney lesions in individuals.Nevertheless,the currentfluores-cent methodologies for point-of-care(POC)diagnosis of mALB in real urine still exhibit suboptimal performance.Herein,the development and synthesis of QM-N2,an albumin-activated near-infrared(NIR)aggregation-induced emission(AIE)fluorescent probe,are presented.The strategic incorporation and positioning of quaternary ammonium salts within the quinoline-malononitrile(QM)scaffold sig-nificantly influence solubility and luminescence characteristics.Specifically,the quaternary ammonium salt-free variant,QM-OH,and the quaternary ammonium salt integrated at the donor function group(DFG)site,QM-N1,display limited solubility in aqueous solutions while demonstrating a distinctfluorescence signal.Conversely,the incorporation of quaternary ammonium salt at the conformational functional group(CFG)site in QM-N2 imparts superior dispersibility in water and reduces the initialfluorescence.Furthermore,the integration of a well-defined D-π-A struc-ture within QM-N2 enables itself with near-infrared emission,which is crucial for mitigating interference from autofluorescence present in urine samples.Upon inter-action with albumin,QM-N2 forms a tight bond with the IIA site of the subdomain of human serum albumin(HSA),inducing alterations in protein configuration and constraining the intrinsic motion offluorescent molecules.This interaction inducesfluorescence,facilitating the sensitive detection of trace albumin.Ultimately,QM-N2 is applied for POC testing of mALB using portable equipment,particularly in the diagnosis of mALB-related diseases,notably chronic renal failure.This positioning underscores its potential as an ideal candidate for self-health measurement at home or in community hospitals.
文摘AIM:To investigate the relationship between Helicobacter pylori(H.pylori) seropositivity and the presence of microalbuminuria.METHODS:Between December 2003 and February 2010,asymptomatic individuals who visited the Seoul National University Healthcare System Gangnam Center for a routine check-up and underwent tests for H.pylori immunoglobulin G antibodies and urinary albumin to creatinine ratio(UACR) were included.All study subjects completed a structured questionnaire,anthropometric measurements and laboratory tests.Anti-H.pylori immunoglobulin G was identified using an enzyme-linked immunosorbent assay kit.A random single-void urine sample,collected using a clean-catch technique,was obtained to determine the UACR.The presence of microalbuminuria was defined as a UACR from 30 to 300 μg/mg.The presence of diabetes mellitus(DM) was defined as either a fasting serum glucose level greater than or equal to 126 mg/dL or taking anti-diabetic medication.Multiple logistic regression analysis was performed to identify the risk factors.The dependent variable was microalbuminuria,and the independent variables were the other study variables.RESULTS:A total of 2716 subjects(male,71.8%;mean age,54.9 years) were included.Among them,224 subjects(8.2%) had microalbuminuria and 324 subjects(11.9%) had been diagnosed with DM.Subjects with microalbuminuria had a significantly higher H.pylori seropositivity rate than subjects without microalbuminuria(60.7% vs 52.8%,P = 0.024).Multivariate analysis after adjustment for age,body mass index(BMI),waist circumference,and glucose and triglyceride levels showed that H.pylori seropositivity was significantly associated with microalbuminuria [odds ratio(OR),1.40,95% CI,1.05-1.89,P = 0.024].After the data were stratified into cohorts by glucose levels(≤ 100 mg/dL,100 mg/dL < glucose < 126 mg/dL,and ≥ 126 mg/dL or history of DM),H.pylori seropositivity was found to be significantly associated with microalbuminuria in diabetic subjects after adjusting for age,BMI and serum creatinine level(OR,2.21,95% CI,1.20-4.08,P = 0.011).In addition,the subjects were divided into five groups.Those without microalbuminuria(an UACR of < 30 μg/mg) were divided into four groups in accordance with their UACR values,and subjects with microalbuminuria comprised their own group.Notably,H.pylori seropositivity gradually increased with an increase in UACR(P = 0.001) and was highest in subjects with microalbuminuria(OR,2.41,95% CI,1.14-5.11).This suggests that H.pylori seropositivity is positively associated with microalbuminuria in diabetic subjects.CONCLUSION:H.pylori seropositivity was independently associated with microalbuminuria,and the prevalence of H.pylori seropositivity was associated with the severity of UACR in diabetic subjects.
