Zinc alpha 2 glycoprotein as an early biomarker of diabetic nephropathy in patients with type 2 diabetes mellitus / Zinco-alfa2-glicoproteina (ZAG) como biomarcador precoce de nefropatia diabética em pacientes com diabetes mellitus tipo 2

Abstract Introduction: Although microalbuminuria remains the gold standard for early detection of diabetic nephropathy (DN), it is not a sufficiently accurate predictor of DN risk. Thus, new biomarkers that would help to predict DN risk earlier and possibly prevent the occurrence of end-stage kidney disease are being investigated. Objective: To investigate the role of zinc-alpha-2-glycoprotein (ZAG) as an early marker of DN in type 2 diabetic (T2DM) patients. Methods: 88 persons were included and classified into 4 groups: Control group (group I), composed of normal healthy volunteers, and three patient groups with type 2 diabetes mellitus divided into: normo-albuminuria group (group II), subdivided into normal eGFR subgroup and increased eGFR subgroup > 120 mL/min/1.73m2), microalbuminuria group (group III), and macroalbuminuria group (group IV). All subjects were submitted to urine analysis, blood glucose levels, HbA1c, liver function tests, serum creatinine, uric acid, lipid profile and calculation of eGFR, urinary albumin creatinine ratio (UACR), and measurement of urinary and serum ZAG. Results: The levels of serum and urine ZAG were higher in patients with T2DM compared to control subjects and a statistically significant difference among studied groups regarding serum and urinary ZAG was found. Urine ZAG levels were positively correlated with UACR. Both ZAG levels were negatively correlated with eGFR. Urine ZAG levels in the eGFR ˃ 120 mL/min/1.73m2 subgroup were higher than that in the normal eGFR subgroup. Conclusion: These findings suggest that urine and serum ZAG might be useful as early biomarkers for detection of DN in T2DM patients, detectable earlier than microalbuminuria.

Resumo Introdução: Embora a microalbuminúria continue sendo o padrão ouro para a detecção precoce da nefropatia diabética (ND), ela não é um preditor suficientemente preciso do risco de ND. Assim, novos biomarcadores para prever mais precocemente o risco de ND e possivelmente evitar a ocorrência de doença renal terminal estão sendo investigados. Objetivo: Investigar a zinco-alfa2-glicoproteína (ZAG) como marcador precoce de ND em pacientes com debates mellitus tipo 2 (DM2). Métodos: Os 88 indivíduos incluídos foram divididos em quatro grupos: grupo controle (Grupo I), composto por voluntários saudáveis normais; e três grupos de pacientes com DM2 assim divididos: grupo normoalbuminúria (Grupo II), subdivididos em TFG normal e TFG > 120 mL/min/1,73 m2), grupo microalbuminúria (Grupo III) e grupo macroalbuminúria (Grupo IV). Todos foram submetidos a urinálise e exames para determinar glicemia, HbA1c, função hepática, creatinina sérica, ácido úrico, perfil lipídico, cálculo da TFG, relação albumina/creatinina (RAC) e dosagem urinária e sérica de ZAG. Resultados: Os níveis séricos e urinários de ZAG foram mais elevados nos pacientes com DM2 em comparação aos controles. Foi identificada diferença estatisticamente significativa entre os grupos estudados em relação aos níveis séricos e urinários de ZAG. Os níveis urinários de ZAG foram positivamente correlacionados com a RAC. Ambos os níveis de ZAG foram negativamente correlacionados com TFG. Os níveis urinários de ZAG no subgrupo com TFG ˃ 120 mL/min/1,73m2 foram maiores do que no subgrupo com TFG normal. Conclusão: Constatamos que a ZAG sérica e urinária pode ser um útil biomarcador precoce para detecção de ND em pacientes com DM2, sendo detectável mais precocemente que microalbuminúria.

