Assessment of serum magnesium and correlation with glycemic control and complication in type 2 diabetes mellitus – A cross-sectional study in a tertiary care hospital in eastern zone of India

Background: Diabetes mellitus (DM) is an expanding global health problem. Type 2 DM (T2DM) patients account about 90% of total DM patients. Magnesium is important for different physiological mechanism. Hypomagnesemia is common in T2DM patient. Magnitude of hypomagnesemia is related with glycemic control and is associated with complications of T2DM. Aims and Objectives: Our aim of the study was to assess the prevalence of hypomagnesemia in patients of T2DM patients and to find their correlation with glycemic control and complications of T2DM patients in rural population of eastern zone of India. Materials and Methods: The hospital-based cross-sectional study includes 99 male and female DM patients between 15 and 60 years age. Fasting blood sugar, postprandial blood sugar, HbA1c, serum total magnesium, and urine albumin creatinine ratio were measured. Data were entered into Microsoft Excel spreadsheet and then analyzed by SPSS (version 25.0; SPSS Inc.) and GraphPad Prism (version 5.0). P < 0.05 was considered statistically significant. Results: From our study, we observed that hypomagnesemia is common in T2DM patients. The magnitude of hypomagnesemia is correlated with glycemic control (P < 0.0001). Moreover, hypomagnesemia is associated with diabetic kidney diseases (P < 0.05). Conclusion: It can be concluded that serum magnesium should be monitored in all T2DM patients and should be managed appropriately because hypomagnesemia may induce complications in T2DM patients.

Self-Measured Blood Pressure and Target Organ Damage in Newly Detected Hypertension in South Gujarat, India

Introduction: Blood pressure transient spikes have been considered to be noise and only a hindrance to a proper assessment of typical blood pressure, which is defined as the actual underlying average blood pres-sure over a long period of time. The current study aimed to see if the highest Self measured Systolic blood Pressure could be utilized to forecast the occurrence of Target organ damage and evaluate the independent association between the maximum Self measured Systolic blood Pressure and Target organ damage in indi-viduals with untreated hypertension. Method: We evaluated the urine albumin/creatinine ratio (UACR) and carotid intima-media thickness (IMT) using ultrasonography in 462 hypertensive individuals who had never taken treatment for their hypertension. Residential blood pressure was recorded. Result: The maximal Self measured Systolic blood Pressure had considerably higher association coefficients with left ventricular mass index (LVMI) and carotid intima-media thickness than the mean Self measured Sys-tolic blood Pressure. Irrespective of the mean Self measured Blood pressure level, multivariate regression studies showed that the maximal Self measured Systolic blood Pressure was independently related with left ventricular mass index and carotid intima-media thickness. Conclusion: Transiently high blood pressure measurements recorded at Self measured shouldn't be dis-missed as noise but rather taken seriously as significant warning signs of hypertensive Target organ damage in the heart and arteries.

Additive antiproteinuric effect of pentoxifylline in patients with diabetic nephropathy under angiotensin receptor blockade: A short-term, randomized, and controlled trial

Background: The ever-increasing prevalence of diabetes has led to a higher incidence of progression into complications including nephropathy. Diabetic kidney disease (DKD) is a chronic condition that is managed with renin-angiotensin-aldosterone system blockers which retard its progression. Pentoxifylline as an add-on therapy has been tried for reducing DKD. Aims and Objectives: The aims of this study were to study the safety and efficacy of pentoxifylline added on to an angiotensin II receptor blocker (ARB) to reduce the progression of the disease condition in diabetic nephropathy (DN) patients over 1 year. Materials and Methods: It is a randomized open-label study conducted in the Department of Nephrology, of a tertiary care center for 1 year. Type 2 diabetes patients with DN who satisfied the eligibility criteria were randomized into pentoxifylline added on to ARB or ARB alone and followed up for urine albumin-creatinine ratio (ACR) and serum tumor necrosis factor (TNF)-alpha. Results: Twenty-six patients were recruited and completed the study. Urine ACR was significantly low in the pentoxifylline group compared to the ARB alone group (P = 0.021). Serum TNF-? was decreased in the pentoxifylline group in comparison to the ARB alone group (P = 0.06). Conclusion: Pentoxifylline caused significant lowering of urinary ACR and urine TNF-? for 4 months.