基金supported by Ministry of Education 211 Project,Hehai UniversityProject of Innovation of Shanghai Municipal Committee of Science and Technology (No.08dj1400600)+6 种基金National Natural Science Foundation of China(No.81001574)Leading Medical Projects at Science and Technology Commission of Shanghai Municipality (No.12401905100)Three-year Projects to Promote Traditional Chinese Medicine,Shanghai(No.ZYSNXD-CC-ZDYJ050)Project of Shanghai Cerebrated TCM Doctor Workshop (No.ZYSNXD-CC-MZY034)Shanghai Association of Chinese Integrative Medicine(No.zxyQ-1245)The Fok Ying-Tong Education Foundation for Young Teacher of University(No.114036)the Foundation of Leading Academic Discipline Project of Shanghai Municipal Education Commission(No.J50307)
文摘BACKGROUND： Microalbuminuria （MAU） is a key component of metabolic syndrome （MetS） and is an early sign of diabetic nephropathy as well. Although routine Western medicine treatments are given to MetS patients to control high blood pressure, hyperglycemia and dyslipidemia, some patients still experience progressive renal lesions and it is necessary to modify and improve the treatment strategy for MetS patients. OBJECTIVE： To investigate the efficacy of Yiqi Huaju Qingli Herb Formula, a compound traditional Chinese herbal medicine, in MetS patients with MAU when it is combined with routine Western medicine treatment. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： Sixty patients with MetS were randomized into the Chinese herbal formula group （CHF, Yiqi Huaju Qingli formula treatment in combination with Western medicine） and control group （placebo in combination with Western medicine）. All treatments were administered for 12 weeks. MAIN OUTCOME MEASURES： Urinary microalbumin （MA）, urinary albumin-to-creatinine ratio （UACR）, 24-hour total urine protein （24-hTP）, body mass index （BMI）, waist circumference （WC）, waist-to-hip ratio （WHR）, fasting plasma glucose （FPG）, 2-hour postprandial plasma glucose （2-hPPG）, glycosylated hemoglobin （HbAlc）, homeostasis model assessment for insulin resistance （HOMA-IR）, blood lipid profile and blood pressure were observed. RESULTS： Compared with the control group, CHF treatment significantly decreased BMI （P〈0.05）, WC （P〈0.01） and WHR （P〈0.01）. Both groups had significant decreases in FPG, 2-hPPG, HbAlc, HOMA-IR, MA, and UACR, with CHF treatment showing better effects on these parameters compared with the control treatment （P〈0.05）. Both treatments significantly reduced the levels of total cholesterol, low-density lipoprotein cholesterol and triacylglycerol （TAG）, and a greater reduction in TAG was observed with CHF treatment （P〈0.05）. The level of high-density lipoprotein cholesterol did not change in the control group after treatment （P〉0.05）, whereas it significantly increased with CHF treatment （P〈0.01）. Compared with before the treatment, significant decreases in systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were observed in both groups （P〈0.01）. However, there was no significant difference between the two groups （P〉0.05）. CONCLUSION： Combined treatment ofYiqi Huaju Qingli Formula and Western medicine significantly alleviated MAU, which may correlate with the improvement of insulin sensitivity and glucose and lipid metabolism. TRIAL REGISTRATION IDENTIFIER： This trial was registered in the Chinese Clinical Trial Registry with the identifier ChiCTR-TRC-11001633.