Asociación de diabetes insípida central y diabetes mellitus tipo 2 / Association between central diabetes insipidus and type 2 diabetes mellitus

La diabetes insípida central es una enfermedad rara del hipotálamo y de la neurohipófisis, y muy inusualmente se halla en el adulto con diabetes mellitus 2. Se manifiesta por un síndrome poliúrico polidípsico, que debe diferenciarse de la diabetes mellitus mal controlada. Ante la similitud de ambas entidades, y lo infrecuente de su coexistencia, se dificulta su sospecha. Se presenta el caso de un hombre de 72 años de edad, con diabetes mellitus 2 y pobre control de la misma (hiperglucemias de ayuno mayores a 180 mg/dl) que cursó un síndrome poliúrico de larga data. La hipernatremia y la osmolalidad plasmática elevadas, junto a una osmolalidad urinaria baja llevaron a la sospecha de diabetes insípida, que posteriormente se confirmó con la prueba de deshidratación y la administración de desmopresina s.c. Con un aumento del 61% de la osmolalidad urinaria calculada una hora post desmopresina s.c. fue diagnosticada como diabetes insípida del tipo central. La resonancia magnética nuclear mostró una mancha brillante con neurohipófisis normal, contribuyendo al diagnóstico de la forma idiopática.

Central diabetes insipidus is a rare disease of the hypothalamus and neurohypophysis. It is very unusually found in the adult with type 2 diabetes mellitus. It is manifested by a polydipsic polyuric syndrome, which must be distinguished from the poorly controlled type 2 diabetes mellitus. Given the similarity of both entities and the unusual nature of their coexistence, their suspicion is difficult. The case of a 72-year-old male with type 2 diabetes mellitus with poor insulin control (fasting hyperglycemia greater than 180 mg/dl) who had a long-standing polyuric syndrome is here presented. Hypernatremia and plasma osmolality elevated together with a low urinary osmolality led to the suspicion of diabetes insipidus, which was subsequently confirmed by the dehydration test and the administration of desmopressin sc. With 61% increase in the calculated urinary osmolarity one hour post desmopressin s.c., diabetes insipidus of central type was diagnosed. Nuclear Magnetic Resonance showed a bright spot with normal neurohypophysis, contributing to the diagnosis of the idiopathic form.

Urinary beta-trace protein gene expression analysis in type 2 diabetes mellitus patients / Análise da expressão do gene da proteína beta-traço na urina de pacientes com diabetes mellitus tipo 2

ABSTRACT Objective: To evaluate the gene expression of beta-trace protein in urine of diabetic patients, with no reduction in glomerular filtration rate, which was defined as below 60mL/min/1.73m2. Methods: Type 2 diabetes mellitus patients were recruited, and a group of non-diabetic individuals served as control. Beta-trace protein gene expression was analyzed by quantitative PCR. Blood samples were collected to establish glucose levels and baseline kidney function. Accuracy was analyzed using ROC curves. Results: Ninety type 2 diabetes mellitus patients and 20 non-diabetic individuals were recruited. The area under the curve was 0.601, sensitivity of 20% and specificity of 89.47%. Among diabetic participants, 18% showed an expression above the cutoff point. Conclusion: These results of accuracy of beta-trace protein gene expression in urine of diabetic patients are promising, although they did not achieve a higher area under the curve level.

RESUMO Objetivo: Avaliar a expressão do gene da proteína beta-traço na urina de pacientes diabéticos, sem redução na taxa de filtração glomerular, definida como abaixo de 60mL/min/1,73m2. Métodos: Foram recrutados pacientes com diabetes mellitus tipo 2, e um grupo de indivíduos não diabéticos serviu como controle. A expressão do gene da proteína beta-traço foi analisada por PCR quantitativa. Amostras de sangue foram coletadas para estabelecer níveis de glicemia e função renal inicial. A acurácia foi analisada utilizando curvas ROC. Resultados: Foram recrutados 90 pacientes com diabetes mellitus tipo 2 e 20 não diabéticos. A área sob a curva foi de 0,601, com sensibilidade de 20% e especificidade de 89,47%. Entre os diabéticos, 18% apresentaram expressão acima do ponto de corte. Conclusão: Estes resultados de acurácia da expressão do gene da proteína beta-traço na urina de pacientes diabéticos são promissores, apesar de não terem atingido um nível alto na área sob a curva.