Association of serum chemerin level with early renal insufficiency in patients with type 2 diabetes / 中华内分泌代谢杂志

Objective:To assess the correlation between circulating chemerin and two indicators of renal function, estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (UACR), in individuals with type 2 diabetes and to determine whether chemerin is an independent marker of early renal insufficiency.Methods:A total of 742 patients with type 2 diabetes were recruited into the cross-sectional community study. Basic information, anthropometric parameters, and biochemical parameters of these individuals were determined and collected, and serum chemerin level was measured using enzyme-linked immunosorbent assay.Results:Chemerin levels were significantly higher in the eGFR-impaired group compared with eGFR-normal group, and macroalbuminuria group compared to the normal or microalbuminuria groups. Spearman′ rank correlation analysis showed serum chemerin level was correlated with eGFR ( r=-0.25, P<0.001), UACR ( r=0.23, P<0.001) and some other biochemical indicators such as triglyceride. And univariate and multivariate logistic regression analyses revealed circulating chemerin was an independent risk factor for eGFR impairment or proteinuria after adjusting corresponding covariates. Receiver operating characteristic (ROC) curve analysis showed that the area under curve (AUC) of circulating chemerin for predicting early impaired eGFR in type 2 diabetes was 0.747, while the AUC of circulating chemerin for predicting macroalbuminuria in type 2 diabetes was 0.748. Conclusion:Circulating chemerin is associated with eGFR or UACR and may be a potential diagnostic marker for early renal insufficiency in type 2 diabetes.

Hypoadiponectinemia as a marker of increased cardiovascular risk in patients with non-alcoholic fatty liver disease: correlation with albumin/creatinine ratio

ABSTRACT Objective: We assessed plasma adiponectin and its correlation with carotid intima-media-thickness (CIMT), as a marker of atherosclerosis, and urine albumin/creatinine ratio (ACR) in patients with non-alcoholic fatty liver disease (NAFLD). Subjects and methods: The study included 100 Egyptian subjects (50 patients with NAFLD with no history of diabetes or hypertension and 50 age and sex-matched normal healthy control subjects). Urine albumin/creatinine ratio (ACR) was assessed in all participants and fasting plasma adiponectin was measured using ELISA technique. Ultrasonography was used to diagnose NAFLD. CIMT was assessed using high-resolution Doppler ultrasonography. Results: Mild albuminuria was detected in patients with NAFLD (mean urine ACR = 42 ± 30 mg/g). Plasma adiponectin was significantly lower and urine ACR and CIMT significantly higher in patients with NAFLD as compared with the control group (P < 0.001 for all). A significant negative correlation was found between plasma adiponectin and both urine ACR and CIMT in patients with NAFLD (P < 0.001 and < 0.05 respectively). A significant positive correlation was also found between CIMT and urine ACR in those patients (P < 0.05). Plasma adiponectin and urine ACR were independent determinants of CIMT in patients with NAFLD (P < 0.01 and < 0.05 respectively). Conclusion: Patients with NAFLD, without diabetes, have an increased risk of atherosclerosis and cardiovascular disease. Hypoadiponectinemia and low-grade albuminuria are important markers of that risk.

