A STUDY ON COMPARISON BETWEEN MICROALBUMINURIA AND MACROALBUMINURIA IN TYPE 2 DIABETICS ON SEVERITY OF DIABETIC RETINOPATHY

Aim: The Aim of study is to measure the prevalence of albuminuria (both microalbuminuria and macroalbuminuria) among type 2 diabetic patients and to estimate its role on severity of diabetic retinopathy in type 2 diabetics. Materials and Methods: A cross sectional study conducted at ophthalmology department,Dr SN Medical College, Jodhpur, Rajasthan in 300 type 2 diabetic patients in one year of study period. All the patients had done ocular examination. The ETDRS scale used for grading Diabetic retinopathy. A morning urine sample used for detecting albuminuria. Urine albumin excretion values 30-300 mg in 24 hrs considered as microalbuminuria and values >300 mg in 24 hrs considered as macroalbuminuria.The analysis was done using SPSS 16.0. Results: The prevalence of microalbuminuria is 31.80% and prevalence of macroalbuminuria is 20.60%. Patients with macroalbuminuria has a greater prevalence of diabetic retinopathy as compare to patients who has normo or microalbuminuria which is statistically significant, p value< 0.001. Conclusion:In type 2 diabetics patients Microalbuminuria is a very useful in estimating the severity of diabetic retinopathy. Patients who have microalbuminuria is on higher risk for the development and progression of diabetic retinopathy

The prevalence of albuminuria among diabetic patients in a primary care setting in Singapore

<p><b>INTRODUCTION</b>Microalbuminuria is an early sign of kidney damage. The prevalence of microalbuminuria in Singapore has been reported to be 36.0%-48.5%. However, the prevalence of microalbuminuria reported in these studies was determined with one urine sample using a qualitative urine test. The aim of this study was to determine the prevalence of micro- and macroalbuminuria using a more stringent criterion of two positive quantitative urine albumin-creatinine ratio (ACR) tests.</p><p><b>METHODS</b>We conducted a cross-sectional study of patients with type 2 diabetes mellitus (T2DM) who were followed up at a primary care clinic in Singapore. Patients were diagnosed to have albuminuria if they had two positive ACR tests within a seven-month period.</p><p><b>RESULTS</b>A total of 786 patients with T2DM met the study's inclusion criteria. 55.7% were already on an angiotensin-converting enzyme inhibitor (ACEI) and/or angiotensin receptor blocker (ARB). The prevalence rates of micro- and macroalbuminuria were 14.2% and 5.7%, respectively. Patients with albuminuria were more likely to have hypertension (odds ratio [OR] 3.47, 95% confidence interval [CI] 1.55-7.80). Diabetics with poorer diabetic control (OR 1.88, 95% CI 1.26-2.79), and higher systolic (OR 1.69, 95% CI 1.14-2.49) and diastolic (OR 1.96, 95% CI, 1.20 to 3.22) blood pressures were more likely to have albuminuria.</p><p><b>CONCLUSION</b>In the present study, the prevalence of microalbuminuria is significantly lower than that previously reported in Singapore. The presence of hypertension, poor diabetic control and suboptimal blood pressure control are possible risk factors for albuminuria in patients with T2DM.</p>

Neutrophil to Lymphocyte Ratio in Sickle Cell Anaemia Patients with Nephropathy.

Background: Sickle cell anaemia (SCA) is associated with a chronic inflammatory component; blood neutrophil to lymphocyte ratio (NLR) has been described as a marker of organ dysfunction and clinical outcome in diseases associated with systemic inflammation. Objective: To evaluate NLR in Nigerian SCA patients with nephropathy. Methods: Seventy-nine (79) SCA patients in steady state and 50 aged-matched controls were prospectively enrolled for this study. Full blood count and dip-stick macro-albuminuria were done for each participant and data was analyzed using descriptive and inferential statistics. The level of statistical significance was defined as p ≤ 0.05. Results: The NLR was significantly higher in cases compared with controls (1.49±0.76 vs. 1.20±0.34, P=0.01) and the ANC was significantly higher in those with NLR ≥ 3.0 compared with those with NLR <3.0 (12.22±5.26x109/L vs. 6.10±2.96x109/L, respectively, P<0.001). Between cases with and without macro-albuminuria and controls, the means of NLR was significantly different (P=0.024). Macro-albuminuria was present in 16 (21.9%) of cases (all of which had NLR <3.0), this was not significantly correlated with NLR (r=-0.99, P=0.71). Conclusion: No significant relationship was observed between NLR and SCA nephropathy.