文摘Childhood obesity represents a complex disease with a well-known cardiometabolic burden including fatty liver,type 2 diabetes,metabolic syndrome,and cardiovascular disease.From a pathogenic point of view,insulin resistance(IR)represents the key factor underlying the spectrum of these obesity consequences.As observed in adults,recent data supported the occurrence of microalbuminuria(MA)as marker of early kidney dysfunction and its potential link with cardiometabolic factors also in children with obesity.In fact,a well-documented pathophysiological hypothesis both in adults and children supported an intimate correlation with the major feature of obesity such as IR through the influence of insulin on renal hemodynamics.Based on the clinical and prognostic relevance of this relationship in daily practice(including an increased risk of chronic kidney disease development overtime),more scientific attention needs to be paid to the evaluation of early kidney damage in children with obesity.In this paper,we attempt to address three debated questions regarding the intriguing liaison between IR and MA in children with obesity:(1)What is the prevalence of pediatric MA?(2)What is the state of art of MA in children with obesity?and(3)Is there a link between IR and MA in children with obesity?
基金supported by the Foundation of Shaanxi Provincial Science and Technology Plan Projects (2007K14-04)
文摘Objective To investigate the therapeutic effect of intensive glycemic control on patients with early diabetic nephropathy. Methods A total of 41 type 2 diabetes patients who developed microalbuminuria were divided into two groups randomly. Patients in Group A received intensive glycemic control and the blood glucose in Group B was regularly controlled. Glycemic monitoring and control were followed for 12 weeks to observe the changes of microalbuminuria in both groups; meanwhile the levels of serum lipids and coagulation indices were also recorded. Results The urine albumin excretion rate (UAER) in Group A decreased significantly from (47.91±13.86)mg/24h to (35.31±14.56)mg/24h after 12 weeks (P<0.05),and this decrease was significantly greater than that in Group B. However,Group B had no significant difference in UAER decrease [(48.93±13.32)mg/24h to (40.48±19.62)mg/24h,P>0.05]. The decrease of triglyceride (TG) and low-density lipoprotein cholesterol (LDL cholesterol),and the increase of high-density lipoprotein cholesterol (HDL cholesterol) showed no significant differences (P>0.05). And the level of plasma fibrinogen (FIB) showed no significant decrease after 12 weeks,either (P>0.05). Conclusion Intensive glycemic control reduces the level of microalbuminuria and may ameliorate the progression of early diabetic nephropathy.
基金95" National Science Technology Project(No. 96-906-02-06).
文摘Objective To investigate the urinary endothelin-1 (ET-l ) excretion and urinary sodium excretion, microalbuminuria and ambulatory blood pressure(ABP) in salt-sensitive(SS) hypertension patients. Methods Twen- ty-one cases of normotensive subjects and 32 cases of uncomplicated hypertensive patients were recruited in this study. Salt sensitivity was determined by acute venous saline loading test. Before saline loading, 24-hour ABP mea- surements were performed. Urine samples were collected to assay ET-1,urinary sodium excretion and urinary albumin excretion(UAF). Results Compared to slat-resistant(SR) subgroup, SS showed low urinary ET-1 excretion in nor- motensive group (P<0.05) or hypertensive group (P<0.01),regardless or saline loading or not. The nighttime MAP of SS was higher than SR subgroup in normotensive or hypertensive group. Urinary sodium excretion during 4h of saline loading was significantly lower in SS than that in SR hypertensive patients (P<0.05). Twenty-four-hour UAE of SS patients was higher than SR group (P<0.01). Results of further correlation analysis indicated that the urinary ET-1 excretion was positively related to urinary sodium content and negatively to ABP and UAE. Conclusion Uri- nary ET-1 is low in SS normotensives or hypertension patients,which may play a role in renal sodium retention and renal impairment or SS hypertension patients.
文摘Objective: To develop and validate a prognostic scoring scheme for the prediction of microalbuminuria in type 2 diabetic patients of Thai descent. Methods: The clinical information from type 2 diabetic patients who were treated at community hospitals was used to develop a prediction model (derivation set). The model evaluated at a tertiary hospital (validation set). A stepwise logistic regression model was used to identify the independent risk variables from the derivation set and a simple point scoring system was derived from the beta-coefficients. The risk scoring scheme was validated by the validation set. Results: The risk scoring scheme is based on six risk predictors: the duration of diabetes, age at the onset of diabetes, systolic blood pressure, low density lipoprotein levels, creatinine levels, and alcohol consumption. The total score ranged from 0 to 11.5. The likelihood of microalbuminuria in patients with low risk (scores ≤ 2) was 0.28, with moderate risk (scores 2.5 to 5.5) was 0.86, and high risk (scores ≥ 6) was 7.36. The area under the ROC curve of the derivation set and validation set were 0.768 (95% CI 0.73 - 0.81) and 0.758 (95% CI 0.70 - 0.80), respectively. Conclusion: Our scoring system is a simple and reasonably accurate method for predicting the future presence of microalbuminuria in type 2 diabetic patients.