A national audit of estimated glomerular filtration rate and proteinuria and the MACB CKD Task Force recommendations

@#Introduction: The Malaysian Association of Clinical Biochemists (MACB) established a Task Force for Chronic Kidney Disease. A survey was undertaken by the Task Force on the reporting of estimated glomerular filtration rate (eGFR) and urine albumin by hospital laboratories in Malaysia in both the government and private sectors. Materials and Methods: An e-mail invitation to participate in an online survey was sent to hospital laboratories in Malaysia (n=140). Questions regarding methods for measuring creatinine, equations for calculating eGFR, eGFR reporting, the terminology used in reporting urine albumin, types of samples and the cut-off values used for normal albuminuria. Results: A total of 42/140 (30%) laboratories answered the questionnaire. The prevalent method used for serum creatinine measurement was the Jaffé method (88.1%) traceable to isotope-dilution mass spectrometry. eGFR was reported along with serum creatinine by 61.9% of laboratories while 33.3% of laboratories report eGFR on request. The formula used for eGFR reporting was mainly MDRD (64.3%) and results were reported as exact numbers even when the eGFR was >60 ml/min/1.73m2 . The term microalbumin is still used by 83.3% of laboratories. There is a large heterogeneity among the labs regarding the type of sample recommended for measuring urine albumin, reference interval and reporting units. Conclusion: It is evident that the laboratory assessment of chronic kidney disease in Malaysia is not standardised. It is essential to provide a national framework for standardised reporting of eGFR and urine albumin. Recommendations developed by the MACB CKD Task Force, if adopted by all laboratories, will lead to a reduction in this variability.

The relationship between heart rate variability and urine albumin/creatinine ratio in patients with type 2 diabetes / 中华内分泌代谢杂志

Objective:To explore the relationship between heart rate variability (HRV) and urine albumin/creatinine ratio (ACR) in patients with type 2 diabetes.Methods:A total of 1 543 patients with type 2 diabetes were selected from the Department of Endocrinology of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, and all the participants received 24-hour Holter monitoring and ACR measurement. HRV parameters include the standard deviation of all normal to normal intervals (SDNN), root mean square differences of successive RR intervals (rMSSD), the percent of adjacent RR intervals with a difference greater than 50 ms (PNN50), low frequency (LF), high frequency (HF), the ratio of LF to HF (LF/HF). Multivariate linear regression was used to analyze the relationship between HRV and ACR. Logistic regression was performed to further analyze the relationship between HRV and albuminuria while HRV parameter was divided into ≤25% (Q1) and ≥25% (Q2-Q4).Results:Multivariate linear regression results showed that the decrease of HRV parameters [ln(SDNN), ln(PNN50), ln(LF), ln(HF), ln(LF/HF)] was closely related to the increase of ln(ACR) (all P<0.05). Logistic regression analysis results showed that SDNN( OR=1.669, 95% CI 1.290-2.159), PNN50( OR=1.372, 95% CI 1.063-1.770), LF( OR=1.918, 95% CI 1.441-2.551), and LF/HF ( OR=1.623, 95% CI 1.220-2.183) were independent risk factors for albuminuria (all P<0.05); Furthermore, logistic regression analysis stratified by the median duration of diabetes (10 years) and cardiovascular disease found that in patients with diabetes≤10 years or without cardiovascular disease, the risk of albuminuria in the SDNN and LF Q1 group were higher than that in the Q2-Q4 group; while in patients with diabetes>10 years or with cardiovascular disease, the risk of albuminuria in the SDNN, PNN50, LF, and LF/HF Q1 group were higher than that in the Q2-Q4 group. Conclusion:The reduction of HRV parameters in patients with type 2 diabetes is closely related to the increase of ACR. With the progress of diabetes, more HRV parameters demonstrated predictive effect for risk of albuminuria.

VEGF-B antibody and interleukin-22 fusion protein ameliorates diabetic nephropathy through inhibiting lipid accumulation and inflammatory responses

Diabetic nephropathy (DN) is considered the primary causes of end-stage renal disease (ESRD) and is related to abnormal glycolipid metabolism, hemodynamic abnormalities, oxidative stress and chronic inflammation. Antagonism of vascular endothelial growth factor B (VEGF-B) could efficiently ameliorate DN by reducing renal lipotoxicity. However, this pharmacological strategy is far from satisfactory, as it ignores numerous pathogenic factors, including anomalous reactive oxygen species (ROS) generation and inflammatory responses. We found that the upregulation of VEGF-B and downregulation of interleukin-22 (IL-22) among DN patients were significantly associated with the progression of DN. Thus, we hypothesized that a combination of a VEGF-B antibody and IL-22 could protect against DN not only by regulating glycolipid metabolism but also by reducing the accumulation of inflammation and ROS. To meet these challenges, a novel anti-VEGFB/IL22 fusion protein was developed, and its therapeutic effects on DN were further studied. We found that the anti-VEGFB/IL22 fusion protein reduced renal lipid accumulation by inhibiting the expression of fatty acid transport proteins and ameliorated inflammatory responses

