Association of different biomarkers of renal function with D-dimer levels in patients with type 1 diabetes mellitus (renal biomarkers and D-dimer in diabetes)

ABSTRACT Objective This study aimed to evaluate the association between different renal biomarkers with D-Dimer levels in diabetes mellitus (DM1) patients group classified as: low D-Dimer levels (< 318 ng/mL), which included first and second D-Dimer tertiles, and high D-Dimer levels (≥ 318 ng/mL), which included third D-Dimer tertile. Materials and methods D-Dimer and cystatin C were measured by ELISA. Creatinine and urea were determined by enzymatic method. Estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI equation. Albuminuria was assessed by immunoturbidimetry. Presence of renal disease was evaluated using each renal biomarker: creatinine, urea, cystatin C, eGFR and albuminuria. Bivariate logistic regression analysis was performed to assess which renal biomarkers are associated with high D-Dimer levels and odds ratio was calculated. After, multivariate logistic regression analysis was performed to assess which renal biomarkers are associated with high D-Dimer levels (after adjusting for sex and age) and odds ratio was calculated. Results Cystatin C presented a better association [OR of 9.8 (3.8-25.5)] with high D-Dimer levels than albuminuria, creatinine, eGFR and urea [OR of 5.3 (2.2-12.9), 8.4 (2.5-25.4), 9.1 (2.6-31.4) and 3.5 (1.4-8.4), respectively] after adjusting for sex and age. All biomarkers showed a good association with D-Dimer levels, and consequently, with hypercoagulability status, and cystatin C showed the best association among them. Conclusion Therefore, cystatin C might be useful to detect patients with incipient diabetic kidney disease that present an increased risk of cardiovascular disease, contributing to an early adoption of reno and cardioprotective therapies.

Microalbuminúria em população não diabética como marcador precoce de nefropatia / Microalbuminuria in non diabetic population as an marker of nephropathy

Resumo Introdução: Anos antes da evolução para diabetes mellitus tipo II, o paciente pode conviver com um período chamado pré-diabetes. A patogênese envolvida no pré-diabetes é a resistência à insulina. Objetivo: Discutir a frequência de microalbuminúria em população não diabética, porém com risco metabólico aumentado, e avaliar a existência de correlação da microalbuminúria com dados do metabolismo glicídico. Métodos: Foram incluídos no estudo 132 pacientes não diabéticos que apresentassem um ou mais fatores de risco para alteração do metabolismo glicídico: hipertensão arterial; obesidade; parentes em primeiro grau com diabetes; indivíduos das etnias hispano-americanas, asiáticas e afro-americanas; mães de recém-nascidos grandes para a idade gestacional (GIG) ou que apresentaram diabetes gestacional; dosagens séricas em jejum de HDL colesterol 250 mg/dL. Resultados: A frequência de microalbuminúria anormal para o método ocorreu em 16%, havendo presença de menores valores de HDL-colesterol e clearance de creatinina nessa mesma população. Considerando a amostra como um todo houve correlação positiva da microalbuminúria com a creatinina sérica e com o ácido úrico. Conclusão: Nosso estudo sugere que a microalbuminúria seja avaliada como marcador de nefropatia incipiente em população não diabética com risco metabólico aumentado.

Abstract Introduction: Years before the progression to diabetes mellitus type II patients can get by with a pre-diabetes called period. The pathogenesis involved pre-diabetes is insulin resistance Objective: This paper discusses the frequency of microalbuminuria in non-diabetic population, but with increased metabolic risk, and attempts to assess whether there is any correlation of microalbuminuria with data from glucose metabolism. Methods: A total of 132 nondiabetic patients who presented one or more risk factors for changes in glucose metabolism were included in the study: arterial hypertension; obesity; first-degree relatives with diabetes; individuals of Hispanic-American, Asian and African-American ethnicities; mothers of newborns who are large for gestational age (LGA) or who had gestational diabetes; serum measurements in fasting HDL cholesterol 250 mg/dL. Results: The results showed a frequency of abnormal microalbuminuria for the method in 16% of this population, and the presence of lower levels of HDL-cholesterol and creatinine clearance in this population. There was a positive correlation between microalbuminury and serum creatinine and uric acid. Conclusion: Our study suggests that microalbuminuria be evaluated as a marker of incipient nephropathy in non-diabetic population with increased metabolic risk.

