Prevalence and determinants of albuminuria in a cohort of diabetic patients in Lebanon

Few data are available on the extent of albuminuria in diabetic populations in the Middle East generally and in Lebanon specifically. We conducted this study to determine the prevalence of albuminuria and its major risk factors in a cohort of diabetic patients in Lebanon.Diabetic patients followed in the outpatient department at the American University of Beirut Medical Center [AUBMC] were included in a prospective observational study. AUBMC is a tertiary referral center and the outpatient department typically handles patients of low socioeconomic status with advanced disease. Patients were classified according to their urinary albumin-to-creatinine ratio [ACR] as having normoalbuminuria [ACR<30 mg/g creatinine], microalbuminuria [ACR=30 to <300 mg/g creatinine], or macro-albuminuria [ACR >/= 300 mg/g creatinine]. The three groups were compared to analyze the association between albuminuria and its risk factors. In addition, independent predictors of albuminuria were determined using multivariate logistic regression and presented as an odds ratio. Microalbuminuria and macroalbuminuria were present in 33.3% and 12.7% of 222 patients [mean age 56.4 years, mean deviation of diabetes 8.6 years, 58.7% women, 43.8% obese], respectively. Factors significantly associated with microalbuminuria included glycemic control, insulin use, and total and LDL cholesterol. Those associated with macroalbuminuria included in addition to glycemic control and insulin use, duration of diabetes, hypertension, elevated mean arterial pressure [MAP], and presence of neuropathy, retinopathy and peripheral vascular disease by bivariate analysis. Only glycemic control was an independent risk factor for both in addition to MAP and retinopathy for macroalbuminuria by multivariate analysis. Albuminuria is highly prevalent among this cohort of diabetic patients in Lebanon. Both glyce-mic control and blood pressure need to be better targeted in its management

Surgical adrenal diseases

There are four adrenal disorders in which surgery is the treatment of choice pheochromocytoma, Cushing's syndrome due to ACTH-independent adrenal disease [adenoma, carcinoma or autonomous hyperplasia], primary aldosteronism due to an adrenal adenoma and some adrenal non-functional "incidentilomas". In all four categories, the optimal result of surgical intervention depends on the following factors: 1. Definitive diagnosis by accurate biochemical assessment of the functional status of the adrenal lesion. 2. Precise localization of the lesion using simple routine as well as advanced imaging techniques. 3. Adequate preoperative preparation and intra-operative monitoring. 4. Close immediate and long-term postoperative follow-up. In this review, the above factors are briefly summarized for each of the four disorders. A small proportion of adrenal lesions requiring surgery are bilateral and in such situations, special intra- and postoperative care should take into consideration the need for appropriate gluco-corticoid and mineralo-corticoid replacement. The advent of laparoscopic surgery has served to reduce the postoperative morbidity of adrenal surgery and is becoming increasingly the procedure of choice except for large lesions [> 8 cm in diameter]