Effect of high blood pressure on thyroid and lipid profile of pregnant women

Background: Hypertension is common medical problem encountered during pregnancy, complicating up to 10% pregnancies. Hypertension is defined as the systolic blood pressure ≤140 mmHg and a diastolic blood pressure ≥90 mmHg on two separate measurements at least 4-6 hours apart. During pregnancy thyroid demand changes with increased iodine uptake and synthesis of thyroid hormone. Serum from pre-eclamptic women had both a higher ratio of free fatty acid to albumin and increase up take of free fatty acids, which are further esterified to triglyceride. The aim of the present study was to evaluate thyroid hormone, lipid profile and urine albumin in hypertensive pregnant women and its comparison with normotensive pregnant womenMethods: Total 90 samples were collected from Beri Maternity Hospital and Civil Hospital, Amritsar. Blood samples were analysed for biochemical parameters viz. lipid profile and thyroid profile. Urine samples were also analysed for presence of albumin.Results: From the study it has been revealed that thyroid stimulating hormone (TSH) levels increased in hypertensive pregnant women mean (4.26±1.1µ/ml). The total cholesterol (234.56±14.2mg/dl), triglyceride (138±16.96mg/dl), HDL (50.7±7.4mg/dl), LDL (156.2±17.11mg/dl) and VLDL (27.7±3mg/dl) was found altered in hypertensive pregnancy as compared to normotensive pregnancy. The albumin excretion was seen in 13.3% hypertensive pregnancies.Conclusions: TSH were elevated in hypertensive pregnant women due to the effects of estrogen. Among all the parameters of lipid profile, total cholesterol, TG, LDL and VLDL has been increased significantly in hypertensive pregnant women as compared to normotensive pregnant women due endothelial dysfunction.

Can urine albumin/creatinine ratio replace 24 hours urinary albumin? / 中华内科杂志

Objective To analyze the correlation between urinary albumin/creatinine ratio (ACR) and 24-hour urinary microalbumin (UMA) and evaluate the predictive value of ARC for early diabetic nephropathy.Methods A total of 368 patients with type 2 diabetes mellitus were retrospectively collected.Early diabetic nephropathy was defined as 24h UMA 30～＜300 mg/24h.The correlation between ACR and 24hUMA,and the area under the receiver operating characteristic (ROC) curve of ACR in diagnosis of early diabetic nephropathy were calculated.Gender,age,course of disease,fasting venous blood glucose,glycosylated hemoglobin,blood pressure,triglyceride and total cholesterol were used as adjusting variables to establish univariate and multivariate logistic models of ACR for early diabetic nephropathy,respectively.A regression model was used to evaluate the diagnostic value of ACR for early diabetic nephropathy.Results The correlation between ACR and 24h UMA was 0.658.The area under ROC curve of ACR for early diabetic nephropathy was 0.907 before and 0.933 after adjustments of gender,age,course of disease,fasting venous blood glucose,glycosylated hemoglobin,blood pressure,triglyceride and total cholesterol,respectively.The OR value of ACR of diabetic nephropathy was 2.016 before and 2.762 after same adjustments.The calibration of Hosmer-Lemeshow chi-square test evaluation model was 19.362 before (P=0.13) and 14.928 after adjustments (P=0.061).Conclusion ACR is a better predictor for early diabetic nephropathy although its value is influenced by gender,age,course of disease,blood sugar,lipid,and blood pressure.

