RESUMEN
In Mexico, chronic kidney disease of unknown origin is highly prevalent. Screening studies in adolescents have shown persistent microalbuminuria (pACR), adaptive podocytopathy and decreased kidney volume (KV). Here, we sought to develop normality tables of kidney dimensions by ultrasound in the Mexican state of Aguascalientes pediatric population (0 to 18y) and evaluate the relationship between the KV and pACR among the region's adolescents in a cross-sectional study. Kidney length (KL) and KV were determined by ultrasound. Our findings were compared with those in international literature of different populations where tables and graphs of normal kidney dimensions by ultrasound were reported. We compared organ dimensions in individuals above the age of 11 without albuminuria with those in patients with pACR recruited through screening studies in adolescents in Aguascalientes. This included 1068 individuals to construct percentile tables and graphs of the KL. Kidney dimensions were significantly lower when compared with all international comparisons. From a total 14,805 screen individuals, we compared 218 adolescents with pACR and 377 individuals without significant albuminuria. The Total KV adjusted to body surface (TKVBS) was significantly associated with pACR (odds ratio 1.03, 95% confidence interval 1.02-1.03). The upper quartile of TKVBS was highly associated with pACR (7.57, 4.13-13.87), hypertension (2.53, 1.66-3.86), and hyperfiltration (26 vs 11.5%). Thus, TKVBS is directly associated with pACR while greater KV, arterial hypertension, and hyperfiltration in patients with pACR suggest that the increase in volume is secondary to kidney hypertrophy. Additionally, the adaptative podocytopathy with low fibrosis seen on kidney biopsy which was performed in a subset of patients, and the smaller kidney dimensions in our population point to prenatal oligonephronia as the primary cause of the detected kidney disease.
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Hipertensión , Insuficiencia Renal Crónica , Humanos , Niño , Adolescente , Albuminuria/diagnóstico , Albuminuria/epidemiología , Albuminuria/etiología , Estudios Transversales , México/epidemiología , Tasa de Filtración Glomerular , Riñón/patología , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/complicaciones , Hipertensión/patologíaRESUMEN
AIM: Evaluate the expression of exomiRs-126, -146, and -155 in urinary exosomes of patients with T2DM and diabetic kidney disease to establish a predictive classification model with exomiRs and clinical variables in order to determine their contribution to DKD. METHODS: The study group included 92 subjects: 64 patients diagnosed with T2DM subclassified into two groups with albuminuria (T2DM with albuminuria, n = 30) and without albuminuria (TD2M, n = 34) as well as 28 healthy, non-diabetic participants. Exosomes were isolated from urine and identified by TEM and flow cytometry. Profile expression of exomiRs-126, -146 and -155 was evaluated by RT-qPCR. Data were analysed by permutational multivariate analysis of variance (PERMANOVA), similarity percentage (SIMPER), principal coordinate analysis (PCO), and canonical analysis of principal coordinates (CAP). RESULTS: T2DM patients with and without albuminuria showed higher levels of miR-155 and miR-146 compared with controls. In addition, T2DM patients with albuminuria presented a significant increase in miR-126 contrasted to controls and patients without albuminuria. PCO analysis explained 34.6% of the total variability of the data (PERMANOVA; p < .0001). Subsequently, SIMPER analysis showed that miR-146, miR-155, and miR-126 together, with some clinical parameters, contributed to 50% of the between-group significance. Finally, the CAP analysis developed showed a correct classification of 89.01% with the analysed parameters. CONCLUSION: A platform using a combination of clinical variables and exomiRs could be used to classify individuals with T2D as risk for developing DKD.