The relationship between serum albumin levels and 24-h ambulatory blood pressure monitoring recordings in non-diabetic essential hypertensive patients

OBJECTIVES: The goal of this study was to evaluate the relationship between serum albumin levels and 24-hour ambulatory blood pressure monitoring (24-h ABPM) recordings in non-diabetic essential hypertensive patients. METHODS: A total of 354 patients (mean [SD] age: 55.5 [14.3] years, 50% females) with essential hypertension and 24-h ABPM recordings were included. Patient 24-h nighttime and daytime ABPM values, systolic and diastolic dipping status and average nocturnal dipping were recorded. The correlations between serum albumin levels and nocturnal systolic and diastolic dipping were evaluated, and correlates of average nocturnal systolic dipping were determined via a linear regression model. RESULTS: Overall, 73.2% of patients were determined to be non-dippers. The mean (SD) levels of serum albumin (4.2 [0.3] g/dL vs. 4.4 [0.4] g/dL, p<0.001) and the average nocturnal systolic (15.2 [4.8] mmHg vs. 0.3 [6.6] mmHg, p<0.001) and diastolic dipping (4.2 [8.6] mmHg vs. 18.9 [7.0] mmHg, p<0.001) were significantly lower in non-dippers than in dippers. A significant positive correlation was noted between serum albumin levels and both systolic (r=0.297, p<0.001) and diastolic dipping (r=0.265, p<0.001). The linear regression analysis revealed that for each one-unit increase in serum albumin, the average nocturnal dip in systolic BP increased by 0.17 mmHg (p=0.033). CONCLUSION: Our findings indicate an association between serum albumin levels and the deterioration of circadian BP rhythm among essential hypertensive patients along with the identification of a non-dipper pattern in more than two-thirds of patients. Our findings emphasize the importance of serum albumin levels, rather than urinary albumin excretion, as an independent predictor of nocturnal systolic dipping, at least in non-diabetic essential hypertensive patients with moderate proteinuria.

Evaluation of biochemical and clinical markers of endothelial dysfunction and their correlation with urinary albumin excretion in patients with type 1 diabetes mellitus

ABSTRACT Objective Endothelial dysfunction (ED) plays an important role in the pathogenesis of diabetic nephropathy. The purpose of the study was to determine flow mediated endothelial dependent vasodilatation (FMD) measurements and serum soluble (s) endothelin-1 (ET-1), intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule (VCAM-1) levels in patients with type 1 diabetes mellitus (T1DM) with or without increased urinary albumin excretion (UAE) and compare them with the healthy controls. Subjects and methods Seventy three patients with T1DM were enrolled. Patients were divided into two subgroups according to microalbumin measurements in 24-hr urine collections. The diabetic patients without microalbuminuria (41 patients) were defined as Group I and those with microalbuminuria (32 patients) were defined as group II. A hundred age and sex matched healthy subjects participated as the control group (Group III). Serum sET-1, sICAM-1, sVCAM-1 levels and FMD measurements were determined in all participants. Results Median FMD measurement was significantly lower in the diabetic groups compared with the control group (6.6, 6.4 and 7.8% in Group I, II and III, respectively) (p < 0.05). FMD was negatively correlated with age (p = 0.042). Median serum sICAM-1 level was higher in the patient groups compared to the control group (p < 0.05). Median serum sVCAM-1 level was higher in the group of patients with increased albuminuria compared to the normoalbuinuric and the control group (p < 0.05). Serum sVCAM-1 level was found to be positively correlated with degree of urinary albumin excretion (p < 0.001). Conclusion We assume that sVCAM-1 may be used as a predictive marker for risk stratification for nephropathy development and progression.

Efeito do exercício físico e suplementação de potássio sobre a pressão arterial, metabolismo glicídico e albuminúria de ratos hipertensos / Effects of physical training and potassium supplementation on blood pressure, glucose metabolism and albuminuria of spontaneously hypertensive rats

Introdução: Ainda é controverso se ocorre sinergismo entre as diferentes medidas não farmacológicas utilizadas no tratamento da hipertensão arterial. Objetivo: Avaliar o efeito do exercício físico aeróbico, da sobrecarga oral de potássio e da sua associação sobre a pressão arterial, metabolismo glicídico, excreção urinária de albumina e morfologia glomerular de ratos espontaneamente hipertensos (SHR). Métodos: SHRs foram divididos em: Grupo Controle (SHR; dieta padrão e sedentário, n = 10); Grupo Exercício (SHR + E; treinado em esteira rolante, dieta padrão, n = 10), Grupo Potássio (SHR + K; sedentário, dieta rica em potássio, n = 10) e Grupo Exercício + Potássio (SHR + E + K; exercitado, dieta rica em potássio, n = 10). Semanalmente, foi aferido o peso corporal (PC) e a pressão arterial de cauda (PAC). Ao final de 16 semanas, foi realizado o Teste de Tolerância oral a Glicose. A albuminúria foi determinada nos períodos basal, na 8ª e 16ª semana. Após o sacrifício, foi realizada a análise do índice de esclerose glomerular e a pesagem da gordura visceral. Resultados: A PAC e o PC não variaram significativamente. Houve melhora da sensibilidade à insulina no Grupo Exercício e Grupo Potássio, mas não no Grupo Exercício + Potássio. Na 16ª semana, a albuminúria de todos os grupos foi significativamente menor que o grupo SHR Controle. O índice de esclerose glomerular e o peso da gordura visceral também foram significativamente menores em todos os grupos tratados quando comparados ao controle. Conclusão: A dieta rica em potássio e o exercício físico determinaram melhora no metabolismo glicídico, na albuminúria e na morfologia glomerular, porém, a sobreposição ...