Evaluation of the Association between Ischemia Modified Albumin (IMA), Glycemic and Lipid Status in Diabetic Nephropathy

Introduction:Hyperglycemia induced oxidative stress in Type 2 Diabetes Mellitus modifyvarious biomolecules to cause Diabetic Nephropathy (DN). IMA (Ischemia-Modified Albumin) is one such oxidative stress marker already examined in various clinical events but have not yet been evaluated in different stages of DN. Aim:To estimate and assess the relationship of IMA with glycemic status and lipid parameters in all stages of DN. Study Design: Cross-sectional study.Place and Duration of Study: Study was conducted at Department of Biochemistry,Kasturba Medical College Hospitals, Mangaluru conducted between 2014 and 2015 Materials andMethods:There were 60 type 2 diabeticcases and 30 healthy controls. Diabetic cases were further categorized into three equal groups on the basis of UACR (urine albumin-creatinine ratio), DN stage I having UACR less than 30 mg/g, DN stage II having UACR 30 to 300 mg/g, and DN stage III havingUACR ≥ 300 mg/g of creatinine. Using enzyme-linked immunosorbent assay serum IMA level was estimated whereas automated analyzers was used for serum creatinine, HbA1c, urine albumin and urine creatinine analysis.Results:Lowest level of IMA (109 ng/mL) measured in DN stage I, which was significantly different from those in DN stage II (154 ng/mL) and DN stage III (178 ng/mL). The significant positive correlation between IMA and fasting blood glucose, glycated hemoglobin were present in stage II and stage III DN. In this study significant positive correlation of serum IMA to serum total cholesterol, low density lipoprotein cholesterol and negative correlation with high density lipoprotein were revealed in all stage of DN. Conclusion:Current study postulates that early evaluation of serum IMA in diabetic patients with deranged lipid profile will provide an index of nephropathy development. This will help in prognosis and controlling complication in diabetes mellitus.

Moderately Increased Albuminuria; Marker of Chronic Complications in Nigerian Diabetes Mellitus Type 2 Patients; Makurdi Perspective.

Background: Diabetes mellitus (DM) and its complications are on the increase especially in the developing countries with significant negative economic consequences on individuals, families and health systems. Objective: We, therefore compared albumin/creatinine ratio, microalbuminuria, and HbA1c among subjects of varying degree of complications with controls to ascertain if they can serve as markers of diabetic chronic complications to enhance early detection of chronic complications amongst diabetes mellitus patients in developing countries. Methods: 109 type 2 DM subjects (47 males and 62 females) and 100 non-DM controls of the same age range (40-80 yrs) were recruited for this study. The chronic complications found were: nephropathy, retinopathy, coronary artery disease, cerebrovascular disease, peripheral vascular disease and diabetic foot. These were further classified into micro vascular complications (nephropathy and retinopathy) and macrovascular complications (Coronary Artery Disease, Cerebrovascular Disease, Peripheral Vascular Disease and diabetic foot).Out of these 109 DM subjects, 36 were without chronic complications, 37 have microvascular complications only and 36 have a combination of microvascular and macrovascular complications. HbA1c, Urine microalbumin and creatinine were analysed using standard methods. Results: The mean levels of HbA1c, Microalbuminuria and albumin-creatinine ratio were significantly higher in DM subjects when compared to the control (p<0.05). Microalbumin, albumincreatinine ratio, and HbA1c were significantly higher in DM subjects with chronic complications than those without complications (p<0.05). However, DM subjects with both macro and micro complications had significant higher level of urine microalbumin, albumin-creatinine ratio, and HbA1c than those with microvascular complications only (p<0.05). Subjects aged 40-45 years had significant (p<0.01) albumin/creatinine ratio than subjects aged 51-55yrs as well as those >60 years. The male subjects had a significant (p<0.01) albumin/creatinine ratio and microalbumin respectively on comparing to their female counterpart Conclusion: Albumin-creatinine ratio is a simple, and less cumbersome tool which could serve as a predictor of complications in type 2 diabetes mellitus.