文摘Objectives: This study proposes to evaluate risk factors for kidney disease in HIV patients treated chronically and correlate with microalbuminuria measurements. Methods: Review charts and analyses of microalbuminuria in subgroup of HIV patients treated at Ceara/Brazil. Results: 149 patients, 69.1% male, mean 38.5 years old, infection mean 86.8 months. Mean Creatinine Clearance 110.2%, Creatinine 0.97, Urea 27.76 mg/dl, CD4+ 600.37 cels/mm3 and detectable viral load 530.59 copies with 61.7% undetectable. Mean Dosages of microalbuminuria/24h 147, 46 ± 820, 45 (N = 48) and microalbuminuria (mg/dl) 32.05 ± 85.25 (N = 43). Kidney Diseases Classification analyses evidenced 6.4% patients in stages ≥3 and 6.2% presented altered Microalbuminuria/24h. Patients using Tenofovir (TDF) 27.27% had Stage 2 and protease inhibitors (PI) had 4.1% in Stage 3. Proteinuria was observed in 5% stage ≥3. Association PI/TDF had 4.1% in Stage 3. No statistical difference between CD4 > or 3 and microalbuminuria/24h > 300 mg (p = 0.69);detectable/undetectable viral load and microalbuminuria/24h (p = 0.63) or stage ≥3 (p = 0.17);relation to Diabetes or arterial hypertension and microalbuminuria 24 h (p = 0.5 and p = 0.21);relation stage ≥3 and microalbuminuria/24h (p = 0.33);relation HIV diagnoses >/< 60 months and stage ≥3 (p = 0.51);or microalbuminuria/24h and TDF (p = 0.4), PI (p = 1), TDF/PI (p = 0.69), Atazanavir (p = 0.4) or Lopinavir/r (p = 1) regimens. There was statistical significance comparing age > or or < 50 years and microalbuminuria/24h (p = 0.55) or microalbuminuria mg/d (p = 0.32). Relating comorbidities risk (Diabetes Mellitus plus Systemic Arterial Hypertension) to Kidney Diseases, it was found that 55.5% patients in Stage 3 or above with comorbidities compared with 15% with comorbidities in lower stages (P = 0.005). Nevertheless, comorbidities presence was not associated with microalbuminuria (p = 0.08). Conclusion: Kidney disease is a real risk for HIV patients and stages ≥3 have to be early detected. Microalbuminuria dosage did not demonstrate more sensibility than proteinuria to early diagnoses, even related to antiretroviral drugs. Major risk factor for kidney damage evidenced to be older than 50 years and there was no protective effect from CD4 or undetectable viral load.
文摘Background: Microalbuminuria is often the first sign of renal involvement predicting overt nephropathy. For this reason, monitoring microalbuminuria and other risk factors associated with this condition is important to take measures to prevent or postpone overt nephropathy. This study aimed to investigate the prevalence of microalbuminuria in type 2 diabetes patients attending three diabetes centers in Tirana city. Patients and Methods: Two hundred and twenty patients with type 2 diabetes attending diabetes centers in Tirana were recruited in this crosssectional study. Medical records were used to collect data on duration of diabetes, waist circumference, history of hypertension, smoking. Blood samples were drawn after 12 h overnight fasting to measure glycosylated hemoglobin (HbA1c), serum cholesterol, triglyceride and creatinine. Microalbuminuria was assessed using dipstick kits in early morning urine samples. Results: The prevalence of normoalbuminuria was 58.3%, microalbuminuria 38.6% and macroalbuminuria 3.1%. Systolic and diastolic blood pressure (p p < 0.01) and fasting plasma glucose (p moalbuminuric subjects. Multiple logistic regression analysis using microalbuminuria as the dependent variable in males shows that independent risk factors for diabetes patients with microalbuminuria were duration of diabetes, systolic blood pressure and waist circumference. We found that the OR for microalbuminuria became statistically significantly increased only at 16 years after the diagnosis of type 2 diabetes. At this time, 43.7% of patients had microalbuminuria. Conclusions: We found a high proportion of type 2 diabetes patients with microalbuminuria which raises implications for health policy inAlbania. This calls for early detection and good control of diabetes to reduce the burden of diabetic kidney disease in the future. Screening programs and optimized control of modifiable risk factors are needed to reduce the risk of diabetic nephropathy.