Introduction: It is still controversial whether there are synergistic effects among different non-pharmacological interventions used in the treatment of hypertension. Objetives: To evaluate the effect of aerobic exercise, oral supplementation of potassium and their combination on blood pressure, glucose metabolism, urinary albumin excretion and glomerular morphology in spontaneously hypertensive rats (SHR). Methods: SHR were divided into groups: Control Group (SHR; standard diet and sedentary, n = 10), Exercise Group (SHR + E; trained on a treadmill, standard diet, n = 10), Potassium Group (SHR + K; sedentary, potassium supplementation, n = 10) and Group Exercise + Potassium (SHR + E + K, exercise, potassium supplementation n = 10). Weekly, body weight (BW) and tail blood pressure (TAP) were measured. At the end of 16 weeks, a Oral Glucose Tolerance Test was performed. Albuminuria was determined in the baseline period, at 8th and at 16th week. After sacrifice, the analysis of glomerular sclerosis index and visceral fat weight was performed. Results: The TAP and BW did not change significantly. There was improvement in insulin sensitivity in SHR + E and SHR + K, but not in SHR + E + K. At week 16, albuminuria in all groups was significantly lower than the SHR control. The glomerular sclerosis index and visceral fat content were also significantly lower in all groups compared to control. Conclusion: An oral supplementation of potassium and exercise led to an improvement in glucose metabolism, in albuminuria and glomerular morphology, however, the overlap of the treatments did not show synergism. .

Microalbuminúria é um marcador prognóstico independente em pacientes com insuficiência cardíaca crônica / Microalbuminuria is an independent prognostic marker in patients with chronic heart failure / Microalbuminuria es un marcador pronóstico independiente en pacientes con insuficiencia cardíaca crónica

FUNDAMENTO: A microalbuminúria tem sido descrita como um fator de risco para doenças cardiovasculares e renais progressivas. Pouco se sabe sobre seu valor prognóstico em pacientes (pts) com Insuficiência Cardíaca (IC) estabelecida. OBJETIVO: Avaliar o papel da microalbuminúria como um marcador de prognóstico em pacientes com IC crônica recebendo medicação padrão. MÉTODOS: De janeiro de 2008 até setembro de 2009, 92 pacientes com IC crônica foram prospectivamente incluídos. A idade média foi de 63,7 ± 12,2 e 37 (40,7 por cento) eram do sexo masculino. A média de fração de ejeção do ventrículo esquerdo (FEVE) foi de 52,5 ± 17,5 por cento. Pacientes em diálise foram excluídos. A Concentração de Albumina Urinária (CAU) foi determinada em primeira amostra de urina da manhã. O tempo decorrido até o primeiro evento (internação por IC, consulta no departamento de emergência por IC ou morte cardiovascular) foi definido como endpoint. O seguimento médio foi de 11 ± 6,1 meses. RESULTADOS: No momento da inclusão no estudo, 38 (41,3 por cento) pacientes tinham microalbuminúria e nenhum paciente teve albuminúria evidente. Pacientes com microalbuminúria apresentaram menor fração de ejeção ventricular esquerda do que o restante dos indivíduos (47,9 ± 18,5 vs. 54,5 ± 17,7 por cento, p = 0,08). A CAU apresentou-se maior em pacientes com eventos (mediana 59,8 vs. 18 mg/L, p = 0,0005). Sobrevida livre de eventos foi menor nos pacientes com microalbuminúria quando comparados com albuminúria normal (p < 0,0001). As variáveis independentes relacionadas a eventos cardíacos foram CAU (taxa de risco p < 0,0001 = 1,02, 95 por cento CI = 1,01-1,03 por 1-U aumento da CAU), e histórico de infarto do miocárdio (p = 0,025, IC = 3,11, 95 por cento IC = 1,15-8,41). CONCLUSÃO: A microalbuminúria é um marcador prognóstico independente em pacientes com IC crônica. Pacientes com microalbuminúria tinham tendência para FEVE inferior.

