Risk factors for development of nephropathy in patients with a diabetic Charcot foot

Objective Charcot foot is a rare complication to neuropathy and can cause severe foot deformities and ulcerations, which often require prolonged antibiotical treatment. The objective of this retrospective study was to investigate whether this treatment is associated to impaired renal function. Results In total, 163 patients were included, of whom 105 (64%) had received β-lactam antibiotics for a mean total duration of 13.0 months. There was a significant increase in the urine albumin/creatinine ratio in the group that received antibiotics (p = 0.017), and the use of antibiotics was associated to a subsequent diagnosis of nephropathy (p = 0.01). Patients treated with antibiotics had a 21.9% risk of developing subsequent nephropathy versus 5.2% for patients not treated with antibiotics. We suggest increased awareness on signs of nephropathy in patients with severe Charcot foot.

Comparison of urine albumin creatinine ratio with the pediatric index of mortality 2 score for prediction of pediatric intensive care unit outcomes

Background Predicting morbidity and mortality in a pediatric intensive care unit (PICU) is of extreme importance to make precise decisions for better outcomes. Aim We compared the urine albumin creatinine ratio (ACR) with the established PICU score, pediatric index of mortality 2 (PIM 2) for predicting PICU outcomes. Methods This cross-sectional study enrolled 67 patients admitted to PICU with systemic inflammatory response syndrome. Urine ACR was estimated on admission, and PIM 2 score was calculated. ACR was compared with PIM 2 for PICU outcome measures: the need for inotropes, development of multiple organ dysfunction syndrome (MODS), duration of PICU stay, and survival. Results Microalbuminuria was found in 77.6% of patients with a median ACR of 80 mg/g. ACR showed a significant association with the need for inotropes (p < 0.001), MODS (p = 0.001), and significant correlation to PICU stay (p 0.001, rho = 0.361). The area under the receiver operating characteristic curve for ACR (0.798) was comparable to that of PIM 2 (0.896). The cutoff value of ACR derived to predict mortality was 110 mg/g. The study subjects were divided into 2 groups: below cutoff and above the cutoff. Outcome variables, inotrope use, MODS, mortality, and PICU stay compared between these subgroups, were statistically significant. Conclusion ACR is a good predictor of PICU outcomes and is comparable to PIM 2 for mortality prediction.

Role of spot urine albumin-creatinine ratio in predicting pre-eclampsia between 20-28 weeks of gestation

Preeclampsia is best characterized as a condition unique to pregnancy that can affect almost any organ system. Appropriate treatment can be given and its effects can be closely monitored. The only widely recognized procedure remains the 24hour urine collection. However, the protracted time involved in sample collection to final reporting in this method, renders it impractical. The current research was therefore aimed at determining the accuracy of the spot urine ratio of albumin-creatinine in asymptomatic pregnant women. Appropriate treatment if started at early stage of the disease helps in closely monitoring of the disease process.A hospital based prospective, observational study was conducted with 150 patients to establish whether a spot urine albumin-creatinine ratio measured between 20-28 weeks gestation could predict pre-eclampsia in asymptomatic pregnant woman in Department of Obstetrics and Gynecology, Kalinga Institute of Medical Sciences and PBM Hospital, Bhubaneswar between September 2018 and April 2020.Of the study group, 28 patients had high ACR value, with 25(89.3%) developed pre-eclampsia and 3(2.4%) remained normotensive whereas among 122 (81.3%) patients that were ACR negative 3 (10.7%) patients developed pre-eclampsia. ACR had a sensitivity of 89.29%, specificity 97.54%, positive predictive value of 89.29% and the negative predictive value is 97.54%.Our analysis showed that in pre-eclampsia patients, urine albumin-creatinine ratio (UACR) values were higher and UACR &#62;35.5 mg / mmol predicted pre-eclampsia well before clinical manifestations started. It is an easy, rapid and reasonably reliable method for predicting and assessing the severity of pre-eclampsia.

Urine Albumin/Creatinine Ratio and Microvascular Disease in Elderly Hypertensive Patients without Comorbidities

Objectives. A high urine albumin/creatinine ratio (UACR) is associated with microvascular disease in hypertensive patients. However, hypertensive patients frequently have other comorbidities. Thus, it is difficult to distinguish the role of UACR from that of comorbidities in microvascular disease. The aim of this study was to evaluate the association between UACR and microvascular disease in elderly hypertension patients without comorbidities. Methods. A cross-sectional cohort study of 2252 essential hypertension patients aged 65-94 years without comorbidities between January 1, 2016, and December 31, 2017, was conducted. Microvascular disease was evaluated by hypertension retinopathy (HR). Multivariable adjusted odds of HR by UACR quartiles were determined using logistic regression. Results. The HR prevalence was 22.1% ( n = 472 ) among the cohort study and was significantly different among UACR quartiles (19.7%, 20.3%, 22.0%, and 26.4% in quartiles 1, 2, 3, and 4, respectively, P = 0.036 ). After adjustment for covariates, higher UACR ( odds ratio OR = 1.42 , 95% confidence interval (CI) 1.05-1.92, quartile 4 versus 1) were significantly associated with HR. Among male patients, higher UACR ( OR = 1.65 , 95% CI 1.07-2.55, quartile 4 versus 1) were significantly associated with HR after adjustment for covariates. Among female patients, however, 64% and 40% increased odds of HR were noted in the highest and lowest UACR (quartiles 4 and 1, respectively) compared to UACR quartile 2. Conclusions. Microvascular disease was associated with higher UACR in elderly male essential hypertension patients without comorbidities but was associated with lower and higher UACR in female patients without comorbidities.