文摘Diabetes mellitus is a disease of great frequency and is a major public health problem. Several complications can occur during the course of diabetes such as diabetic nephropathy, which starts with microalbuminuria in diabetic patients. This was a cross-sectional and analytical study which took place from 23 September to 23 December 2021 in the Endocrinology-Metabolism-Nutrition Department of the CNHU-HKM of Cotonou, Benin. We carried out an exhaustive census of the patients. Type 2 diabetic patients were included in the study, and 24-hour microalbumunuria, fundus examination and assessment of complications were performed. We identified 145 type 2 diabetic patients of whom 44 had positive microalbuminuria, i.e. a prevalence of 30.3%. There were 61 men and 84 women with a sex ratio of 0.72. The mean age was 59 years with extremes of 26 and 85 years. The complications identified in diabetics with positive microalbuminuria were Neuropathy (43.2%), Nephropathy (22.7%) and Retinopathy (20.5%). Factors associated with microalbuminuria in diabetics were: age, occupation, hypertension, diabetes imbalance, erectile dysfunction. Conclusion: Microalbuminuria is common in type 2 diabetes. It should be managed early to slow the progression of kidney disease to the end stage.
文摘Microalbuminuria in adults has been found to be an early indicator of both renal and systemic vascular disease, as well as significant cardiovascular risk predictor and therapeutic marker. Its role in essential hypertension in adults has also been well established. As diseases like hypertension and obesity have their roots in childhood and are already present in children, influencing the morbidity in adulthood, the role of microalbuminuria has been extensively investigated in children as well. Most investigations have been performed in diabetic children, confirming its clinical significance. There is also enough evidence to suggest that microalbuminuria in obese children should be taken as seriously as in children with diabetes. In children with hypertension rare studies also indicate that its presence identifies hypertensive children with higher risk, although the exact role has to be confirmed in prospective and larger studies. The mechanisms of microalbuminuria onset could be the result of renal damage secondary to hypertension or underlying renal and systemic endothelial dysfunction. Evidence from small intervention studies in children with microalbuminuria also suggests that early intervention with antihypertensive drugs is likely to be beneficial, pointing out the role of microalbuminuria as a therapeutic marker in children too. In addition, we have to stress the importance of follow-up of children with microalbuminuria, confirmation of its persistence and identification of progression. However, longitudinal prospective studies in children, investigating its future cardiovascular risk, are still lacking.
文摘Microalbuminuria (MAU) is a predictor of cardiovascular mortality in patients with diabetes mellitus (DM) and hypertension (HTN) and also in an unselected population. The American Diabetes Association (ADA) and the National Kidney Foundation (NKF) define MAU as an albumin/creatinine ratio (ACR) between 30 and 300 μg/mg in both men and women. Aim: To evaluate the possible relationship among MAU, HTN and gender and ethnicity in Brazilian nondiabetic primary hypertensive patients. Design: Population-based study. Participants: Ninety-eight men and women, seventy-two black and twenty-six white nondiabetic primary hypertensive patients aged 20 years or older were selected. Forty healthy individuals, paired according to age, gender, and ethnics were used as controls. Methods: Early-morning midstream urine was used. Urinary albumin was spectrophotometrically measured with Coomassie Brillant Blue G-250. Creatinine was determined by a method based on Jaffe’s reaction. ACR (μg albumin/mg creatinine) was calculated. Data are expressed as medians. Results: ACR level was significantly higher in 98 hypertensive patients (38.00) than in 40 control individuals (23.00) (P < 0.001). ACR level was significantly higher in 48 hypertensive male (46.00) than in 50 hypertensive female (34.00) (P = 0.008). No significant effect of ethnicity on ACR levels between 26 hypertensive Whites (35.50) and 72 hypertensive Blacks (38.00) was observed (P = 0.978). Conclusions: The ACR level, significantly higher in hypertensive patients than in control individuals, supports data from the literature. To our knowledge, this is the first study demonstrating that the ACR level is significantly higher in men than in women. The lack of an ethnicity effect supports what was already asserted, namely, that in Brazil, at an individual level, color, as determined by physical evaluation, is a poor predictor of genomic African ancestry, as estimated by molecular markers.