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Diabetes Mellitus Tipo 2 , Nefropatías Diabéticas , MicroARNs , Albuminuria/etiología , Albuminuria/genética , Biomarcadores , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/genética , Nefropatías Diabéticas/etiología , Nefropatías Diabéticas/genética , Femenino , Humanos , Masculino , MicroARNs/genética , MicroARNs/metabolismoRESUMEN
Non-coding RNA (ncRNA), released into circulation or packaged into exosomes, plays important roles in many biological processes in the kidney. The purpose of the present study is to identify a common ncRNA signature associated with early renal damage and its related molecular pathways. Three individual libraries (plasma and urinary exosomes, and total plasma) were prepared from each hypertensive patient (with or without albuminuria) for ncRNA sequencing analysis. Next, an RNA-based transcriptional regulatory network was constructed. The three RNA biotypes with the greatest number of differentially expressed transcripts were long-ncRNA (lncRNA), microRNA (miRNA) and piwi-interacting RNA (piRNAs). We identified a common 24 ncRNA molecular signature related to hypertension-associated urinary albumin excretion, of which lncRNAs were the most representative. In addition, the transcriptional regulatory network showed five lncRNAs (LINC02614, BAALC-AS1, FAM230B, LOC100505824 and LINC01484) and the miR-301a-3p to play a significant role in network organization and targeting critical pathways regulating filtration barrier integrity and tubule reabsorption. Our study found an ncRNA profile associated with albuminuria, independent of biofluid origin (urine or plasma, circulating or in exosomes) that identifies a handful of potential targets, which may be utilized to study mechanisms of albuminuria and cardiovascular damage.
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Albuminuria/etiología , Ácidos Nucleicos Libres de Células , Exosomas , Hipertensión/sangre , Hipertensión/complicaciones , ARN no Traducido/genética , Transcriptoma , Albuminuria/diagnóstico , Biomarcadores , Presión Sanguínea , Susceptibilidad a Enfermedades , Femenino , Perfilación de la Expresión Génica , Regulación de la Expresión Génica , Redes Reguladoras de Genes , Humanos , Hipertensión/diagnóstico , Hipertensión/etiología , Biopsia Líquida/métodos , MasculinoRESUMEN
Background: The state of Aguascalientes, Mexico, has been recognized as a chronic kidney disease hotspot. Screening studies have revealed a high prevalence of persistent albuminuria (pA), histologically characterized by glomerulomegaly, and incomplete podocyte fusion, probably associated with oligonephrony. To date, urinary biomarkers have not been explored in this population. Objective: The aim of the study was to identify the presence of potential biomarkers of early renal injury in patients with pA (pACR) and that correspond with the characteristic nephropathy profile that prevails in this entity. Methods: This is a cross-sectional, analytical, and comparative study. Four groups were recruited: adolescents aged 10-17 years with pACR, isolated albuminuria (iACR), no albuminuria (negative control), and adults with biopsy-confirmed glomerulopathy (positive control). Urinary excretion of SerpinA3, heat-shock protein-72 (HSP-72), podocalyxin (PCX), and nephrin was evaluated in urine samples. SerpinA3 and HSP-72 were analyzed by Western blot, and PCX and nephrin were quantified by enzyme-linked immunosorbent assay. Results: The mean GFR in the pACR group was 113.4 mL/min/1.73m2 and differed significantly only from that of the positive control group (65.1 mL/min/1.73m2). The mean albuminuria value in the pACR group was 48.9 mg/g. SerpinA3 concentration differed between groups (0.08 vs. 0.25 ng/mL, p < 0.001): it was significantly higher in the pACR group compared to the negative controls (p = 0.037). Conclusion: SerpinA3 was significantly associated with pA and could become a biomarker of early kidney injury. Further investigations are required to determine whether SerpinA3 precedes the development of albuminuria and its pathogenic role.