BACKGROUND: Microalbuminuria has been described as a risk factor for progressive cardiovascular and renal diseases. Little is known about its prognostic value in patients (pts) with established heart failure (HF). OBJECTIVE: To assess the role of microalbuminuria as a prognostic marker in patients with chronic HF receiving standard medication. METHODS: From January 2008 through September 2009, 92 pts with chronic HF, were prospectively included. Mean age was 63.7±12.2 and 37 (40.7 percent) were male. Mean left ventricular ejection fraction (LVEF) was 52.5±17.5 percent. Pts under dialysis were excluded. Urinary albumin concentration (UAC) was determined in first morning spot sample of urine. Time to first event (HF hospitalization, emergency department visit for HF or cardiovascular death) was defined as endpoint. Mean follow-up was 11±6.1 months. RESULTS: At the time of inclusion in the study, 38 (41.3 percent) pts had microalbuminuria and no patient had overt albuminuria. Pts with microalbuminuria had lower left ventricular ejection fraction than the rest of the individuals (47.9±18.5 vs 54.5±17.7 percent, p=0.08). UAC was higher in patients with events (median 59.8 vs 18 mg/L, p=0.0005). Event-free survival was lower in pts with microalbuminuria as compared with normoalbuminuria (p<0.0001). Independent variables related to cardiac events were UAC (p<0.0001, hazard ratio=1.02, 95 percent CI=1.01 to 1.03 per 1-U increase of UAC), and previous myocardial infarction (p=0.025, HR=3.11, 95 percent CI=1.15 to 8.41). CONCLUSION: Microalbuminuria is an independent prognostic marker in pts with chronic HF. Pts with microalbuminuria had a trend for lower LVEF.

FUNDAMENTO: La microalbuminuria ha sido descripta como un factor de riesgo para enfermedades cardiovasculares y renales progresivas. Poco se sabe sobre su valor pronóstico en pacientes (pts) con Insuficiencia Cardíaca (IC) establecida. OBJETIVOS: Evaluar el papel de la microalbuminuria como un marcador de pronóstico en pacientes con IC crónica recibiendo medicación estándar. MÉTODOS: De enero de 2008 hasta setiembre de 2009, 92 pacientes con IC crónica fueron prospectivamente incluidos. La edad media fue de 63,7 ± 12,2 y 37 (40,7 por ciento) eran del sexo masculino. La media de fracción de eyección del ventrículo izquierdo (FEVI) fue de 52,5 ± 17,5 por ciento. Pacientes en diálisis fueron excluidos. La Concentración de Albúmina Urinaria (CAU) fue determinada en primera muestra de orina de la mañana. El tiempo transcurrido hasta el primer evento (internación por IC, consulta en el departamento de emergencia por IC o muerte cardiovascular) fue definido como endpoint. El seguimiento medio fue de 11 ± 6,1 meses. RESULTADOS: En el momento de la inclusión en el estudio, 38 (41,3 por ciento) pacientes tenían microalbuminuria y ningún paciente tuvo albuminuria evidente. Pacientes con microalbuminuria presentaron menor fracción de eyección ventricular izquierda que el resto de los individuos (47,9 ± 18,5 vs. 54,5 ± 17,7 por ciento, p = 0,08). La CAU presentó mayor en pacientes con eventos (mediana 59,8 vs. 18 mg/L, p = 0,0005). La sobrevida libre de eventos fue menor en los pacientes con microalbuminuria cuando fueron comparados con albuminuria normal (p < 0,0001). Las variables independientes relacionadas a eventos cardíacos fueron CAU (tasa de riesgo p < 0,0001 = 1,02, 95 por ciento CI = 1,01-1,03 por 1-U aumento de la CAU), e historia de infarto de miocardio (p = 0,025, IC = 3,11, 95 por ciento IC = 1,15-8,41). CONCLUSIÓN: La microalbuminuria es un marcador pronóstico independiente en pacientes con IC crónica. Pacientes con microalbuminuria tenían tendencia a FEVI inferior.

Microalbuminuria como elemento de predicción de nefropatía y riesgo cardiovascular en pacientes diabéticos / Microalbuminuria as predictor of nephropathy and cardiovascular risk factor among diabetic patients

Microalbuminuria, defined as urinary excretion of albumin in the range of 30-300 mg/g creatinine, affects 20-30 percent of the type 2 diabetic (DM2) patients and 30-40 percent of type 1 diabetic (DM1) patients who, without intervention, progress to macroalbuminuria at rates of 5 and 7.5 percent per year, respectively. Hyperglycemia, by activating different metabolic pathways and the renin-angiotensin-aldosterone system, determines an increase in reactive oxygen species (ROS) which finally causes endothelial dysfunction. Albuminuria reflects a generalized endothelial dysfunction, that is related to cardiovascular disease in diabetic patients. Therefore, microalbuminuria becomes a predictor of renal damage, a coronary risk factor and a predictor of cardiovascular diseases. Several studies have demonstrated that progression of albuminuria can be prevented in normotensive and hypertensive DM1 and DM2 patients with the use of an inhibitor of angiotensin converting enzyme II or an antagonist of the angiotensin II receptor. These measures also provide cardiovascular protection in diabetic patients, an effect that is independent of the hypotensive action of the drug. In microalbuminuric diabetic patients, treatment should be oriented to diminish or avoid progression of microalbuminuria, and to maintain blood pressure, glucose and lipids within the recommended limits to avoid vascular and renal damage.

