Comparison of methods for determination of microalbuminuria in diabetic patients

Microalbuminuria is an early marker of prognostic significance in diabetic renal disease. The aim of the present study was to compare methods which do not require radioactive markers for estimating microalbuminuria (20-300 mg l-1) with a radioimmunoassay for albumin estimation. Albumin concentrations of 329 diabetic patients were measured using two laser turbidimetric methods for albuminuria and proteinuria, two semiquantitative tests (Albusure and Albustix), and a routine albumin radioimmunoassay. The four methods in the order laser immunoturbidimetric for albuminuria, laser turbidimetric for proteinuria, Albusure and Albustix gave the following results: sensitivity 0.97, 0.93, 0.97 and 0.81; specificity 0.92, 0.88, 0.94 and 0.55; positive predictive value for microalbuminuria 0.83, 0.75, 0.85 and 0.42; negative predictive value for microalbuminuria 0.99, 0.97, 0.99 and 0.88. We suggest that both laser turbidimetric methods are reliable and can replace methods with radioactive markers, the same being true for the Albusure test.     

Rapid screening test evaluation for microalbuminuria in diabetes mellitus

Microalbuminuria predicts clinical nephropathy and cardiovascular disease in diabetes mellitus. This study was undertaken to evaluate a screening microalbuminuria test with the Micral test II dipstick in a general practice setting and compare whether, if three urine samples are tested, any advantage is offered over a testing single sample. Two hundred and eighty diabetic patients attending a primary health care centre were studied. The first morning urine albumin concentration was determined by dipstick over 3 consecutive days. We studied two valuation methods: Method 1. Three-sample method: the test was considered positive if albumin was equal to or above 20 mg/l in at least two of three tests; Method 2. Single-sample method: we selected the third test, i.e. the most recent urine sample; if albumin was equal to or above 20 mg/l it was considered positive. The gold standard was the albumin excretion rate measured by a nephelometric method in a 24-h urine collection. Sensitivity, specificity, predictive values and Kappa coefficient were calculated. The diagnostic performance was assessed by a receiver operating characteristic curve. Microalbuminuria was defined for different thresholds of albumin excretion rate, 15, 20, 25 and 30 μg/min: their frequency was 38, 29, 23 and 18%, respectively. For method 1, the sensitivity of Micral test II oscillated between 70–94% and the specificity between 93–83%. For method 2, the sensitivity oscillated between 64–86%, and the specificity between 88–80%. Both methods had a high diagnostic performance. The Kappa coefficient was 84 and 60% for method 1 and 2, respectively. The Micral test II is a rapid, valid and reliable method for microalbuminuria screening in diabetic patients. It constitutes an important tool for diabetic surveillance in general practice. Although the use of three samples provides better results, the use of a single sample produces acceptable results at a low cost. Received: 12 September 1997 / Accepted in revised form: 4 September 1998     

Prevalence of hypertension and microalbuminuria in adult type 1 (insulin-dependent) diabetic patients without renal failure in Italy. I. Validation of screening techniques to detect microalbuminuria

The prevalence of microalbuminuria and arterial hypertension among type 1 (insulin-dependent) diabetic patients is poorly known in Italy. In the preliminary phase of a large outpatient screening programme, we addressed the possibility of using non-time urine samples to predit the chance of detecting albumin excretion rate (AER) in the range of microalbuminuria. We therefore measured urinary albumin and creatinine concentration in timed overnight collections from 641 type 1 diabetic patients with serum creatinine levels lower than 133 mol/l. AER was strongly and comparably predicted both by urinary albumin concentration (U_Alb;r ²=0.754) and by the urinary albumin to creatinine concentration ratio (A/C;r ²=0.773). After exploring several independent cut-off levels for U_Alb and A/C, AER in the range 20–200 g/min (n=91) was found to be predicted with 90% sensitivity and specificity either by U_Alb20 mg/l or by A/C2.0 mg/mmol. U_Alb was negatively associated with diuresis, and false negative outcomes were explained by polyuria when screening by this variable. A/C was positively associated with female gender among normoalbuminuric patients, in line with the lower urinary excretion of creatinine in women (7.2±0.25 vs 10.2±0.35 mol/min,P<0.00001). A significant excess of false positive outcomes in women compared with men was found when screening by any A/C cut-off level equal to or less than 2.5 mg/mmol. Simplified screening techniques seem to remain, however, a practicable option for the detection of microalbuminuria both in epidemiology and in clinical practice.See Appendix     

Comparison of overnight, morning and 24-hour urine collections in the assessment of diabetic microalbuminuria

With the aim of comparing different urine collection periods in the assessment of micro-albuminuria, urinary albumin excretion rates (AERs) were measured in samples from 24 h, overnight, and morning urine collections in 54 patients aged 17 to 62 years with insulin-dependent diabetes mellitus with a mean duration of 15 years. The AER in overnight urine was found to be reduced by 25% compared to the rate in 24 h and morning urine. Assessing the ability to predict a 24 h AER within the microalbuminuric range (20-200 micrograms/min) we found a sensitivity of 90% and a specificity of 88% for both overnight and morning urine samples. These values were slightly improved by relating AER to the excretion of creatinine and it is concluded that overnight as well as morning urine collections can be used when diagnosing microalbuminuria in insulin-dependent diabetics. Furthermore the results show that the albumin to creatinine ratio in morning urine is a reliable estimate of 24 h AER and better than measurement of the albumin concentration alone.     