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Insuficiencia Renal Crónica , Serpinas , Adulto , Humanos , Adolescente , alfa 1-Antiquimotripsina , Prevalencia , Estudios Transversales , Albuminuria/epidemiología , Albuminuria/etiología , Insuficiencia Renal Crónica/epidemiología , Biomarcadores , Tasa de Filtración GlomerularRESUMEN
Background: The effect of glycemic control on diabetic kidney disease (DKD) is well known. Recent evidence has suggested that Vitamin D (VD) may have a nephroprotective effect in diabetes, but the relationship between VD, glycemic control, and albuminuria has yet to be clarified. Objective: Evaluate the relationship between 25-hydroxy-vitamin D [25(OH)D], HbA1c, and albuminuria in Diabetes Mellitus (DM). Patients and Methods: Cross-sectional study with 1576 individuals with DM who had 25(OH)D, HbA1c, and albuminuria levels measured. Patients with abnormal creatinine levels were excluded, in order to avoid interference on VD levels by impaired kidney function. Results: Patients with HbA1c ≥7% had lower 25(OH)D when compared to patients with HbA1c <7% (29.7 ± 10.2 vs 28.1 ± 9.9 ng/ml, p = 0.003) and 25(OH)D levels seems to predict 1.5% of HbA1c behavior. The 25(OH)D concentrations in patients with normoalbuminuria were higher than the levels observed in those with micro or macroalbuminuria (29.8 ± 9.0 vs 26.8 ± 8.6 and 25.1 ± 7.6, respectively, p = 0.001), patients who had 25(OH)D <20 ng/ml and 25(OH)D <30 ng/ml were at a higher risk of presenting albuminuria [OR = 2.8 (95% CI = 1.6 - 4.9), p<0.001, and OR = 2.1 (95% CI = 1.3 - 4.6), p<0.001, respectively]. In our regression model, albuminuria was influenced by HbA1c (r² = 0.076, p<0.00001) and 25(OH)D (r² = 0.018, p = 0.002) independently. Conclusion: Our study found an association between vitamin D levels, HbA1c and DKD. Additionally, our data suggest that the association between urinary albumin excretion and vitamin D levels is independent of glycemic control in patients with diabetes. Even though our patients presented normal creatinine levels, it is necessary further prospective studies to confirm if this association precedes or not the loss of renal function.
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Albuminuria/sangre , Diabetes Mellitus/sangre , Hemoglobina Glucada/metabolismo , Vitamina D/análogos & derivados , Anciano , Albuminuria/epidemiología , Albuminuria/etiología , Brasil/epidemiología , Estudios Transversales , Diabetes Mellitus/epidemiología , Nefropatías Diabéticas/sangre , Nefropatías Diabéticas/diagnóstico , Nefropatías Diabéticas/epidemiología , Nefropatías Diabéticas/etiología , Femenino , Control Glucémico/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Vitamina D/sangre , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/epidemiologíaRESUMEN
INTRODUCTION: Sickle cell anemia affects more than 30 million people worldwide. Chronic kidney disease develops in 40% of individuals. The death rate of patients with sickle nephropathy is still high, with little known predictors related to its development. To answer the question "What predictors are associated with the onset of chronic kidney disease in patients with sickle cell anemia?", this article seeks to contribute to a better understanding of sickle nephropathy, making possible a new look at the sickle cell anemia and its kidney complications. METHODS: A systematic review was developed, using the PRISMA recommendation, for cohort studies on predictors related to the outcome of sickle nephropathy in patients with sickle cell anemia. RESULTS: Initially 321 studies were identified in Pubmed, of which six were selected to compose this systematic review. Lower hemoglobin levels, increased ages and albuminuria were the most pointed predictors associated with chronic kidney disease. CONCLUSION: The main predictors associated with the development of chronic kidney disease in individuals with sickle cell anemia were lower hemoglobin levels, increased ages, and albuminuria. New studies evaluating predictors for the development of chronic kidney disease in sickle cell anemia are needed to better understand its installation and prevent its progression.
