ABSTRACT
Microalbuminuria is an early indicator of cardiac and renal vascular endothelial damage in individuals with diabetes mellitus, impaired glucose tolerance, hypertension, and the CardioMetabolic Syndrome. This simple, inexpensive dipstick screening test is not only associated with an increased risk of progressive renal insufficiency but also with an increased risk of cardiovascular disease and events. Regular screening for microalbuminuria will allow for early detection and intervention to prevent renal and vascular complications of these disease states.
Subject(s)
Albuminuria/epidemiology , Albuminuria/prevention & control , Cardiovascular Diseases/epidemiology , Kidney Failure, Chronic/epidemiology , Mass Screening , Cardiovascular Diseases/complications , Diabetes Mellitus, Type 2/complications , Humans , Kidney Failure, Chronic/etiology , Metabolic Syndrome/epidemiology , Missouri/epidemiology , Oxidative Stress , Public Health , United States/epidemiologySubject(s)
Calciphylaxis/etiology , Metabolic Syndrome/complications , Thiocyanates/therapeutic use , Biopsy , Calciphylaxis/drug therapy , Calciphylaxis/pathology , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Injections, Intravenous , Middle Aged , Thiocyanates/administration & dosageABSTRACT
BACKGROUND: Vascular calcification is associated with metabolic syndrome, diabetes, hypertension, atherosclerosis, chronic kidney disease, and end stage renal disease. Each of the above contributes to an accelerated and premature demise primarily due to cardiovascular disease. The above conditions are associated with multiple metabolic toxicities resulting in an increase in reactive oxygen species to the arterial vessel wall, which results in a response to injury wound healing (remodeling). The endothelium seems to be at the very center of these disease processes, acting as the first line of defense against these multiple metabolic toxicities and the first to encounter their damaging effects to the arterial vessel wall. RESULTS: The pathobiomolecular mechanisms of vascular calcification are presented in order to provide the clinician-researcher a database of knowledge to assist in the clinical management of these high-risk patients and examine newer therapies. Calciphylaxis is associated with medial arteriolar vascular calcification and results in ischemic subcutaneous necrosis with vulnerable skin ulcerations and high mortality. Recently, this clinical syndrome (once thought to be rare) is presenting with increasing frequency. Consequently, newer therapeutic modalities need to be explored. Intravenous sodium thiosulfate is currently used as an antidote for the treatment of cyanide poisoning and prevention of toxicities of cisplatin cancer therapies. It is used as a food and medicinal preservative and topically used as an antifungal medication. CONCLUSION: A discussion of sodium thiosulfate's dual role as a potent antioxidant and chelator of calcium is presented in order to better understand its role as an emerging novel therapy for the clinical syndrome of calciphylaxis and its complications.