Application of the ratio of urine albumin to creatinine (ACR) in the urine samples at different time points in monitoring the early renal injury in patients with type 2 diabetes / 实用医学杂志

Objective To investigate the application of using urine ACR at different time points instead of 24-hour urinary albumin (24 h UA) for screening of early renal injury in patients with type 2 diabetes. Methods The 24-h urine samples at different time pointsfrom 89 hospitalized patients were collected. The correlations of the ACR of urine samples at different time points were compared with the 24-h UA. When the 24-h UA was taken as the standard,the receiver operating characteristic (ROC) curves of urine ACR at different time points were established and analized. Results No significant differences in urine ACR between the morning urine group [ACR 9.02 (5.69~ 11.64)mg/mmol] and the random urine group [ACR 8.65 (5.80 ~ 11.83) mg/mmol] (P > 0.05). A positive correlation was observed between the morning urine ACR and the random urine ACR (r = 0.951,P < 0.01), however, the ACR of the morning and the random urine group were all positively correlated with the 24-h UA (r=0.886, 0.859, P<0.01). There were no significant differences in the sensitivities and the specificities between the morning and the random urine specimens in screening for albuminuria (92.6%vs 90.1%, and 87.5%vs 87.5%, respectively). When the 24-h UA was taken as the standard,the area under the ROC curves of the ACR in the random urine specimens and the morning urine specimens were 0.954 ± 0.022 and 0.960 ± 0.021 , respectively. There were no statistical differences between these two groups. Conclusions The morning urine and the random urine ACR , instead of the 24-h UA , could be used for both the early screening and monitoring of the renal injury , and the random urine ACR detection is simple ,convenient and accurate for patients.

Observation on the Influence of Valsartan Combined with Bailing Capsules on Urinary Albumin Excretion Rate in Early Stage of Type 2 Diabetic Nephropathy / 中国药师

Objective:To observe the influence of valsartan combined with Bailing capsules on urinary albumin excretion rate in early stage of type 2 diabetic nephropathy ( DN) , and explore its protection in early DN. Methods:Sixty patients with early DN were randomly divided into two groups. On the basis of diet control and blood glucose regulation, the control group (n=30) was given valsartan 160 mg, qd, while the prevention group (n=30) was treated by valsartan (160 mg·d-1) combined with Bailing capsules (2. 0g, po, tid), and the treatment course was 12 weeks. The urinary albumin excretion rate ( UAER) , mean arterial blood pressure ( MAP) , serum creat-inine ( Scr) and hemoglobin A1c ( HbA1c) were measured and compared before and after the treatment in the two groups. Results:UAER in the two groups was significantly reduced after the treatment compared with that before the treatment (P0. 05). Conclusion:Valsartan combined with Bailing capsules shows certain effects in the treatment of early stage of type 2 diabetic nephropathy by decreasing the urinary albumin excretion.

Protective effects of Cordyceps sinensis on experimental rats with diabetic kidney / 国际中医中药杂志