The relationship between microalbuminuria by using urine dipsticks and diabetic retinopathy in type 2 diabetes.

OBJECTIVE: Study the association between microalbuminuria and diabetic retinopathy in type 2 diabetic patients. MATERIAL AND METHOD: A cross-sectional analytic study of 1,111 cases with type 2 diabetic patients recruited from seven public hospitals, between June and December 2006 was performed RESULT: Two hundred eighty six subjects (79 males and 207 females) with urine dipsticks for microalbuminuria detection tested positive at least 2 of the 3 morning urine samples within 6 months. They were divided into 2 equal groups, micro- and normoalbuminuria based on quantity of albumin. Indirect ophthalmologic examination of all subjects' eyes for diabetic retinopathy was performed by ophthalmologists (retinal specialists). The present study showed that the proportion of diabetic retinopathy was 19.6% (28/143) and 12.6% (18/ 143) in micro- and normoalbuminuric groups, respectively. The difference of proportion between the groups was 7% but was statistically not significant (p = 0.108). CONCLUSION: Microalbuminuria detected using urine dipstick was not cross-sectionaly associated with diabetic retinopathy in type 2 diabetic patients.

Disfunção endotelial no diabetes melito tipo 1: [revisão] / Endothelial dysfunction in type 1 diabetes: [review]

As complicações vasculares são a maior causa de morbimortalidade em pacientes com diabetes. Os mecanismos envolvidos no desenvolvimento das doenças micro e macrovasculares são complexos e parcialmente compreendidos, mas se iniciam invariavelmente por um endotélio que se torna disfuncionado. O óxido nítrico é um importante regulador da função endotelial e o comprometimento da sua atividade é fator determinante para a disfunção endotelial (DE). No diabetes tipo 1, diversos fatores, como a hiperglicemia aguda, mau controle glicêmico crônico, tempo de diagnóstico e presença de neuropatia autonômica ou microalbuminúria estão associados à DE. Tanto o estresse oxidativo, como a ativação da via dos polóis, via da proteína quinase C e formação dos produtos avançados de glicação não-enzimática são potenciais mecanismos patogenéticos da DE. A detecção precoce da disfunção endotelial tem valor prognóstico para o desenvolvimento de complicações vasculares e pode ser importante em estratégias de prevenção primária de eventos cardiovasculares no diabetes tipo 1.

Vascular complications are the main cause of mortality and morbidity in diabetes. Mechanisms involved in the development of micro and macrovascular disease are complex and partially understood, but invariably begin as a dysfunctional endothelium. Nitric oxide is an important regulator of endothelial function and the impairment of its activity is determinant of the endothelial dysfunction. In type 1 diabetes, many factors like acute, chronic and post-prandial hyperglycemia, as well as the duration of diabetes or autonomic neuropathy and microalbuminuria are associated to endothelial dysfunction. Oxidative stress, polyol pathway activation, protein kinase C activation and the presence of advanced glycation end-products are potential mechanisms involved in the development of endothelial dysfunction. Early detection of endothelial dysfunction has prognostic value for the development of vascular complications and may be important in strategies for primary prevention of cardiovascular endpoints in type 1 diabetes.

Homeostase pressórica e complicações microvasculares em pacientes diabéticos / Blood pressure homeostasis and microvascular complications in diabetic patients

A retinopatia e a nefropatia estão entre as mais prevalentes e incapacitantes complicações associadas a dano microvascular no diabete melito (DM). A gravidade da hiperglicemia e a presença de hipertensão arterial sistêmica estão entre os principais fatores de risco para essas complicações. A monitorização ambulatorial da pressão arterial (MAPA) permitiu uma melhor compreensão dos padrões de variação da pressão arterial em pacientes diabéticos. Vêm-se acumulando evidências de que pacientes com DM podem apresentar padrões alterados da homeostase pressórica durante as 24h. Mesmo pequenas alterações da homeostase pressórica, freqüentemente vistas em pacientes normotensos na avaliação da pressão arterial por aferição em consultório, podem estar implicadas em aumento de risco de complicações microvasculares. Essas alterações pressóricas, associadas à hiperglicemia, podem produzir perda da auto-regulação dos vasos retinianos, acelerando ou agravando a retinopatia diabética. Provavelmente a MAPA poderá se tornar um instrumento útil de avaliação clínica em pacientes diabéticos normotensos, auxiliando no processo de identificação precoce do risco de desenvolvimento de complicações microangiopáticas. O objetivo desse artigo é fornecer uma revisão atualizada e orientada para a prática clínica sobre homeostase pressórica e DM.