Marcadores de funcionamiento renal en pacientes diabéticos tipo 2. Policlínico "Milanés". Municipio Matanzas / Renal function markers type 2 diabet ic patients. Polyclinic "José J. Milanés". Municipality of Matanzas

Introducción: la nefropatía diabética, es un trastorno metabólico en el que la hiperglucemia induce disfunción en diversos tipos de células del riñón, que deriva en insuficiencia renal progresiva. Objetivo: describir el comportamiento de variables de funcionamiento renal en pacientes diabéticos tipo 2 en tres consultorio médicos de la familia del Policlínico Comunitario "José J. Milanés", Municipio de Matanzas, entre mayo del 2013 y mayo del 2014. Materiales y métodos: se realizó un estudio descriptivo transversal en un universo conformado por 129 pacientes con diabetes mellitus tipo 2. La muestra fueron 85 pacientes seleccionados por muestreo aleatorio simple. Variables objeto de estudio: tiempo de evolución de la enfermedad, glucemia, creatinina, microalbuminuria y filtrado glomerular. Resultados: 39 pacientes se encontraban con un período de diagnóstico entre 6 y 10 años, correspondiendo a esta etapa el mayor por ciento (45.9 %). 74 pacientes (87 %) presentó hiperglicemia y el 76,9 % (30 pacientes) presentaron cifras elevadas de creatinina. Para el filtrado glomerular predominaron los pacientes que se encuentran en el estadio II con un 43.6 % y tiempo de evolución entre los 6 y los 10 años, en la microalbuminuria, se destaca que el 42,1 % de los pacientes con menos de 5 años de evolución de la enfermedad presentaban cifras de microalbuminuria por encima de 30 mg/l). Conclusiones: predominaron los pacientes con tiempo de evolución entre los 6 a 10 años, grupo con los mayores porcentaje de pacientes con glucemia, creatinina, filtrado glomerular y microalbuminuria elevados. EL total de pacientes con más de 16 años de evolución de la enfermedad tenían cifras elevadas de filtrado glomerular y microalbuminuria (AU).

Introduction: diabetic nephropathy is a metabolic disturbance in which hyperglycemia induces dysfunction in different kinds of kidneys cells. It derives in progressive renal insufficiency. Objective: to describe the behaviour of renal function variables in type 2 diabetic patients in three family physician consultation (CMF, abbreviation in Spanish) of the Community Polyclinic "José J. Milanés", municipality of Matanzas in the period May 2013-May 2014. Materials and methods: descriptive, transversal study in a universe of 129 patients with type 2 diabetes mellitus. Simply randomized sample composed by 85 patients. The studied variables were time of disease evolution, glycemia, creatinine, microalbuminuria and glomerular filtration. Results: 39 patients were found in a diagnostic period between 6 and 10 years, the biggest percent (45.9 %) corresponding to this stage. 74 patients (87 %) presented hyperglycemia and 30 patients (76.9 %) showed high quantitites of creatinine. Patients that were in the II stage for 43.6 % and evolution time between 6 and 10 years predominated in the glomerular filtration; 42.1 % of the patients with less than 5 years of the disease evolution showed amounts of microalbuminuria of over 30 mg/l. Conclusions: it was found the predomination of patients with 6-10 years of evolution time, the group with the highest percent of patients with increased glycemia, creatinine, glomerular filtration and microalbuminuria. The total of the patients with more than 16 years of disease evolution had high amounts of glomerular filtrate and microalbuminuria (AU).

Microproteínas urinarias en diabéticos tipo 2 normoalbuminúricos / Urinary microproteins in normoalbuminuric type 2 diabetic patients / Microproteínas urinárias em diabéticos tipo 2 normoalbuminúricos