Asunto(s)
Anemia de Células Falciformes , Enfermedades Renales , Insuficiencia Renal Crónica , Albuminuria/etiología , Anemia de Células Falciformes/complicaciones , Estudios de Cohortes , Humanos , Riñón , Insuficiencia Renal Crónica/etiologíaRESUMEN
Objetivo: Caracterizar los pacientes con retinopatía diabética desde el punto de vista epidemiológico y clínico. Métodos: Se realizó un estudio descriptivo y transversal en el Centro Oftalmológico de Santiago de Cuba, desde octubre del año 2017 hasta octubre de 2019, en una población de 42 pacientes diabéticos tipo 2. Resultados: Predominaron los pacientes con tiempo de diabetes mellitus mayor de 10 años, y edades de 55 años o más (60,0 por ciento); el mayor porcentaje correspondió al color de piel negra (66,7 por ciento ); la agudeza visual mayor de 0,6 se presentó en el 49,4 por ciento de los casos; la retinopatía diabética proliferativa fue la más presentada con 55,9 por ciento. Hubo predominio, además, de los valores de hemoglobina glicosilada por encima del 7 por ciento y de la normoalbuminuria con 46,7 y 66,7 por ciento, respectivamente, en ambos grupos. Conclusiones: Los valores elevados de hemoglobina glicosilada y la normoalbuminuria se asocian, desde el punto de vista clínico, a la retinopatía diabética proliferativa(AU)
Objective: Characterize diabetic retinopathy patients from a clinical and epidemiological point of view. Methods: A descriptive cross-sectional study was conducted of 42 type 2 diabetic patients at Santiago de Cuba Ophthalmology Center from October 2017 to October 2019. Results: A predominance was found of patients who had had diabetes mellitus for more than 10 years and were aged 55 years or over (60.0 percent); black skin color prevailed with 66.7 percent; visual acuity above 0.6 was present in 49.4 percent of the cases, and proliferative diabetic retinopathy was the most common type (55.9 percent). In both groups glycosylated hemoglobin values above 7 percent prevailed, whereas normal albuminuria was predominant with 46.7 percent and 66.7 percent, respectively. Conclusions: High glycosylated hemoglobin and normal albuminuria values are clinically associated to proliferative diabetic retinopathy(AU)
Asunto(s)
Humanos , Persona de Mediana Edad , Hemoglobina Glucada/efectos adversos , Retinopatía Diabética/epidemiología , Albuminuria/etiología , Agudeza Visual , Epidemiología Descriptiva , Estudios Transversales , Hemoglobinuria/diagnósticoRESUMEN
SUMMARY INTRODUCTION: Sickle cell anemia affects more than 30 million people worldwide. Chronic kidney disease develops in 40% of individuals. The death rate of patients with sickle nephropathy is still high, with little known predictors related to its development. To answer the question "What predictors are associated with the onset of chronic kidney disease in patients with sickle cell anemia?", this article seeks to contribute to a better understanding of sickle nephropathy, making possible a new look at the sickle cell anemia and its kidney complications. METHODS: A systematic review was developed, using the PRISMA recommendation, for cohort studies on predictors related to the outcome of sickle nephropathy in patients with sickle cell anemia. RESULTS: Initially 321 studies were identified in Pubmed, of which six were selected to compose this systematic review. Lower hemoglobin levels, increased ages and albuminuria were the most pointed predictors associated with chronic kidney disease. CONCLUSION: The main predictors associated with the development of chronic kidney disease in individuals with sickle cell anemia were lower hemoglobin levels, increased ages, and albuminuria. New studies evaluating predictors for the development of chronic kidney disease in sickle cell anemia are needed to better understand its installation and prevent its progression.