文摘BACKGROUND Type 2 diabetes mellitus(T2DM)often leads to vascular complications,such as albuminuria.The role of insulin autoantibodies(IAA)and their interaction with D-dimer in this context remains unclear.AIM To investigate the characteristics of IAA and its effect on albuminuria in T2DM patients.METHODS We retrospectively analyzed clinical data from 115 T2DM patients with positive IAA induced by exogenous insulin,and 115 age-and sex-matched IAA-negative T2DM patients as controls.Propensity scores were calculated using multivariate logistic regression.Key variables were selected using the least absolute shrinkage and selection operator(LASSO)algorithm.We constructed a prediction model and analyzed the association between IAA and albuminuria based on demographic and laboratory parameters.RESULTS The IAA-positive group had significantly higher D-dimer levels[0.30(0.19-0.55)mg/L vs 0.21(0.19-0.33)mg/L,P=0.008]and plasma insulin levels[39.1(12.0-102.7)μU/mL vs 9.8(5.5-17.6)μU/mL,P<0.001]compared to the IAA-negative group.Increases in the insulin dose per weight ratio,diabetes duration,and urinary albumin-to-creatinine ratio(UACR)were observed but did not reach statistical significance.The LASSO model identified plasma insulin and D-dimer as key factors with larger coefficients.D-dimer was significantly associated with UACR in the total and IAA-positive groups but not in the IAA-negative group.The odds ratio for D-dimer elevation(>0.5 g/L)was 2.88(95%confidence interval:1.17-7.07)in the IAA-positive group(P interaction<0.05).CONCLUSION D-dimer elevation is an independent risk factor for abnormal albuminuria and interacts with IAA in the development of abnormal albuminuria in T2DM patients.
基金This study was jointly supported by Doctoral Start-up Project of Guangdong Natural Science Foundation （No. 7301662） and Medical Science and Technology Project, Guangzhou Municipal Bureau of Health （No. 20121A0111）. The authors thank Dr. Guangqiao Zeng （State Key Laboratory of Respiratory Disease, Guangzhou Medical University） for his assistance in medical writing. Dr. Zeng declares he has no conflicts of interest therein.
文摘This work aims to estimate the value of diffusion weighted imaging （DWI） and diffusion tensor imaging （DTI） in detecting early-stage kidney injury in type 2 diabetic patients with normoalbuminuria （NAU） versus microalbuminuria （MAU） prospectively. A total of 30 T2DM patients with normal kidney function were recruited and assigned to the NAU group （n = 14） or MAU group （n = 16） according to 8 h overnight urinary albuminuria excretion rate （AER） results. A contemporary cohort of health check-up recipients were included as controls （n = 12）. DWI and DTI scans were performed on bilateral kidney using SE single-shot EPI, and apparent diffusion coefficient （ADC） and fractional anisotropy （FA） of the renal parenchyma was determined from ADC and FA maps of the three groups. ADC and FA values were compared among the three groups. According to DWI with a b value of 400 s/mm^2, the MAU and NAU groups showed significantly lowered mean ADC values compared with the healthy controls （P 〈 0.01）. The mean ADC in the MAU group [（2.22± 0.07） × 10^-3 mm^2/s] was slightly lower than that of the NAU group [（2.31 ± 0.22） × 10^- 3 mm^2/s], but this difference was not statistically significant （P 〉 0.05）. The FAvalue in the MAU group was higher than that in the control group （0.45 ± 0.07 vs. 0.3±0.03, P = 0.004） but did not differ from that in the NAU group （0.42 ± 0.03） （P 〉 0.05）. ADC and FA values may be more sensitive than urine AER in reflecting early-stage kidney injury and, hence, may facilitate earlier detection and quantitative evaluation of kidney injury in T2DM patients. Combined evaluation of ADC and FA values may provide a better quantitative approach for identifying diabetic nephropathy at early disease stages.