En pacientes diabéticos tipo 2 normoalbuminúricos se observa la presencia de Microproteínas Urinarias (MU) en el rango 68-25 kDa. El objetivo del trabajo fue identificar en distintos estadios de la nefropatía diabética si dicho rango corresponde a un marcador de daño tubular. Se estudiaron 119 orinas espontáneas de pacientes diabéticos tipo 2; se les midió la relación albúmina/creatinina urinaria y la creatinina sérica. Se dividieron en 5 grupos: 71 normoalbuminúricos, 28 microalbuminúricos, 12 macroalbuminúricos, 2 urémicos en pre-diálisis y 6 en hemodiálisis. Las MU se detectaron en geles de poliacrilamida en 2 dimensiones para uso clínico y se analizaron con el programa Image J 1.30v. La identificación de las MU se realizó por “immunoblotting” o por espectrometría de masa MALDI-TOF-TOF. El 66% de los normoalbuminúricos presentaron las siguientes MU: orosomucoide, fragmento de 35 kDa de la cadena pesada H4 del inter alfa I inhibidor de tripsina y Beta Trace, las cuales no reflejaron daño tubular debido a que la concentración de las mismas no se incrementó en los pacientes en hemodiálisis, en comparación con los normoalbuminúricos. Dichas proteínas están vinculadas al endotelio vascular y podrían constituir un marcador urinario vascular-tubular renal de utilidad clínica en patologías sistémicas con riesgo cardiovascular y funcionalidad renal conservada.

Urinary excretion of microproteins (MU) was detected in normoalbuminuric type 2 diabetic patients, in the range of 68-25 kDa using SDS-PAGE with silver staining. The purpose of this study was to identify MU in diabetic patients in different grades of diabetic nephropathy, in order to clarify the diagnostic relevance as a marker of renal tubular damage. In the spontaneous urine of 119 type 2 diabetic patients, urinary albumin, urinary creatinine and serum were determined. Five groups were formed: 71 normoalbuminuric, 28 microalbuminuric, 12 macroalbuminuric, 2 in pre-dialysis and 6 in hemodialysis. The MU were separated by two-dimensional polyacrylamid gel electrophoresis for clinical use (2D UC) and were identified by immunoblotting or MALDI-TOF-TOF mass spectrometry and analyzed using Image J version 1.30v. Of the normoalbuminurics patients studied, 66% excreted the following MU: orosomucoid, 35 kDa fragment of inter-alpha-trypsin inhibitor heavy chain H4 (ITIH4) and Beta Trace; but their concentrations did not reflect tubular damage because they exhibited a progressive downregulation. These proteins are involved in vascular endothelium, and they could be a marker of renal tubular-microvascular disease that would be useful in systemic diseases with cardiovascular risk and with preserved renal function.

Em pacientes diabéticos tipo 2 “normoalbuminúricos” se observa a presença de microproteínas urinárias (MU) em um intervalo compreendido entre 68 e 25 kDa. O objetivo do trabalho é identificar em distintos estágios da nefropatia diabética se tal intervalo corresponde a um marcador de dano tubular. Foram estudadas 119 amostras de urina espontânea de pacientes diabéticos tipo 2; foi medida a reação albumina/creatinina urinária e a creatinina sérica. Dividiram-se em 5 grupos: 71 normoalbuminúricos, 28 microalbuminúricos, 12 macroalbuminúricos, 2 urêmicos pré-dialise e 6 em hemodiálise. Foram detectadas as MU em géis de poliacrilamida em duas dimensões para o uso clínico e analisadas com o programa Image J versão 1.30v. A identificação das MU foi realizada por “immunoblotting” ou por espectrometria de massa MALDI-TOF-TOF. 66% de normoalbuminúricos apresentaram as seguintes MU: orosomucoide, Fragmento de 35 kDa da cadeia pesada H4 do interalfa inibidor da tripsina e Beta Trace, as quais não mostraram dano tubular devido a que a concentração das mesmas não está aumentada nos pacientes em hemodiálise, em comparação com os normoalbuminúricos. Estas proteínas estão envolvidas com o endotélio vascular e poderiam constituir um marcador urinário vascular-tubular renal de utilidade clínica em patologias sistêmicas com risco cardiovascular e funcionalidade renal conservada.