Asunto(s)
Humanos , Insuficiencia Renal Crónica/etiología , Anemia de Células Falciformes/complicaciones , Enfermedades Renales , Estudios de Cohortes , Albuminuria/etiología , RiñónRESUMEN
Wholegrain (WG) consumption has been associated with reduced risk factors for cardiorenal metabolic diseases (CRMD). In Latin-America. WG intake is low and scarce studies on this subject have been found. We aimed to evaluate the association between WG consumption and risk factors for CRMD in the 2016-2017 Chilean-National Health Survey. This cross-sectional study included 3110 participants representative of a total population of 11,810,647 subjects > 18 y, not taking insulin and with complete data on CRMD risk factors. Outcomes were metabolic syndrome and its components, albuminuria, and impaired glomerular filtration rate (GFR). WG consumption was categorized as regular (≥every two days), sporadic (≥once a month), and non-consumers. Associations were analyzed by multivariable logistic regressions adjusted for confounders taking into account the complex sample design of the survey. Regular WG consumers showed a lower risk of high blood pressure (OR: 0.61, 95%CI: 0.41-0.91) compared to non-consumers in fully-adjusted models. Although inverse associations were noticed with other metabolic syndrome components and impaired GFR, none was statistically significant. The association between WG and BP remained robust in the sensitivity analysis. In conclusion regular WG consumption was associated with a 39% lower risk of high blood pressure in Chilean adults.
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Enfermedades Cardiovasculares/epidemiología , Dieta/estadística & datos numéricos , Síndrome Metabólico/epidemiología , Insuficiencia Renal Crónica/epidemiología , Granos Enteros , Adulto , Albuminuria/epidemiología , Albuminuria/etiología , Factores de Riesgo Cardiometabólico , Enfermedades Cardiovasculares/etiología , Chile , Estudios Transversales , Dieta/efectos adversos , Ingestión de Alimentos/fisiología , Femenino , Tasa de Filtración Glomerular , Encuestas Epidemiológicas , Humanos , Hipertensión/epidemiología , Hipertensión/etiología , Modelos Logísticos , Masculino , Síndrome Metabólico/etiología , Persona de Mediana Edad , Prevalencia , Insuficiencia Renal Crónica/etiología , Adulto JovenRESUMEN
RESUMEN Objetivo: Identificar la relación de la hemoglobina glicosilada y la albuminuria con la progresión de la retinopatía diabética. Métodos: Se realizó un estudio descriptivo y transversal en el Centro Oftalmológico de Santiago de Cuba desde octubre del año 2017 hasta octubre de 2019. La muestra fue de 42 pacientes diabéticos tipo 2. Resultados: Predominaron los pacientes con tiempo de diabetes mellitus mayor de 10 años y las edades de 55 años o más con el 60,0 por ciento. El color de piel negra fue mayor con 66,7 por ciento; la agudeza visual mayor de 0,6 se presentó en el 49,4 por ciento y la retinopatía diabética proliferativa fue la más presentada con 55,9 por ciento. Predominaron además valores de hemoglobina glicosilada mayores de 7 por ciento en ambos grupos y la normoalbuminuria fue la que predominó en ambos grupos con 46,7 y 66,7 por ciento. Conclusiones: Los valores elevados de hemoglobina glicosilada y la normoalbuminuria se asocian de forma clínica a retinopatía diabética proliferativa(AU)
ABSTRACT Objective: Identify the relationship of glycosylated hemoglobin and albuminuria to progression of diabetic retinopathy. Methods: A descriptive cross-sectional study was conducted at Santiago de Cuba Ophthalmology Center from October 2017 to October 2019. The sample was 42 type 2 diabetic patients. Results: A predominance was found of patients with diabetes mellitus for more than 10 years and the 55 years and over age group (60.0 percent). Black skin color prevailed with 66.7 percent, visual acuity above 0.6 was present in 49.4 percent, and proliferative diabetic retinopathy was the most common type (55.9 percent). In both groups glycosylated hemoglobin values above 7 percent prevailed and normal albuminuria was predominant with 46.7 percent and 66.7 percent. Conclusions: High glycosylated hemoglobin and normal albuminuria values are clinically associated to proliferative diabetic retinopathy(AU)
