Microalbuminuria in essential hypertension: A single centre study

To evaluate the prevalence of microalbuminuria in patients with essential hypertension and its relationship to severity of hypertension, to renal function and its association with coronary artery disease and target organ damage, present study was conducted. Total 100 primary hypertensive, non diabetic patients and 25 healthy normotensive, non diabetic patients (controls) admitted in S.S.G.H (Sir Sayajirao General Hospital) from June 2009 to November 2011. Patient's complete history, routine investigation along with microalbuminuria was measured by ACR by immunoturbidimetric method. In present study patient’s mean age was 52.7 years. Total 70% of patients selected for study were males and 30% were females. Total 50% to 75% of patients in the 61 -80 year age group were positive for microalbuminuria. Total 42.85% of males were positive for microalbuminuria as compared to 33.33% of females. Total 75% of patients having hypertension for more than 8 years had microalbuminuria. Total 67.5% of patients positive for microalbuminuria had associated target organ damage. Total 45% of patients positive for microalbuminuria had left ventricular hypertrophy and 40% of patients had hypertensive retinopathy. Microalbuminuria helps to identify incipient nephropathy and vascular changes. Its detection can thus help to prevent the development of complications by aggressive treatment to get down targeting blood pressure.

DIABETES INDUCED MICROALBUMINURIA - A CRITICAL REVIEW

Microalbuminuria is a marker and a risk factor of diabetic renal complications commences its role in path-ogenesis of nephropathy at its third stage, the stage of incipient nephropathy. Microalbuminuria is followed by overt nephropathy and end- stage renal disease of irreversible renal damage. Early detection of microal-buminuria has a decisive role in the healthy survival of diabetics. Urine albumin excretion rate and albumin creatinine ratio on timed urine samples, early morning samples or spot urine are of beneficial use. Ayurve-da describes diabetes mellitus as Prameha roga in which the major pathogenesis takes precedence in Moot-rasaya. Microalbuminuria can be described as Prameha Janya Vrikka Roga. It occurs due to Sanga (ob-struction), Vimarga Gamana (abnormal movement) of albumin; one of the constituents of Raktadhatu (blood) through Rakta and Mootra Vaha Srotas (channels of blood and urine). Medicines which are Pramehaghna (anti-diabetic), Mootra and Raktavaha Srothosodhana (cleanse the channels) may be of good worth to rectify the pathology of microalbuminuria providing an improved life for diabetics.

Microalbuminuria and Traditional Serum Biomarkers of Nephropathy among Diabetic Patients at Mbarara Regional Referral Hospital in South Western Uganda

Background. Diabetic nephropathy (DN) is a common finding in diabetic patients. Microalbuminuria is the earliest clinical evidence of DN. Early detection of microalbuminuria is very important; it allows timely interventions to prevent progression to macroalbuminuria and later end-stage renal disease (ESRD). Objectives. To determine the prevalence of microalbuminuria in diabetic patients and establish its association with traditional serum renal markers in assessment of incipient nephropathy. Methods. This cross-sectional study involved 140 participants with diabetes mellitus (DM) attending the diabetic clinic of Mbarara Regional Referral Hospital. Questionnaires were used to obtain participant data after obtaining written informed consent. Data collected included: age, sex, level of education, history of smoking and alcohol consumption, hypertension, body mass index, family history, and duration of DM. Morning spot urine samples were collected from each participant and blood drawn for analysis of other renal markers. Urine microalbumin was determined quantitatively using immunoturbidity assay (Microalbumin kit, Mindray). Serum creatinine and uric acid and glucose levels were determined by spectrophotometric methods. Results. The overall prevalence of microalbuminuria was 22.9%. Using a simple and multiple linear regression model, serum creatinine (β=0.010, 95% CI (0.005, 0.014), P=0.0001) and glucose (β=0.030, 95% CI (0.011, 0.048), P=0.0017) levels were significantly associated with microalbuminuria. After adjusting for linearity, family history of DM was the only predictor of microalbuminuria (β=0.275, 95% CI (0.043, 0.508), P=0.002). Although microalbuminuria was weakly associated with eGFR (OR=1.2, 95% CI (0.24, 5.96)), the relationship was not statistically significant (P=0.824). Conclusion. The prevalence of microalbuminuria in patients with diabetes in this study was high. The study suggests the need to screen for microalbuminuria early to reduce the possible burden of ESRD. When serum creatinine is used as a renal function marker among diabetic patients, it should be combined with microalbuminuria for better assessment of incipient nephropathy.

Assessing albuminuria in spot morning samples from diabetic patients

Microalbuminuria assessment is essential for diagnosing incipient nephropathy in diabetic patients. The present study aim to evaluate whether urinary albumin concentration (UAC) and urinary albumin-to-creatinine ratio (UACR) agree with 24 h urine collection in screening for albuminuria > 30 mg/24 h in type 1 and 2 diabetics. In this cross-sectional study were evaluated 293 diabetic patients (117 type 1 and 176 type 2). Albuminuria was determinated by turbidimetric immunoassay. The best discriminator value was 22 mg/l (sensitivity 82.5%, specificity 74.0%) for UAC and 27.3 mg/g creatinine (sensitivity 83.3%, specificity 80.9%) for UACR. Areas under ROC curves were 0.868 and 0.878, respectively (p = 0.53). Lower discriminators as 10 mg/l (sensitivity 94.2%, specificity 48.6%) and 10 mg/g creatinine (sensitivity 96.7%, specificity 49.1%) attained high sensitivities. UAC and UACR from spot morning urine had similar accuracy in screening microalbuminuria. The simplicity and lower cost of UAC justifies its preferential clinical use.

The Telmisartan Renoprotective Study from Incipient Nephropathy to Overt Nephropathy – Rationale, Study Design, Treatment Plan and Baseline Characteristics of the Incipient to Overt: Angiotensin II Receptor Blocker, Telmisartan, Investigation on Type 2 Diabetic Nephropathy (INNOVATION) Study

We planned the INNOVATION study to determine whether telmisartan, an angiotensin-2-receptor blocker, delays the progression of renal disease from incipient nephropathy to overt nephropathy in hypertensive or normotensive Japanese patients with type 2 diabetes mellitus. The INNOVATION study is a randomized, double-blind, placebo-controlled trial. Eligible patients must have incipient nephropathy (defined as a urinary albumin to creatinine ratio of 100-300 mg/g creatinine) and a serum creatinine concentration of < 1.5 mg/dl for men and < 1.3 mg/dl for women. Patients who need treatment with angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors are excluded. Eligible patients are randomly assigned to three groups: telmisartan titrated to 40 mg; telmisartan titrated to 80 mg; or placebo. The primary endpoint is the time from baseline visit to first detection of overt nephropathy (defined by a urinary albumin to creatinine ratio that is > 300 mg/g creatinine and 30% higher than the baseline on at least two consecutive visits). A total of 1855 patients have been enrolled from 160 study centres. In 527 randomized patients (28.4% of the enrolled patients), mean (SD) urinary albumin to creatinine ratio and serum creatinine concentration at baseline were 173.3 (47.2) mg/g creatinine and 0.78 (0.19) mg/dl. Sixty-eight per cent of the patients had hypertension at baseline. Mean (SD) systolic and diastolic blood pressures at baseline were 137.1 (14.6) and 77.5 (10.3) mmHg. The INNOVATION study will determine whether telmisartan, an angiotensin II receptor blocker, provides clinical benefits in hypertensive or normotensive patients with diabetes mellitus and diabetic nephropathy.