Prevalence of microalbuminuria in type 2 diabetic patients in Karachi: Pakistan a multi-center study

To determine the frequency of microalbuminuria and its associations in type-2 diabetic subjects attending diabetes centers/clinics across Karachi, Pakistan. Two thousand one hundred subjects with type-2 diabetes were screened for microalbuminuria using Micral test strip II. A single screening test was performed in 25 diabetes centers/units in different districts of Karachi from January 2003 to December 2003. The overall prevalence of microalbuminuria was 34%. Mean age of subjects was 53.1 years + 11.9 years, mean BMI was 25.8 ' 4.1 and mean duration of diabetes was 8.8 ' 5.21 years. Fifty seven percent were males and 43% females. Sixty two percent of the subjects had a systolic blood pressure >130 mmHg. Forty five percent had a family history of diabetes and 5% had a family history of hypertension. Univariate analyses demonstrated significant associations between microalbuminuria and age, duration of diabetes, male gender, smoking status, microvascular and macrovascular complications, hypertension, high triglycerides, high serum LDL, low serum HDL, and high fasting and random blood sugars. When adjusted for the effects of other variables in the model, age, diastolic blood pressure, serum LDL and retinopathy were found to be significantly associated with microalbuminuria. The prevalence of microalbuminuria in type 2 diabetic subjects in this cross-sectional multicentre study across Karachi was 34% and this was significantly related to age, diastolic blood pressure, serum LDL and retinopathy

Determination of Urinary Myo-/Chiro-Inositol Ratios from Korean Diabetes Patients

Of two major forms (myo- and chiro-inositol) of inositols, only chiro-inositol enhances the activity of proteins involved in intracellular glucose metabolism. This study aims to determine the urinary myo-/chiro-inositol ratio in type 1 and type 2 diabetes patients and compare its ratio with the normal control group. The 24-hour urinary myo- and chiro-inositols in 71 Korean diabetes patients and 39 control subjects have been quantified using high-performance liquid chromatography, and their ratios have been evaluated as indices of insulin resistance. The level of 24-hour urinary myo-inositol was significantly higher in both type 1 and type 2 diabetes than with the control group, whereas the urinary chiro-inositol in type 1 or type 2 diabetes was lower than that in normal subjects. The myo-/chiro-inositol ratio in diabetes patients was higher than that in the control group. Twenty four-hour urinary myo-/ chiro-inositol ratios were significantly elevated in type 1 and type 2 diabetes patients compared to the control group, suggesting that a high ratio of urinary myo-/chiro- inositol in type 2 diabetes patients might be used for an index of insulin resistance.

Screening for microalbuminuria in type 2 diabetes: a reconsideration.

To study the effect of timing of urine collection in determination of microalbuminuria in type 2 diabetic patients, timed urine (night time and daytime) as well as spot urine (first morning and random morning) samples were collected from 44 type 2 diabetic patients, 21 with normoalbuminuria and 23 with microalbuminuria. The methods of spot urine albumin expression for microalbuminuria were also compared between albumin concentration (AC) and albumin to creatinine ratio (ACR). Night time albumin excretion rate (AER) was 16 per cent lower and daytime AER was 13 per cent higher than 24-h AER (p<0.001). Forty-one (93%) of both night time and daytime urine samples had results corresponding with 24-h AER. For the spot urine, expression as AC showed a slightly stronger correlation with 24-h AER than expression as ACR. The levels of albumin in random morning urine samples were 50 and 35 per cent significantly higher than those in first morning urine samples when expressed as AC and ACR, respectively. In conclusion, because of low diurnal variation of AER, either daytime or night time urine could be used for screening of microalbuminuria in type 2 diabetes. Since mean albumin levels obtained from random morning urine were higher than those obtained from first morning urine, the cut-off level should be set higher in random morning urine in order to give comparable sensitivity in predicting microalbuminuria. The spot urine, either first morning or random morning urine, had a good correlation with the 24-h AER whether expressed as AC or ACR. Given the cost of the latter, the authors suggested measuring spot urine AC instead of ACR for screening of microalbuminuria in type 2 diabetes.