Treatment and Prevention of Common Complications of Chronic Kidney Disease.

Chronic kidney disease (CKD) is a worldwide public health problem with an increasing incidence and prevalence. Outcomes of CKD include not only complications of decreased kidney function and cardiovascular disease but also kidney failure causing increased morbidity and mortality. Unfortunately, CKD is often undetected and undertreated because of its insidious onset, variable progression, and length of time to overt kidney failure. Diabetes is now the leading cause of CKD requiring renal replacement therapy in many parts of the world, and its prevalence is increasing disproportionately in the developing countries. This review article outlines the current recommendations from various clinical guidelines and research studies for treatment, prevention and delaying the progression of both CKD and its common complications such as hypertension, anemia, renal osteodystrophy, electrolyte and acid-base imbalance, and hyperlipidemia. Recommendations for nutrition in CKD and measures adopted for early diabetic kidney disease to prevent further progression have also been reviewed. There is strong evidence that early detection and management of CKD can prevent or reduce disease progression, decrease complications and improve outcomes. Evidence supports that achieving optimal glucose control, blood pressure, reduction in albuminuria with a multifactorial intervention slows the progression of CKD. Angiotensin-converting enzyme inhibitors and angiotensin-II receptor antagonists are most effective because of their unique ability to decrease proteinuria, a factor important for the progression of CKD.

Risk factors associated with the development of overt nephropathy in type 2 diabetes patients: A 12 years observational study.

Background & objectives: Diabetic nephropathy (DN) is the leading cause of chronic kidney disease and end-stage renal disease in developing countries. Early detection and risk reduction measures can prevent DN. The aim of the study was to determine the risk factors for the development of proteinuria over a period of 12 years of follow up in normoalbuminuric type 2 diabetes patients attending a specialized centre. Methods: Of the 2630 type 2 diabetes subjects newly registered in 1996, 152 (M:F;92:60) normoalbuminuric subjects had baseline and subsequent measurements of anthropometric, haemodynamic and biochemical details spanning 12 years. The subjects were divided into 2 groups based on the renal status during follow up visits. Group 1 (non-progressors) had persistent normoalbuminuria and group 2 (progressors) had persistent proteinuria. Presence of other diabetic complications during follow up and details on antidiabetic and antihypertensive agents were noted. Results: During median follow up of 11 years in subjects with normal renal function at baseline, 44.1 per cent developed proteinuria at follow up. Glucose levels, HbA1c, systolic blood pressure (SBP), triglycerides, and urea levels were significantly higher at baseline among progressors than non-progressors. Progressors had a longer duration of diabetes and significant fall in estimated glomerular filtration rate (eGFR) levels at follow up. In Cox's regression analysis, baseline age, duration of diabetes, baseline HbA1c and mean values of HbA1c, triglycerides, SBP and presence of retinopathy showed significant association with the development of macroalbuminuria. Interpretation & conclusions: Type 2 diabetes patients with uncontrolled diabetes and increase in blood pressure are at high risk of developing nephropathy. Age, long duration of diabetes, elevated BP, poor glycaemic control and presence of retinopathy were significantly associated with the progression of diabetic nephropathy.

Recomendações atuais para a detecção da nefropatia diabética / Guidelines for the detection of diabetic nephropathy