Descenso pressórico surante o sono e mucroalbuminúria em pacientes normotensos com diabetes tipo 1 / Pressure descence during the sleep and microalbuminuria in normotensive patients with type 1 diabetes

O objetivo deste trabalho é estudar o descenso pressórico durante o período do sono em pacientes normotensos com diabetes tipo 1 , estratificados em função da microalbuminúria. Submeteram-se 37 pacientes, com idade de 26,5 +/- 6,7 anos e duração da doença de 8 anos (1-34), à determinação da taxa de excreção urinária de albumina (EUA) por radioimunoensaio e à monitorização ambulatorial da pressão arterial (MAPA). A microalbuminúria foi definida como EUA >/= 20 e< 200ng/min em pelo menos duas de três amostras de urina noturna. Considerou-se "não-dipper" sistólico ou diastólico, como o descenso pressórico durante o sono < 10 por cento dos respectivos valores de vigília. Encontramos 9 pacientes microalbuminúricos. A frequência de "não-dipper" sistólico foi de 89 por cento nos micro e de 78 por cento nos normoalbuminúricos (8/9 VS, 22/28; p=0,656) e de "não-dipper" diastólico de 55 por cento e de 18 por cento, respectivamente (5/9 VS, 5/28; p= 0,041). O grupo "não-dipper" diastólico tinha maior duração da doença (10,5 (2-18) VS. 7 (1-34 anos); p= 0,043), maior EUA (20,6 (2,2-82,4) VS, 6,2 (2, 1-63,7ng/min); p= 0,04) e concomitante ausência do descenso sistólico. No modelo de regressão múltipla apenas a microalbuminúria manteve-se correlacionada com a ausência do descenso diastólico (p= 0,036; R= 0,236), Concluímos que o comprometimento do descenso sistólico em pacientes diabéticos tipo 1 normotensos é o mais frequente e a ausência do descenso diastólico está associada principalmente com a microalbuminúria.

Monitorizaçäo ambulatorial da pressäo arterial e microalbuminúria em diabéticos insulino-dependentes normotensos / Ambulatory blood pressure monitoring and microalbuminuria in normotensive subjects with insulin-dependent diabetes mellitus

OBJECTIVE: To assess the association between microalbuminuria with ambulatory blood pressure monitoring in normotensive individuals with insulin-dependent diabetes mellitus. METHODS: Thirty-seven patients underwent determination of the rate of urinary excretion of albumin through radioimmunoassay and ambulatory blood pressure monitoring. Their mean age was 26.5 + or - 6.7 years, and the mean duration of their disease was 8 (1-34) years. Microalbuminuria was defined as urinary excretion of albumin > or = 20 and <200µg/min in at least 2 out of 3 urine samples. RESULTS: Nine (24.3 per cent) patients were microalbuminuric. Ambulatory blood pressure monitoring in the microalbuminuric patients had higher mean pressure values, mainly the systolic pressure, during sleep as compared with that in the normoalbuminuric patients (120.1 + or - 8.3 vs 110.8 + or - 7.1 mmHg; p=0.007). The pressure load was higher in the microalbuminuric individuals, mainly the systolic pressure load during wakefulness [6.3 (2.9-45.9) vs 1.6 (0-16 per cent); p=0.001]. This was the variable that better correlated with the urinary excretion of albumin (rS=0.61; p<0.001). Systolic pressure load >50 per cent and diastolic pressure load > 30 per cent during sleep was associated with microalbuminuria (p=0.008). The pressure drop during sleep did not differ between the groups. CONCLUSION: Microalbuminuric normotensive insulin-dependent diabetic patients show greater mean pressure value and pressure load during ambulatory blood pressure monitoring, and these variables correlate with urinary excretion of albumin.

A microalbuminúria e sua relaçäo com diabetes, hipertensäo arterial e doenças cardiovasculares: uma revisäo / The microalbuminuria and its relationship with diabetes, arterial hypertension and cardiovascular diseases: a review

A microalbuminúria (MA) é o aumento da excreçäo urinária de albumina näo detectável por fitas reagentes, mas quantificável por métodos imunológicos, como radioimunoensaio (RIA) ou ensaios imunoenzimáticos. Esta alteraçäo bioquímica é considerada sinal precoce de nefropatias em diabéticos e/ou hipertensos. Apresenta significante fator de risco associado à retinopatia e preditivo para doenças cardiovasculares. A coleta de urina adequada para a verificaçäo de MA parece ser a overnight porque é menos afetada pelas variaçöes fisiológicas (postura e exercícios). Considera-se MA uma excreçäo urinária de albumina de 30-300mg/24h

Residual ß-cell function and microvascular complications in type 1 diabetic patients