Asunto(s)
Humanos , Persona de Mediana Edad , Hemoglobina Glucada/efectos adversos , Agudeza Visual , Retinopatía Diabética/diagnóstico , Albuminuria/etiología , Epidemiología Descriptiva , Estudios TransversalesRESUMEN
Metformin, an AMP-activated protein kinase (AMPK) activator, has been shown in previous studies to reduce kidney fibrosis in different models of experimental chronic kidney disease (CKD). However, in all of these studies, the administration of metformin was initiated before the establishment of renal disease, which is a condition that does not typically occur in clinical settings. The aim of the present study was to investigate whether the administration of metformin could arrest the progression of established renal disease in a well-recognized model of CKD, the subtotal kidney nephrectomy (Nx) model. Adult male Munich-Wistar rats underwent either Nx or sham operations. After the surgery (30 days), Nx rats that had systolic blood pressures of >170 mmHg and albuminuria levels of >40 mg/24 h were randomized to a no-treatment condition or to a treatment condition with metformin (300 mg·kg-1·day-1) for a period of either 60 or 120 days. After 60 days of treatment, we did not observe any differences in kidney disease parameters between Nx metformin-treated and untreated rats. However, after 120 days, Nx rats that had been treated with metformin displayed significant reductions in albuminuria levels and in markers of renal fibrosis. These effects were independent of any other effects on blood pressure or glycemia. In addition, treatment with metformin was also able to activate kidney AMPK and therefore improve mitochondrial biogenesis. It was concluded that metformin can arrest the progression of established kidney disease in the Nx model, likely via the activation of AMPK.
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Proteínas Quinasas Activadas por AMP/metabolismo , Activadores de Enzimas/farmacología , Riñón/efectos de los fármacos , Metformina/farmacología , Nefrectomía , Insuficiencia Renal Crónica/prevención & control , Albuminuria/etiología , Albuminuria/metabolismo , Albuminuria/prevención & control , Animales , Modelos Animales de Enfermedad , Progresión de la Enfermedad , Activación Enzimática , Fibrosis , Hipertensión/etiología , Hipertensión/metabolismo , Hipertensión/prevención & control , Riñón/enzimología , Riñón/patología , Riñón/cirugía , Masculino , Mitocondrias/efectos de los fármacos , Mitocondrias/metabolismo , Mitocondrias/patología , Biogénesis de Organelos , Ratas Wistar , Insuficiencia Renal Crónica/etiología , Insuficiencia Renal Crónica/metabolismo , Insuficiencia Renal Crónica/patología , Factores de TiempoAsunto(s)
Humanos , Masculino , Persona de Mediana Edad , Cadenas kappa de Inmunoglobulina/análisis , Podocitos/inmunología , Enfermedades Renales/inmunología , Túbulos Renales Proximales/inmunología , Paraproteinemias/complicaciones , Dexametasona/uso terapéutico , Resultado del Tratamiento , Creatinina/sangre , Cristalización , Ciclofosfamida/uso terapéutico , Microscopía Electrónica de Transmisión/métodos , Diagnóstico Diferencial , Albuminuria/etiología , Quimioterapia Combinada , Podocitos/patología , Podocitos/ultraestructura , Lesión Renal Aguda/diagnóstico , Bortezomib/uso terapéutico , Enfermedades Renales/diagnóstico por imagen , Túbulos Renales Proximales/ultraestructura , Antiinflamatorios/uso terapéutico , Antineoplásicos/uso terapéuticoAsunto(s)
Cadenas kappa de Inmunoglobulina/análisis , Enfermedades Renales/inmunología , Túbulos Renales Proximales/inmunología , Podocitos/inmunología , Lesión Renal Aguda/diagnóstico , Albuminuria/etiología , Antiinflamatorios/uso terapéutico , Antineoplásicos/uso terapéutico , Bortezomib/uso terapéutico , Creatinina/sangre , Cristalización , Ciclofosfamida/uso terapéutico , Dexametasona/uso terapéutico , Diagnóstico Diferencial , Quimioterapia Combinada , Humanos , Hipopotasemia/etiología , Inmunosupresores/uso terapéutico , Enfermedades Renales/diagnóstico por imagen , Enfermedades Renales/patología , Túbulos Renales Proximales/patología , Túbulos Renales Proximales/ultraestructura , Masculino , Microscopía Electrónica de Transmisión/métodos , Persona de Mediana Edad , Paraproteinemias/complicaciones , Podocitos/patología , Podocitos/ultraestructura , Resultado del TratamientoRESUMEN