Objective To observe the Cordyceps extract on experimental rats with diabetic kidney and to explore its mechanism of action.Methods The rat models of diabetic were established by intraperitoneal injecting streptozotocin.Kidney weight and the index of kidney were measured,and 1,4,7weeks blood sugar,serum creatinine,urine microalbumin and urea were dynamically observed for evaluating Cordyceps extract on experimental rats with diabetic kidney.Results The 1,4,and 7 weeks of kidney weight was (0.662± 0.062) g,(0.670±0.061) g,(0.657±0.063) g,renal index was (0.312±0.041) ％,(0.309±0.402) ％,(0.311 ±0.0317) ％,serum creatinine was (0.51±0.03)mg/d1,(0.57±0.03)mg/d1,(0.52±0.02)mg/d1,albumin was (1.77±0.17)mg/24 h,(1.52±0.19)mg/24 h,(1.56±0.11)mg/24 h.urea was (90.71 ±0.37)mmol/L,(91.57±0.48) mmol/L,(90.56±0.39)mmol/L in the normal control group respectively.While in the model group,the value of kidney weight was (0.879±0.037)g,(0.912±0.038)g,(0.871±0.393)g,renal index was (0.494±0.039)％,(0.487±0.038)％,(0.465±0.235)％,serum creatinine was (3.71 ±0.14) mg/d1,(3.51±0.12) mg/d1,(3.32±0.11)mg/d1,urinary albumin was (7.29±0.22)mg/24 h,(7.11±0.34)mg/24 h,(7.14±0.21)mg/24 h.urea was (109.59± 8.42),(92.52±2.41),(90.71 ±0.67) respectively.Compared with the normal control group these values were decreased significantly in the model group (P＜0.05).In the Cordyceps sinensis group kidney weight was (0.837±0.036)g,(0.747±0.029)g,(0.694±0.357)g,renal index was (0.412±0.024)％,(0.395±0.037)％,(0.361±0.027)％,serum creatinine was (1.44±0.11)mg/d1,(0.81± 0.04) mg/d1,(0.62±0.03) mg/d1,urinaryalbumin was (5.71±0.25)mg,(4.52±0.21)mg,(3.96±0.15)mg,urea was (109.59± 8.42) mmol/L,(92.52±2.41) mmol/L,(90.71 ± 0.67) mmol/L respectively.Compared with the model group these values were decreased significantly(P＜0.05) in the Cordyceps sinensis group.Conclusion Cordyceps sinensis extract has a protective effect on kidney of diabetic rats.

Urinary Albumin Excretion Rate: Diagnostic and Prognostic Utility in Essential Hypertension.

Context : To evaluate the usefulness of urinary albumin excretion rate (UAER) i.e. Albumin/Creatinine Ratio (ACR) in diagnosis and prognosis of essential hypertension (EHT). Objectives : To find out the association of urinary albumin excretion rate with the pathophysiology of essential hypertension. Study Design : A cross-sectional analytical study. Materials & Methods : Urinary albumin excretion (UAE), urinary creatinine (UC) and UAER were analyzed and compared between hypertensive cases and age & sex matched normotensive controls of age group 30-65 years using unpaired two-tailed Student ‘t’ test. All statistical analyses were done with PASW (SPSS) v.18.0. Results : Systolic BP (SBP) and diastolic BP (DBP) of cases were found to be significantly higher (p < 0.001) than controls. Urine MAlb level (p < 0.001) and ACR (p < 0.001) in cases were significantly higher compared to controls. Correlation studies showed that SBP and DBP was significantly positively correlated with urine MAlb (SBP: r = 0.859, DBP: r = 0.733; p < 0.001) and ACR (SBP: r = 0.830, DBP: r = 0.739; p < 0.001). Sex-wise comparison in cases revealed that males had statistically non-significant (p > 0.05) lower levels of urine MAlb as compared to females but had significantly higher (p < 0.001) levels of urine creatinine and lower (p < 0.001) ACR compared to females. Conclusion: Urinary MAlb levels and ACR are seen to be increased in hypertensive subjects compared to normotensive subjects. ACR was significantly higher in female hypertensives than males which can be credited to the physiologically observed lower urine creatinine levels compared to males. Both Microalbuminuria and ACR can serve as specific and well-established marker of cardiovascular and renal damage in EHT.

Association of serum 25-hydroxyvitamin D3 and urine albumin-to-creatinine ratio in type 2 diabetic patients / 中华内分泌代谢杂志

To study the association of serum 25-hydroxyvitamin D3 level with urine albumin-to-ereatinine ratio in 193 type 2 diabetic patients.Multivariate linear regression demonstrated that serum 25-hydroxyvitamin D3 level was an independent risk factor in predicting urine albumin excretion level in type 2 diabetic patients(β =-0.02,95％CI -0.04 - -0.01,P＜0.01 ).

Practical aspects of calculation, expression and interpretation of urine albumin measurement.