To determine the influence of residual ß-cell function on retinopathy and microalbuminuria we measured basal C-peptide in 50 type 1 diabetic outpatients aged 24.96 + or - 7.14 years, with a duration of diabetes of 9.1 + or - 6.2 years. Forty-three patients (86 percent) with low C-peptide (<0.74 ng/ml) had longer duration of diabetes than 7 patients (14 percent) with high C-peptide (<0.74 ng/ml) (9 (2-34) vs 3 (1-10) years, P = 0.01) and a tendency to high glycated hemoglobin (HBA1) (8.8 (6-17.9) vs 7.7 (6.9-8.7)percent, P = 0.08). Nine patients (18 percent) had microalbuminuria (two out of three overnight urine samples with an albumin excretion rate (AER)> or - 20 and <200 µg/min) and 13 (26 percent) had background retinopathy. No association was found between low C-peptide, microalbuminuria and retinopathy and no difference in basal C-peptide was observed between microalbuminuric and normoalbuminuric patients (0.4 + or - 0.5 vs 0.19 + or - 0.22 ng/ml, P = 0.61) and between patients with or without retinopathy (0.4 + or - 0.6 vs 0.2 + or - 0.3 ng/ml, P = 0.43). Multiple regression analysis showed that duration of diabetes (r = 0.30, r2 = 0.09, P = 0.031) followed by HBA1 (r = 0.41, r2 = 0.17, P = 0.01) influenced basal C-peptide, and this duration of diabetes was the only variable affecting AER (r = 0.40, r2 = 0.16, P = 0.004). In our sample of type 1 diabetic patients residual ß-cell function was not associated with microalbuminuria or retinopathy

Microalbuminuria: marcador de micro y macroangiopatía diabética / Microalbuminuria: marker of diabetic micro and macroangiopathy

La microalbuminuria, definida como la excreción urinaria de albúmina (EUA). En el rango 30-300 mg/24 h, tiene una prevalencia de 35-40 por ciento en los DID y de 25 por ciento en los DNID. Se asocia entre otros factores a hiperglicemia, hipertensión y dislipidemia.Los pacientes microalbuminúricos tendrían un aumento de la porosidad del endotelio de las membranas basales de todos los capilares, lo que daría origen a un daño vascular generalizado. La microalbuminuria sería un marcador de micro y macroangiopatía diabética (Hipótesis del Steno). La identificación de los pacientes microalbuminúricos amerita un estricto control de la glicemia, de la presión arterial y del perfil lipídico, con el objeto de prevenir el desarrollo de las complicaciones crónicas de la diabetes. El tratamiento con inhibidores de la enzima convertidora de angiotensina, en diabéticos microalbuminúricos normo e hipertensos, permite disminuir la EUA y prevenir o enlentecer la progresión a la etapa de proteinuria

Microalbuminúria na hipertensäo essencial / Microalbuminuria in essential hypertension

O termo microalbuminária significa a excreção urinária de albumina anormal, subclínica, não-detectável pelos métodos bioquímicos usuais. Pelo fato de ser um marcador de lesão glomerular, passou a ser pesquisada em hipertensos essenciais para diagnóstico de lesão renal precoce. É potencialmente reversível: a detecção e o tratamento podem prevenir a evolução para nefropatia hipertensiva clínica. Em diabéticos, a microalbuminúria foi definida como o aumento anormal da excreção urinária de albumina, situado entre os valores > 30 e < 300 mg/24h (>20 a 200< mug/min). Em hipertensos essenciais utilizam-se valores mais baixos para sua definição. A prevalência em hipertensos essenciais varia consideravelmente na literatura, entre 5 por cento e 47 por cento. É associada, em hipertensos essenciais, à maior incidência de eventos cardiovasculares, hipertrofia ventricular esquerda, insuficiência cardíaca, retinopatia hipertensiva, doença arterial periférica, arterioesclerose generalizada e mortalidade, e a distúrbios metabólicos como hiperinsulinemia e dislipidemias. A fisiopatologia é multifatorial, dependendo de maior passagem transcapilar glomerular de albumina, e/ou lesões estruturais glomerulares, e/ou alterações tubulares, podendo ser influenciada também por fatores genéticos e raciais.

Relación entre microalbuminuria y función pulmonar en enfermedad pulmonar obstructiva crónica (EPOC)

Introducción: Se sospecha que la alteración de órganos y sistemas diferentes del respiratorio, entre ellos el riñon y el endotelio, es frecuente en pacientes con EPOC. Los estudios de evaluación funcional glomerular en EPOC son escasos y han sido objeto de serias críticas. La excreción urinaria de albúmina es una medida muy sensible de alteración glomerular y endotelial. Objetivo: Evaluar la prevalencia de microalbuminuria en sujetos con EPOC sin otras causas de lesión glomerular y relacionarla con las pruebas funcionales respiratorias estándar. Pacientes y Métodos: Treinta y dos pacientes con edad promedio de 60 años, con EPOC moderado a severo (promedio del VEF1/CVF 49 por ciento del predicho) e hipoxemia leve (PaO2 promedio 52 mmHg) para la altura de Santafé de Bogotá (2640 m). Se realizaron exámenes de curva flujo-volumen, espirometría y gases arteriales, recolección de una muestra de orina durante seis horas para determinación de excreción de albúmina y uroanálisis y determinación de creatinina sérica en sangre venosa. Se buscaron relaciones entre la excreción de albúmina y los demás valores de función respiratoria, oxigenación y equilibrio ácido-básico (coeficiente de correlacción de Pearson) y diferencias entre grupos (ANOVA, Kruskal Wallis H). Resultados: La prevalencia de microalbuminuria patológica (30 microgramos/minuto) fue de 3,12 por ciento (1/32 pacientes). No hubo asociación significativa entre ninguna variable descriptiva, del estado funcional, la severidad de la obstrucción, la oxigenación y excreción urinaria de albúmina. Tampoco se demostró diferencia en la excreción de albúmina entre grupos al separarlos de acuerdo con el grado de obstrucción. Conclusión: La prevalencia de microalbuminuria en estos sujetos con EPOC, sin otros factores de riesgo para la lesión endotelial, es baja (31,12 por ciento) y la magnitud de la excreción urinaria de albúmina no esta determinada por la obstrucción espiratoria ni por la hipoxemia arterial. Aunque es necesario realizar otras pruebas de función endotelial, parece que este órgano no es afectado de manera directa por la EPOC