BACKGROUND: Protein supplement use is common in bodybuilders because protein supplements are thought to increase muscle mass by preventing protein catabolism during exercise routines. Information on the consequences of protein supplement use is scarce and contradictory. Therefore, the identification of a kidney damage marker, such as microalbuminuria, could be transcendent in preventing probable organ compromise in healthy persons. The aim of this study is to determine the presence of microalbuminuria in gym members and whether there is an associated risk with protein supplement use. METHODS: An analytic, descriptive, cross-sectional study was conducted. It included gym members whose clinical and nutritional histories were taken, identifying protein supplement use. Microalbuminuria was then determined through a random urine sample. Descriptive and inferential statistics were used for the data analysis. The objective was to determine the presence of microalbuminuria in gym members and whether there is an associated risk with protein supplement use. RESULTS: A total of 107 gym members, 71 men and 36 women, that met the inclusion criteria of the study were analyzed. Their mean age was 35±13 years, and the prevalence of microalbuminuria was 9.34%. There was active protein supplement use in 58% of the study participants, with a mean consumption duration of 16±22 months. No association with the presence of microalbuminuria was found (P=0.35). CONCLUSIONS: The prevalence of microalbuminuria in gym members was higher than that of the general healthy population and was not associated with protein supplement use.
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Albuminuria/etiología , Diosgenina/efectos adversos , Fitosteroles/efectos adversos , Proteínas/metabolismo , Adulto , Albuminuria/metabolismo , Estudios Transversales , Ejercicio Físico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Proteínas/efectos adversos , Adulto JovenRESUMEN
BACKGROUND: After two-years of follow-up of 263 apparently healthy 18- to 30-year-old men in communities affected by Mesoamerican nephropathy (MeN), we identified three distinct case groups: a subgroup with (i) established renal dysfunction (case-group 1); individuals with (ii) a rapid decline in kidney function (case-group 2); and individuals with (iii) stable kidney function (non-cases). This paper investigates whether local tests are potentially useful for the timely identification of these case groups. METHODS: Creatinine levels were measured in local laboratories every six months for two years. Aliquots were sent to a centralized laboratory for measurements of cystatin C and creatinine levels. We investigated agreement between the locally and centrally measured creatinine-based Chronic Kidney disease Epidemiology Collaboration (CKD-EPI) equation for estimating the Glomerular Filtration Rate (eGFR). A logistic regression analysis was used to assess predictive factors for case groups 1 and 2 compared to non-cases. Predictive variables were locally measured eGFR, and urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels. The discrimination performance of the model was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS: Considerable variation in local eGFR measurements was observed. The prediction model for case-group 1 included baseline kidney function and with or without uNGAL (AUC = 0.98, 95% confidence interval (CI), 0.91-1.00). The prediction model for case-group 2 also required eGFRScr at six and twelve months after baseline, with or without uNGAL levels (AUC = 0.88; 95% CI 0.80-0.99). CONCLUSIONS: Established renal dysfunction was detected at a single time point using local measurements and uNGAL. For the detection of a rapid decline in kidney function over time, at least 2 more measurements at six and twelve months are needed.
