ABSTRACT
Background: Proteinuria is recognized as one of the earliest sign of renal function deterioration in chronic smokers. Proteinuria occurs due to alteration in glomerular permeability and later due to failure of reabsorption of filtered protein by the tubular cells. Normally, most healthy adults excrete 20 – 150 mg of protein in urine over 24 hours. However, it is difficult to collect 24 hrs urine samples. Objectives: To advocate the use of PCI (protein creatinine index) in assessment of proteinuria and to compare dipstick result with PCI in the assessment of proteinuria in chronic cigarette smokers. Material & Methods: A total of 30 cigarette smokers and 40 age and sex matched controls were included for the study. A random specimen of urine collected from each cigarette smoker and non- smoker was tested quantitatively by manual sulfosalicylic acid colorimetric method for the estimation of protein concentration. Creatinine concentration in each specimen was measured by modified Jaffe’s method and the urinary PCI was calculated. Results: Normal range of PCI which has been established in this study is 50 to 259. Significantly higher amounts of protein were found to be excreted in urine in chronic smokers (9.313 ± 4.003 mg/dl) as compared to healthy non smokers (7.738 ± 2.05 mg/dl). On comparison of PCI between healthy non smoker and chronic smoker subjects, PCI has been found to be significantly elevated in chronic smokers (healthy non smoker- 118.32 ± 56.86, chronic smoker- 180.1 ± 88.23) (p=0.001). Conclusion: PCI of random urine sample can provide a very useful, simple and convenient method for the quantitative assessment of proteinuria to confirm the advent of kidney damage, avoiding the drawbacks of 24 hrs urine collection.
Subject(s)
Adult , Humans , Creatinine/analysis , Creatinine/urine , Proteinuria/analysis , Proteinuria/diagnosis , Proteinuria/urine , Reagent Strips/diagnosis , Renal Insufficiency/diagnosis , Renal Insufficiency/urine , Smoking/adverse effects , Smoking/urine , Young AdultABSTRACT
There were no studies on the different stages of diabetic nephropathy in Saudi Arabia, particularly the earliest stages. We have therefore investigated the frequency of occurrence of varying degrees of proteinuria including microalbuminuria in noninsulin-dependent diabetes mellitus [NIDDM] Saudi patients as well as the correlation of varying degrees of proteinuria with other diabetic complications and risk factors. One hundred and twenty-five NIDDM patients were studied. Fifty-seven were males and 68 were females. Their mean age was 49.8 +/- 10 years with a mean duration of diabetes of 9.48 +/- 6 years. The mean of HbAlc was 10.3 +/- 2.6%, serum creatinine was 76.7 +/- 23 mmol/L, creatinine clearance 94.3 mL/min, glomerular filtration rate 129.7 +/- 44 and effective renal plasma flow was 496.5 +/- 153. The pattern of proteinuria group was as follows: nephrotic range proteinuria 5.6%, clinical proteinuria 30.4%, microalbuminuria 16.8%. Hypertension and retinopathy were present in 36.8% and 37% of the patients respectively. A significant correlation was found between the presence of hypertension, duration of diabetes and development of diabetic nephropathy. Similarly, a significant correlation was found between retinopathy and the degree of proteinuria. In conclusion, the pattern of diabetic nephropathy in the Saudi NIDDM patients is similar to that in the Western world. Hypertension and duration of diabetes mellitus are important risk factors in the development of diabetic nephropathy. There is a good correlation between retinopathy and the degree of proteinuria
Subject(s)
Diabetes Mellitus, Type 2 , Risk Factors , Proteinuria/analysis , Diabetes MellitusABSTRACT
En el presente trabajo se incorporan y ordenan procedimientos para obtener la mayor información posible a nivel laboratorio clínico en la indagación de proteínas "M" y la definición de su clase (cadenas pesadas) y tipo (cadenas livianas). Se propone una secuencia de las siguientes técnicas: electroforesis, inmunoelectroforesis, inmunofijación, inmunodifusión radial cuantitativa, tratamientos despolimerizantes e inmunosustracción. La inmunosustracción, descripta por W. A. White y col., consiste en la remoción de la inmunoglobulina en estudio mediante un antisuero específico en presencia de polietilenglicol, separación del inmunocomplejo precipitado y posterior evaluación del sobrenadante mediante inmunofijación; se identifica la cadena liviana que pertenece a la inmunoblobulina sustraída por su ausencia al fijar con el antisuero correspondiente. Es particularmente útil cuando se desea establecer la correspondencia liviana/pesada en presencia de bandas homogéneas múltiples, identificar bandas menores enmascaradas en un fondo policlonal y excluir la presencia coincidente de cadenas livianas libres. Se aconseja incorporar el tratamiento despolimerizante con 2-mercaptoetanol previamente a la cuantificación de IgM por inmunodifusión radial ya que la comparación previa entre controles tratados y no tratados reveló una diferencia muy significativa cuando se analizó mediante contraste de diferencias entre pares homólogos (n = 12, test t = 37,2 p <0,01)