Reserva funcional renal en niños con diabetes mellitus insulinodependiente / Renal function reserve in children with insulin dependent diabetes mellitus

Para valorar la presencia de nefropatía diabética incipiente en niños con diabetes mellitus insulino dependiente (DMID), se estudió la reserva funcional renal (RFR) mediante la administración de proteínas por vía bucal. Se estudió una serie de 12 escolares y adolescentes con DMID bajo control metabólico aceptable (HbA1c < 14 por ciento), menos de cinco años de evolución, albuminuria negativa en tira reactiva, sin complicaciones crónicas de la biabetes. Se midieron la filtración glomerular (FG) y el flujo plasmático renal efectivo (FPRE) basales y después de la administración de 1.5 g/kg de peso corporal, de proteínas por vía bucal, y la microalbuminuria en dos ocasiones antes y dos ocasiones después de la administración de las proteínas. La FG (151.2 ñ 5.9 vs 147.9 ñ 5.5 mL/min/1.73 m²) y el FPRE (883.8 ñ 46.1 vs 816.3 ñ 37.0 mL/min/1.73 m²) no aumentaron después de la carga de proteínas, por lo que se consideró que la RFR estaba abolida. La excreción urinaria de proteínas no se modificó después del procedimiento, respecto al valor basal. La desaparición de la RFR permite identificar la nefropatía diabética en una etapa en la que aún no están presentes otros marcadores de daño renal incipiente como la microalbuminuria y, por lo tanto, posibilita iniciar tratamiento para esta complicación en etapas más tempranas de la misma. Reserva funcional renal; hiperfiltración; nefropatía diabética; filtración glomerular; flujo plasmático renal; diabetes mellitus insulino dependiente

Correlation between procollagen IIIP and microalbuminuria in diabetic patients with limited articular mobility syndrome before and after control of the diabetic state

This work studied the relationship between procollagen III peptide and micro-albuminuria in insulin-dependent diabetes mellitus with limited articular mobility syndrome before and after treatment. 52 patients [12 normal control] were selected; group I: 20 IDDM with hand stiffness [limited articular mobility syndrome] and group II: 20 IDDM without hand stiffness. All cases were subjected to complete history and clinical examination to exclude previous or presence of diseases and drug that may affect glucose tolerance. The results demonstrated that serum PIIIp level is raised in all diabetic patients with limited articular mobility syndrome [group I] than in nondiabetic. It was found that the role of urinary albumin excretion in both diabetic groups are significantly correlated with the duration of diabetes and it is related to poor metabolic control. From correlation study, there is a significant positive correlation between fasting blood sugar and both PIIIp and micro-albuminuria in diabetic patient [P <0.055]. There is no significant correlation between PIIIp and both micro-albuminuria and morning stiffness [p <0.05] in diabetic group

Clinical significance of microalbuminuria in evaluation of patients with mild essential hypertension

This study included 50 recently diagnosed patients with mild primary hypertension and 50 age and sex matched healthy subjects as control group. All patients and control subjects were examined for the presence of microalbuminuria, dyslipidemia, LVH and hyperreninemia during the routine outpatient clinical evaluation of hypertension. Microalbuminuria and LVH were more evident in the hypertensive group [38%, 32%] than in the control group [8%, 0%] [P <0.001]. Microalbuminuria was positively correlated with LVH [r = 0.36, P <0.001] and PRA [r = 0.76, P <0.05], but not correlated with dyslipidemia. Patients with high PRA were found to be significantly associated with microalbuminuria and LVH [P <0.001] than patients with low or normal PRA or the control subjects as well. Strip testing for microalbuminuria in hypertensive patients may be of great value in identifying patients at high cardiovascular risk with simple, cost effective and easy test can be performed in outpatient basis. When microalbuminuria is detected and confirmed, a series of further assessments and monitoring of other risk factors should be instituted