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Pruebas de Función Renal , Riñón/fisiopatología , Insuficiencia Renal Crónica/epidemiología , Adolescente , Adulto , Albuminuria/etiología , Albuminuria/orina , Área Bajo la Curva , Creatinina/sangre , Creatinina/orina , Cistatina C/sangre , Progresión de la Enfermedad , Enfermedades Endémicas , Estudios de Seguimiento , Tasa de Filtración Glomerular , Humanos , Lipocalina 2/sangre , Masculino , Nicaragua/epidemiología , Curva ROC , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/fisiopatología , Insuficiencia Renal Crónica/orina , Riesgo , Encuestas y Cuestionarios , Adulto JovenAsunto(s)
Albuminuria/etiología , Albuminuria/orina , Anemia de Células Falciformes/complicaciones , Peptidil-Dipeptidasa A/orina , Factores de Edad , Albuminuria/diagnóstico , Anemia de Células Falciformes/diagnóstico , Enzima Convertidora de Angiotensina 2 , Biomarcadores , Niño , Susceptibilidad a Enfermedades , Humanos , Sistema Renina-AngiotensinaRESUMEN
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.
Asunto(s)
Creatinina/sangre , Cistatina C/sangre , Diabetes Mellitus Tipo 1/sangre , Nefropatías Diabéticas/sangre , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Urea/sangre , Adulto , Albuminuria/etiología , Albuminuria/fisiopatología , Biomarcadores/sangre , Diabetes Mellitus Tipo 1/fisiopatología , Nefropatías Diabéticas/fisiopatología , Ensayo de Inmunoadsorción Enzimática , Femenino , Tasa de Filtración Glomerular , Humanos , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
INTRODUCTION: Living kidney donor (LKD) transplantation is increasing due to organ shortage. Clinical studies have shown that the risk of developing end-stage renal disease (ESRD) in donors is similar to that in the general population. Our goal was to evaluate postdonation renal outcomes assessed by glomerular filtration rate (GFR), proteinuria, and blood pressure. METHODS: A total of 210 LKD transplants were performed at Hospital Italiano de Buenos Aires between 2000 and 2014. Postdonation outcomes were analyzed in 109 donors. GFR was assessed by 24-hour creatinine clearance (as 24-hour ClCr) and estimated using the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. Additionally, we correlated the predonation renal functional reserve (RFR) with postdonation GFR. Donor results were compared to the expected GFR (adjusted to age and single kidney). Other renal outcome indicators measured were albuminuria and blood pressure, and they were compared (predonation and postdonation) using univariate analysis. RESULTS: A total of 109 patients were followed up for 47 ± 34 months (range, 12-168): 70% were female, age at donation was 48.58 years (range, 25-70), and predonation serum creatinine was 0.85 ± 0.17 mg/dL. Postnephrectomy GFR (24-hour ClCr) was significantly lower compared to predonation GFR (105.38 ± 21.78 mL/min/1.73 m2 vs 90.14 ± 17.78 mL/min/1.73 m2). However, postdonation GFR was not significantly different compared to the expected GFR. No differences were found for blood pressure or albuminuria. Age >50 and an RFR (<20%) was associated with a lower GFR. CONCLUSIONS: In this population of LKD, renal outcome (24-hour CrCl, albuminuria, and blood pressure) was within the expected outcome for healthy individuals after uninephrectomy.
Asunto(s)
Donadores Vivos , Nefrectomía/efectos adversos , Complicaciones Posoperatorias/epidemiología , Insuficiencia Renal Crónica/epidemiología , Recolección de Tejidos y Órganos/efectos adversos , Adulto , Anciano , Albuminuria/epidemiología , Albuminuria/etiología , Albuminuria/fisiopatología , Argentina/epidemiología , Presión Sanguínea , Creatinina/sangre , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular/fisiología , Humanos , Riñón/fisiopatología , Pruebas de Función Renal , Trasplante de Riñón , Masculino , Persona de Mediana Edad , Nefrectomía/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Periodo Posoperatorio , Proteinuria/epidemiología , Proteinuria/etiología , Proteinuria/fisiopatología , Insuficiencia Renal Crónica/etiología , Insuficiencia Renal Crónica/fisiopatología , Tiempo , Recolección de Tejidos y Órganos/métodosRESUMEN
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.