There is a large variation for estimation of albumin in urine between different laboratories. Clinical practice guidelines for the urine albumin measurements have been issued by professional organizations in several countries. These guidelines are not uniform in recommendations regarding sample type, time of sample collection, units of reporting, reference intervals used for interpretation, nor methods used to measure albumin. The aim of this article is to provide practical information regarding laboratory measurement, calculations, reporting and interpretation of urine albumin excretion. For laboratory estimation of urine albumin one can follow clinical practice guidelines suitable for their region or country or recommended by professional organization. There is lot of confusion about reporting of results in different units. Ideally, International System of Units should be adopted. Also there should be agreement all over the world to use single system of units for expressing results for urine albumin measurement. At present in India there are no such clear guidelines about laboratory measurement of urine albumin.

Alprostadil combined with Irbesartan in treatment of early diabetic nephropathy / 中国综合临床

ObjectiveTo observe the clinical efficacy of combined irbesartan and alprostadil treatment of early diabetic nephropathy (DN).Methods A total of 120 patients with early type 2 diabetes of hospitalization were randomly divided into 3 groups: irbesartan group of 40 patients (150 mg, once per day)(group irbesartan),40 patients treated with alprostadil (physiological saline and alprostadi 10 μg))(group alprostadi) ,40 patients treated with alprostadil combined irbesartan (dose same as the other two groups)(combined group).All cases were observed for 4 weeks.Comparison of serum creatinine (Cr), blood urea nitrogen(BUN) ,24 hour urinary albumin(24hUAE) changes after treatment.ResultsAfter treatment 4 weeks 24hUAE of the three groups were significantly decreased (t = 2.07, t = 2.01 and t = 3.15, Ps ＜ 0.05) .The decrease of 24hUAE in the combined treatment group ([252.69 ± 33.56]mg/24h) was better than that in the irbesartan group([268.75 ± 34.42)](t = 2.11, P ＜ 0.05)and in the alprostadil group ([267.95 ± 30.75])mg/24h (t = 1.998, P ＜ 0.05) .No significant difference were observed between the Irbesartan and alprostadil group.During treatment, several patients affected by swell, uncomfortable in the alprostadil group, but improved after treatment.No other adverse effect was observed.Conclusion Alprostadil combined with irbesartan treatment of early diabetic nephropathy is an effective way.

Urine Albumin Creatinine Ratio is Associated with Carotid Atherosclerosis in a Community Based Cohort: Atherosclerosis Risk of Rural Area in Korean General Population Study

BACKGROUND: Albuminuria is a surrogate marker of endothelial dysfunction and a predictor of cardiovascular events. Data are limited with regard to the relationship between albuminuria and subclinical atherosclerosis in a community-based cohort. We determined the association between albuminuria measured by the urine albumin creatinine ratio (UACR) and carotid intima media thickness (CIMT) in a Korean rural population. METHODS: We enrolled 1,369 healthy subjects older than 40 years (857 males and 518 females) with normal renal function and measured the CIMT. We excluded subjects with overt proteinuria (> 300 mg/day) or with treatment of diabetes mellitus, hypertension, dyslipidemia, and any cardiovascular disease. The subjects were stratified into the quartile value of the UACR (lowest quartile: UACR 17.7). And we evaluate the relationship between UACR and CIMT by linear regression and logistic regression analysis. RESULTS: Increasing quartile of the UACR had a stepwise increase in body mass index, blood pressure, cholesterol profile [low density lipoprotein (LDL)-cholesterol and triglyceride], glucose, homeostratic model assessment of insulin resistance (HOMA-IR), and C-reactive protein (all p values < 0.001). Maximal CIMT from the 1st to the 4th quartile values of the UACR were 0.74 +/- 0.17, 0.77 +/- 0.18, 0.78 +/- 0.18, and 0.82 +/- 0.21 mm, respectively (p < 0.001). In a multivariate regression model adjusted for age, sex, systolic blood pressure, triglyceride, LDL-cholesterol, fasting blood sugar, waist circumference, adiponectin, HOMA-IR, high sensitive C-reactive protein, smoking, UACR showed a significant association with maximal CIMT (B = 0.014, R2 = 0.145, p = 0.002). CONCLUSION: Albuminuria measured by the UACR was significantly associated with both CIMT and traditional risk factors of atherosclerosis except for smoking in healthy Koreans.