Microalbuminuria y su asociación a otros factores pronósticos, en pacientes diabéticos no insulino dependientes tipo 2 / Microalbuminuria and its association with other prognostic factors, in type 2 non-insulin diabetic patients

Se estudiaron 60 pacientes con diabetes mellitus no insulino dependiente (tipo 2) para evaluar la presencia de microalbuminuria y la coexistencia de algunos factores relacionados con la enfermedad. De ellos, 33.3 por ciento presentó microalbuminuria. Luego de 10 años de evolución de la enfermedad presentó microalbuminuria 42.4 por ciento de los pacientes. Otros factores evaluados tales como el control metabólico (44.4 por ciento), la presencia de retinopatía (51.6 por ciento) y la presión arterial diastólica superior a 90 mmHg (40 por ciento) se asociaron a la presencia de microalbuminuria. Concluimos que la microalbuminuria se asoció más frecuentemente a mayor duración de la enfermedad, descontrol metabólico, retinopatía y presión arterial diastólica superior a 90 mmHg

Respuesta de la glucemia a la administración de insulina sublingual / Sublingual insuline in diabetes type 2

Se presentan los resultados de un estudio para evaluar la respuesta de la glucemia después a la administración de una dosis de insulina por vía sublingual en un grupo de pacientes dabéticos tipo 2. Se seleccionaron 10 sujetos del Hospital General Regional No. 72 y 50 sujetos del Hospital de Solidaridad de Jimiltepec Oaxaca. Todos los sujetos suspendieron el tratamiento antidiabético 24 horas previas. Se administró una dosis de insulina regular dentro de cápsulas de gelatina a razón de 16 unidades en promedio. Se tomaron muestras sanguíneas a los 0 y 15, 30, 45, 60, 90 y 120 minutos. La glucemia se determinó por técnica de glucosa-oxidasa. En el grupo de Insulina se observa disminución de la glucemia inicial a los 120 minutos; no hubo modificación de los niveles de glucemia con placebo. La insulina administrada en cápsulas por vía sublingual disminuye los niveles de glucemia en sujetos con diabetes mellitus tipo 2

Exercise induced proteinuria as an early indicator of diabetic nephropathy.

Diabetic nephropathy is a life threatening microvascular complication of diabetes characterized by presence of proteinuria and progressive impairment of renal function. This study was carried out on 25 patients of diabetes mellitus and 25 healthy individuals who served as controls. All the persons were asked to perform certain programmed amount of exercise and protein excretion rates were measured in urine collected over following three periods: just before exercise, just after exercise and one hour post exercise. It was observed that basal urinary protein excretion rate as well as exercise induced urinary protein levels were significantly higher in diabetics than in control (p < 0.001). Values were significantly higher in uncontrolled diabetes as compared to those with good metabolic control. Urinary protein values were also related to the duration of diabetes. Higher values were observed in patients having diabetes of more than 5 years as compared to those with less than 5 years duration. This test is good and easy to perform for early detection and management of diabetic nephropathy which is essential to reduce long term morbidity and mortality in diabetics.

Excreción urinaria de albúmina en diabéticos no insulino-dependientes: efecto de un inhibidor de la enzima convertidora de angiotensina / Albumin urinary excretion in non insulin dependent diabetic patients: effects of an angiotensin converting enzyme inhibitor

Microalbuminuria in diabetic patients is diagnostic of early renal involvement and angiotensin converting enzyme inhibitors reduce albumin excretion in these subjects. To asses the effect of ACEI on urinary albumin excretion, non insulin dependent diabetic patients with normal blood pressure were randomly assigned to receive enalapril 10 mg/day or placebo and followed during 18 months. Those with high blood pressure were randomly assigned to receive enalapril or acebutolol in doses necessary to normalize blood pressure and followed during 12 months. Every 3 month, urinary albumin excretion was measured in a 4 hour urine sample by radioimmunoassay. One hundred fifty two patients were recruited for the study and 46 were lost from follow up. In 17 subjects with normal blood pressure initial urinary albumin excretion below cutoff values (30 mg/24 h) and treated with enalapril, this parameter did not change; in 20 treated with placebo, it incresed from 5.8ñ6.1 to 18.2ñ7.5 mg/24 h. In 11 patients with normal pressure and initial urinary albumin, this parameter did not change with enalapril and increased in 10 with placebo from 87.3ñ75.1 to 253.6ñ61.1 mg/24 h. In hypertensive patients with normal urinary albumin excretion, no changes in this parameter were observed in those treated with acebutolol (n=10) or enalapril (n=14). In hypertensive with high urinary albumin excretion, it decreased from 119.2ñ8.5 to 40.0ñ4.7 mg/24 h with enalapril treatment (n=12) and no change was observed in those treated with acebutolol (n=11). In Conclusion, enalapril decreases urinary albumin excretion in non insulin dependent diabetic patients