Effects of the Soluble Guanylate Cyclase Stimulator Praliciguat in Diabetic Kidney Disease

Background and objectivesImpaired nitric oxide signaling through soluble guanylate cyclase has been implicated in the pathophysiology of diabetic kidney disease. Praliciguat, a soluble guanylate cyclase stimulator that amplifies nitric oxide signaling, inhibited kidney inflammation and fibrosis in animal models.Design, setting, participants, & measurementsIn a phase 2 trial, 156 adults with type 2 diabetes, eGFR 30–75 ml/min per 1.73 m2, and urine albumin-creatinine ratio 200–5000 mg/g treated with renin-angiotensin system inhibitors were randomly allocated 1:1:1 to placebo, 20 mg praliciguat, or 40 mg praliciguat daily for 12 weeks. The primary efficacy and safety outcomes were change from baseline to weeks 8 and 12 in urine albumin-creatinine ratio and treatment-emergent adverse events, respectively. Other outcomes assessed were 24-hour ambulatory BP and metabolic parameters.ResultsOf 156 participants randomized, 140 (90%) completed the study. The primary efficacy analysis demonstrated a mean change from baseline in urine albumin-creatinine ratio of −28% (90% confidence interval, −36 to −18) in the pooled praliciguat group and −15% (−28 to 0.4) in the placebo group (difference −15%; −31 to 4; P=0.17). Between-group decreases from baseline to week 12 for praliciguat versus placebo were seen in mean 24-hour systolic BP (−4 mm Hg; −8 to −1), hemoglobin A1c (−0.3%; −0.5 to −0.03), and serum cholesterol (−10 mg/dl; −19 to −1). The incidence of treatment-emergent adverse events was similar in the pooled praliciguat and placebo groups (42% and 44%, respectively). Serious adverse events, events leading to study drug discontinuation, and events potentially related to BP lowering were reported at higher frequency in the 40-mg group but were similar in 20-mg and placebo groups.ConclusionsPraliciguat treatment for 12 weeks did not significantly reduce albuminuria compared with placebo in the primary efficacy analysis. Nonetheless, the observed changes in urine albumin-creatinine ratio, BP, and metabolic variables may support further investigation of praliciguat in diabetic kidney disease.Clinical Trial registry name and registration number:A Study to Evaluate the Soluble Guanylate Cyclase (sGC) Stimulator IW-1973 in Diabetic Nephropathy/Diabetic Kidney Disease as Measured by Albuminuria, NCT03217591

Study of association between urine albumin creatinine ratio and ankle brachial index or peripheral arterial disease in type 2 diabetes mellitus patients

Background: To establish association between urine albumin creatinine ratio and ankle brachial index or peripheral arterial disease in type 2 diabetes patients.Methods: Total 74 patients of type 2 diabetes mellitus of >50 years of age subjected to calculation of urine albumin creatinine ratio and ankle brachial index was calculated using doppler sonography and estimation of peripheral arterial diseases was done. The data obtained subjected to analysis.Results: In group with ABI <0.9 suggestive of PAD, mean age of the patient was 62.32±5.8 years, mean BMI was 26.11±2.48kg/m2, mean duration of diabetes was 11.19±41 years, 7 (18.92%) were smokers, 15 (40.54%) were insulin users, 27 (72.97%) were hypertensive, mean SBP was 142.49±13.46mmHg, mean DBP was 84±6.42mmHg, mean serum cholesterol was 221.35±17.10mg/dl, mean serum triglyceride was 242.81 ± 17.10mg/dl, mean serum HDL was 44.03±5.77mg/dl, mean serum LDL was 116.89±28.77mg/dl, mean urine ACR was 294.62±314.90mg/gm, prevalence of normoalbuminuria, microlbuminuria and macroalbuminuria was 12 (32.43%), 21 (56.76%) and 4 (10.81%) respectively. The statistical significant difference was found in age, duration of diabetes, number of patients on insulin therapy, systolic BP, serum cholesterol, triglyceride, LDL, HDL, urine ACR and distribution of albuminuria.Conclusions: we conclude that statistical significant relationship exist between urine ACR and PAD. Hence urinary ACR can be considered as surrogate marker for early prediction of PAD in elderly patients with type 2diabetes mellitus eventually leading to aggressive intervention for prevention and management.