文摘Background There is significant evidence showing that microalbuminuria and arterial compliance are sensitive markers for early cardiovascular diseases. However, whether microalbuminuria is associated with reduced arterial compliance in Chinese metabolic syndrome （MS） patients remains unknown. Methods According to the definition of MS proposed by ATPⅢ in 2001, USA, subjects （n=362） were divided into three groups according to the number of risk factors： group 1 （control）, group 2 （medium, 〈 3 risk factors） and group 3 （MS, ≥ 3 risk factors）. Both large artery compliance （C1） and small artery compliance （C2） were measured with the CVProfilor DO-2020 Cardiovascular Profiling System, and microalbuminuria was evaluated with the ratio of albumin to urine creatinine. Results （1） As C1 and C2 levels elasticity decreased, albumin creatinine ratio （ACR） and the prevalence of microalbuminuria increased within those groups with MS risk factors. C1 and C2 were negatively correlated with the ranking of MS risk factors, ACR was positively correlated with the ranking of MS risk factors （all P〈0.05）. （2） Subjects were also categorized into a microalbuminuria group and a normal group, C1 and C2 in the microalbuminuria group were lower than in the normal group. （3） Multivariate regression analysis showed that increased systolic blood pressure （SBP） and reduced arterial compliance were the main risk factors for microalbuminuria in the MS group. Conclusions The risk of developing microalbuminuria was higher in the subjects with multiple metabolic abnormalities. Increased systolic blood pressure and reduced arterial compliance may be the main predictors for microalbuminuria in MS.
基金supported by Public Welfare research projects of Futian District,Shenzhen(No.FTWS20160015)
文摘Background Microalbuminuria （MAU） and ambulatory arterial stiffness index （AASI） may predict cardiovascular events and death. However, there is little information about the correlation between the two parameters in patients with type 2 diabetes mellitus （T2DM）. Therefore, we examined the association of MAU with 24-hour AASI in patients with T2DM. Methods A total of 189 patients with 24-hour ambulatory blood pressure monitoring （24h-ABPM） who were hospitalized from January 2011 to January 2017 were selected. 136 patients without hypertension were screened. The subjects were divided into two groups according to urinary albumin-to-creatinine ratio （uACR）. MAU group was defined as uACR of 30-299 mg/g （n=69）, NMAU group was defined as uACR 〈30 mg/g （n=67）. AASI was calculated as 1 minus the regression slope of diastolic blood pressure （DBP） value vs. systolic blood pressure （SBP） value according to ABPM. The differences of clinical and bio- chemical indicators between the two groups were determined. The correlation between AASI and MAU was analyzed by unconditional forward stepwise logistic regression. Results Patients with MAU had significantly higher level of diabetic duration, TC, LDL-C, Scr, AASI and lower eGFR than NMAU group （P〈0.05）. Using MAU as the dependent variable （ 1 with MAU and 0 without MAU）, LDL-C, decreased eGFR, AASI were independent risk factors of MAU in patients with T2DM. The ROC curve of AASI in predicting the risk of MAU showed when AASI was 0.48, the area under the curve was the largest 0.659（95 % CI 0.568-0.750, P=0.001）. The sensitivity was 71.0% and the specificity was 56.7%. Conclusions Patients with MAU have higher AASI than patients without MAU. As a new index of arterial stiffness, AASI is associated with MAU, and could inde- pendently predict MAU in patients with T2DM.