Evaluación cardiovascular en diabéticos no insulinodependientes microalbuminúricos / Cardiovascular evaluation in non insulin depedent diabetics with microalbuminuria

En diabéticos no insulinodependientes, microalbuminuria (30 a 300 mg en 24 horas) sería un marcador de nefropatía, retinopatía proliferativa y morbimortalidad cardiovascular, y reflejaría daño vascular generalizado. En el presente trabajo se estudia una casuística de 56 diabéticos tipo II divididos en 2 grupos: normoalbuminúricos (con albuminuria de 24 h menor de 30 mg), 36 casos; microalbuminúricos (con albuminuria de 24 h entre 30 y 300 mg), 20 casos. Todos ellos eran < de 70 años, tenían ECG de reposo normal; creatininemia menor de 1,2 mg por litro y proteinuria menor de 500 mg en 24 horas. En los integrantes de abos grupos se realizaron ergometría y ecocardiograma bidimensional doppler color. Los dos grupos eran comparables en edad; sexo; años de tratamiento de la diabetes; control metábolico; índice de masa corporal; cifras de presión arterial; función renal y pérfil lipídico. El análisis estadístico de los resultados revela que los diabéticos no insulinodependientes microalbuminúricos presentan una significativa mayor frecuencia de alteraciones ergométricas y ecocardiográficas que los normoalbuminúricos, destacando la respuesta hipertensa y la disfunción ventricular diastólica

Microalbuminuria in non insulin dependent diabetes and essential hypertension: a marker of severe disease.

Sixty five (65) hypertensive, 91 non-insulin dependent diabetes and 50 matched, healthy controls were examined for the presence of microalbuminuria, using the Micral strip test. Microalbuminuria was observed in 25 per cent of diabetics and 21.54 per cent of hypertensive subjects. None of the controls demonstrated microalbuminuria. Diabetics with microalbuminuria were poorly controlled and demonstrated significantly higher systolic pressure. In hypertensive subjects, microalbuminuria was seen more in patients with severe disease. In both diabetics and hypertensives, presence of microalbuminuria was significantly influenced by the disease duration.

Microalbuminuria en diabéticos no insulinodependientes / Microalbuminuria in non-insulindependent diabetics

La prevalencia de microalbuminuria en los diabéticos no insulinodependientes varía entre un 8 y 43 por ciento. Su presencia se asocia a obesidad, hipertensión arterial y dislipidemia, probablemente a través de un mecanismo patogénico común: la insulinorresistencia. La microalbuminuria se ha destacado como un importante marcador de nefropatía diabética y de patologías cardiovasculares. Los diabéticos no insulinodependientes constituyen un grupo de mayor riesgo con mortalidad precoz, que deben ser tratados en forma preventiva. Entre estas medidas debe considerarse el estricto control metabólico de la diabetes, el tratamiento de la dislipidemia, obesidad e hipertensión arterial. Los inhibidores de la enzima convertidora se han demostrado eficaces en disminuir los niveles de microalbuminuria, incluso en los diabéticos no insulinodependientes normotensos

Risk factors for development of proteinuria by type II (non-insulin dependent) diabetic patients