A nefropatia diabética (ND) é uma complicação crônica grave do diabetes melito (DM); é a principal causa de insuficiência renal terminal. A ND é classificada em 3 estágios conforme a excreção urinária de albumina (EUA): normoalbuminúria (EUA <17 mg/l), microalbuminúria (EUA 17-174 mg/l) e macroalbuminúria (>174 mg/l). Da fase de microalbuminúria pode ocorrer regressão para normoalbuminúria (30% casos) ou progressão para a macroalbuminúria, quando ocorre maior risco de evolução para a doença renal crônica (DRC) terminal. O diagnóstico da ND é realizado através da medida da albumina na urina e pela avaliação da taxa de filtração glomerular (TFG). Recomenda-se a medida da albumina em amostra isolada de urina (primeira da manhã ou amostra casual), podendo-se medir o índice albumina-creatinina ou a concentração de albumina. Valores elevados de albuminúria devem ser confirmados em pelo menos 2 de 3 coletas de urina, em um intervalo de 3 a 6 meses. Na impossibilidade da medida da albuminúria, a medida de proteínas totais (proteinúria @430 mg/l em amostra ou >500 mg/24 h), pode ser utilizada para diagnóstico de fases mais avançadas de ND. Em pacientes com DM tipo 2 o rastreamento deve iniciar ao diagnóstico de DM, e nos pacientes com DM tipo 1 deve ser após os 10 anos de idade; logo após o início da puberdade; ou quando a duração do DM for >5 anos. Se negativo repetir anualmente; e, se positivo, recomenda-se a monitoração mais frequente da albumina urinária. A estimativa da TFG é realizada através de fórmulas que empregam a creatinina sérica, ajustadas para idade, gênero e etnia. São recomendadas as equações do estudo Modification of Diet in Renal Disease (MDRD) e Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Deve ser levado em conta que, em pacientes com DM, essas equações tendem a subestimar a TFG. A ND deve ser identificada o mais precocemente possível e para isto tanto os profissionais de saúde como os pacientes com DM devem ser conscientizados.

Diabetic nephropathy (DN) is an important chronic complication of diabetes mellitus (DM) and is the leading cause of end-staage renal disease. DN is classified into stages according to the urinary albumin excretion (UAE): normoalbuminuria (UAE <17 mg/l), microalbuminuria (UAE 17-174 mg/l), and macroalbuminuria (UAE >174 mg/l. From microalbuminuria there might be regression to normoalbuminuria (30% cases) or progression to macroalbuminuria, in which case there is higher risk of progression to advanced chronic kidney disease (CKD). DN has a high cardiovascular morbidity and mortality rate that is possibly more significant than the progression to terminal CKD. DN diagnosis is established by the measurement of albumin in the urine and assessment of glomerular filtration rate (GFR). The measurement of albumin in an isolated urine sample (first morning urine or random sample) is recommended, with the possibility of measuring albumin-creatinine ratio or albumin concentration. High levels of albuminuria should be confirmed by at least 2 out of 3 urine samples within a time interval of 3 to 6 months. If albuminuria cannot be measured, total protein level (proteinuria @ 430 mg/l in a sample or > 500 mg/24 h) can be used to diagnose advanced stages of DN. In patients with type 2 DM, screening should start upon diagnosis of DM, and in patients with type 1 DM, it should be started after the patient turns 10 years old; soon after the onset of puberty; or when the duration of DM is >5 years. In case of negative results, screening should be repeated annually and, if the result is positive, more frequent monitoring of urinary albumin is recommended. GFR estimation is calculated using formulas that employ serum creatinine adjusted for age, gender, and ethnicity. Modification of Diet in Renal Disease (MDRD) study and CKD-EPI (Chronic Kidney Disease - Epidemiology Collaboration) equations are the recommended. In patients with DM, this equation shows a tendency to underestimate GFR.

The ReIationship Between Glycemia,Lipidemia and Proteinuria in Different Stages of Diabetic Nephropathy / 医学研究杂志

Objective To establish the prevalence of renal involvement in a large group of patients with type 2 diabetes and evaluate several risk factors of early stages and advanced stages of albuminuria. Methods Five hundred and sixty-six patients(265 males, mean age:57.8?13.3 years, diabetes duration 8.35?6.4 years;301 females, mean age:60.0?12.4 years, diabetes duration 9.9?7.3 years) from the endocrinology unit of Beijing Tongren hospital were included in this study. Urinary albumin excretion rate(UAER),age ,diabetes duration, arterial blood pressure, body mass index(BMI),waist to hip ratio(WHR),fasting blood glucose(FBG),HbA1c,lipid profile were evaluated. Results The prevalence of microalbuminuria, macroalbuminuria was 24.6% and 16.8% respectively. On logistic regression analysis, using the presence or absence of microalbuminuria as dependent variable, arterial blood pressure and, fasting blood glucose were included in the model in both males and females. When analyzing patients with microalbuminuria vs those with macroalbuminuria, in females, arterial blood pressure and triglycerides were included in the model. In males, only blood pressure was included in the mole. Conclusions High fasting blood glucose and arterial blood pressure were independent risk factors of microalbuminuria in type 2 diabetic patients .High arterial blood pressure and disorder in lipid profile were independently associated with macroalbuminuria.