1. Renal involvement in non-insulin dependent diabetes mellitus patients is the single most important cause of renal failure. The aim of this study was to evaluate the clinical features and to assess the risk factors for the development of proteinuria by non-insulin dependent diabetic patients. 2. Risk factors (expressed as an odds ratio) were calculated by multiple logistic regression analysis taking into account age, sex, body mass index, known duration of diabetes, presence of arterial hypertension, fasting plasma glucose, cholesterol and triglycerides as independent variables and proteinuria as the dependent variable. Sixty-four normoalbuminuric (24-h albumin excretion rate < 30 micrograms/min, 27 females, mean age 53.7 years) and 53 proteinuric (24-h proteinuria > 0.5 g, 31 females, mean age 59.3 years) were studied. 3. Proteinuric patients were older, with a longer mean known duration of diabetes (12.4 vs 5.6 years), higher mean fasting plasma glucose (214 vs 168 mg/dl) and plasma creatinine (1.5 vs 1.1 mg/dl) and more frequently presented diabetic retinopathy (94 per cent vs 23 per cent ), peripheral neuropathy (94 per cent vs 23 per cent ) and arterial hypertension (73 per cent vs 16 per cent ) than normoalbuminuric patients. Age > 50 years, body mass index > 28.6 kg/m2, known duration of diabetes > 10 years, presence of arterial hypertension, and fasting plasma glucose > 160 mg/dl were significantly and independently associated with development of proteinuria

Excreción de albúmina urinaria en el diabético: su relación con las complicaciones vasculares / Urinary albumin excretion in the diabetic: its association with vascular complications

Se determinó la excreción urinaria de albúmina (EUA) en 315 diabéticos (174 tipo I y 141 tipo II) sin proteinuria detectable por el método del ácido sulfosalicílico y sin ninguna condición capaz por sí misma de producir albuminuria. Se empleó un método radioinmunológico de alta sensibilidad y especificidad desarrollado en nuestro laboratorio para la detección de microalbuminuria (EUA). El límite máximo de EUA fue de 25 mg/L. La EUA superior a esa cifra en nuestra serie fue de 37 % (62 % en los dibéticos tipo I y 38 % en los de tipo II). Los pacientes con EUA mayor de 25 mg/L, tanto del tipo I como del II tenían tiempos de evolución de la diabetes significativamente mayores, al compararlos con los que tenían una EUA normal. Nuestros resultados demuestran la importancia del estudio de la EUA en el diagnóstico precoz de alteraciones renales subclínicas. Comprobamos una asociación significativa entre los niveles elevados de EUA (mayor de 25 mg/L y la presencia de retinopatía diabética e hipertensión arterial, lo cual confiere a la prueba un posible valor predictivo para el desarrollo y progresión de estas complicaciones

Infecçäo urinária em diabéticos insulino-independentes / Urinary infection in non-insulin-dependent diabetic patients

Foram estudados 39 diabéticos insulino-independentes (13 do sexo masculino e 26 do sexo feminino), com média de idade de 49,9% (ñ18,8) anos e média de duraçäo da doença de 90,72 (ñ77,13) meses. O grupo controle foi composto por 30 indivíduos näo diabéticos sem história familiar, sendo 11 do sexo masculino e 19 do feminino, com média de idade de 40,83 (ñ 13,81) anos. Observaram-se 10,2% de infecçöes urinárias (quatro casos) no grupo de diabéticos, e 3,3% (um caso) no grupo controle. No grupo de diabéticos os pacientes afetados eram três do sexo feminino e um do masciulino; no grupo controle constatou-se apenas um indivíduo do sexo feminino com infecçöes urinária. Näo se verificou correlaçäo significativa entre a freqüência de infecçäo urinária e a média de duraçäo do diabetes. Os diabéticos com infecçäo urinária apresentavam média de glicemia de 241,5 (ñ117,58)mg/dl, enquanto aqueles sem infecçäo revelavam média de glicemia de 147,71 (ñ50,97)mg/dl (p < 0,05). A média de idade dos diabéticos com infecçäo urinária era de 65,75 (ñ8,6) anos, enquanto que aqueles näo afetados tinham média de idade de 57,6 (ñ15,5) anos (p < 0,05). Na nossa amostra, o exame de elementos anormais e sedimentos urinários (EAS) e os sintomas urinários näo foram indicadores da presença de infecçäo urinária, enfatizando a importância da realizaçäo de urinoculturas periódicas nos diabéticos