糖尿病心率变异性分析与微量白蛋白尿的关系

目的 探讨糖尿病患者微白蛋白尿与心脏自主神经病变之间的关系。方法 应用２４小时动态心率变异性（ＨＲＶ）频率分析技术,对４６例糖尿病患者及３１例正常对照者测定了ＨＲＶ,并与尿白蛋白排泄率作相关分析。结果 糖尿病患者在不同尿白蛋白排泄（ＵＡＥ）阶段,心率变异性时域分析各项指标参数均为降低,其中伴微白蛋白尿组（ＤＭＢ）较正常蛋白尿组（ＤＭＡ）ＨＲＶ各项参数降低更明显,有极显著性差异（Ｐ〈０．０１）。糖尿     

High-dose thiamine therapy for patients with type 2 diabetes and microalbuminuria: a randomised, double-blind placebo-controlled pilot study

Aims/hypothesis  High-dose supplements of thiamine prevent the development of microalbuminuria in experimental diabetes. The aim of this pilot study was to assess whether oral supplements of thiamine could reverse microalbuminuria in patients with type 2 diabetes. Methods  Type 2 diabetic patients (21 male, 19 female) with microalbuminuria were recruited at the Diabetes Clinic, Sheikh Zayed Hospital, Lahore, Pakistan, and randomised to placebo and treatment arms. Randomisation was by central office in sequentially numbered opaque, sealed envelopes. Participants, caregivers and those assessing the outcomes were blinded to group assignment. Patients were given 3 × 100 mg capsules of thiamine or placebo per day for 3 months with a 2 month follow-up washout period. The primary endpoint was change in urinary albumin excretion (UAE). Other markers of renal and vascular dysfunction and plasma concentrations of thiamine were determined. Results  UAE was decreased in patients receiving thiamine therapy for 3 months with respect to baseline (median −17.7 mg/24 h; p < 0.001, n = 20). There was no significant decrease in UAE in patients receiving placebo after 3 months of therapy (n = 20). UAE was significantly lower in patients who had received thiamine therapy compared with those who had received placebo (30.1 vs 35.5 mg/24 h, p < 0.01) but not at baseline. UAE continued to decrease in the 2 month washout period in both groups, but not significantly. There was no effect of thiamine treatment on glycaemic control, dyslipidaemia or BP. There were no adverse effects of therapy. Conclusions/interpretation  In this pilot study, high-dose thiamine therapy produced a regression of UAE in type 2 diabetic patients with microalbuminuria. Thiamine supplements at high dose may provide improved therapy for early-stage diabetic nephropathy. Trial registration: CTRI (India) CTRI/2008/091/000112 Funding: Pakistan Higher Education Commission     

Microalbuminuria in diabetes: a population study of the prevalence and an assessment of three screening tests

A single observer reviewed 842 of the 917 known diabetic patients registered with 40 GPs in the Poole area. A midstream urine specimen was tested for proteinuria using Albustix (Ames) and cultured to detect bacterial infection. After the first 3 months of the survey, the aliquot of this specimen was frozen for later determination of the random albumin/creatinine ratio (R-Alb/Creat). Patients were requested to submit a timed overnight urine collection for estimation of urinary albumin excretion rate (AER). Of the 842 patients reviewed, 493 (59%) submitted timed overnight urine collections; 43 were excluded because of urinary infection and/or proteinuria. One hundred and thirty-three (30%) of 450 diabetic patients were found to have microalbuminuria, although only 31 (7%) had an AER greater than 30 micrograms/min. Six hundred and seven urine samples were collected for R-Alb/Creat but 68 were excluded because of infection and/or proteinuria; in 10 further samples urinary creatinine was not measured. Two hundred and four (38%) of 532 diabetic patients were found to have an elevated R-Alb/Creat. There was a significant correlation between AER and R-Alb/Creat (r = 0.32, p less than 0.001) but a considerable number of patients showed either a normal AER and high R-Alb/Creat or the reverse. The value of R-Alb/Creat or an overnight urinary albumin concentration, or an overnight urinary albumin/creatinine ratio (ON-Alb/Creat) as screening tests to predict AER greater than 30 micrograms/min was assessed. An ON-Alb/Creat greater than 2.0 mg/mmol was the optimal screening test (sensitivity 96% and specificity 99.7%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Microalbuminuria in diabetes: relationships between urinary albumin excretion and diabetes-related variables

A single observer reviewed 842 of the 917 known diabetic patients registered with 40 GPs in the Poole area. Fifty-nine per cent (493) of those reviewed submitted a timed overnight urine collection to measure albumin excretion rate (AER) and overnight albumin/creatinine ratio (ON-Alb/Creat); 43 samples were excluded because of urinary tract infection and/or proteinuria. A random urine sample was obtained in 607 diabetic patients to measure the random albumin/creatinine ratio (R-Alb/Creat); 68 specimens were excluded because of infection and/or proteinuria, and in a further 10 samples urinary creatinine was not measured. Stepwise multiple regression analyses found significant associations with the following variables: for AER, blood glucose (p = 0.001), smoking category (p = 0.002), sex (p = 0.034), and systolic blood pressure (p = 0.035); for R-Alb/Creat, blood glucose (p = 0.001), retinopathy (p = 0.004), systolic blood pressure (p = 0.004), diastolic blood pressure (p = 0.015), coronary artery disease (p = 0.02), sex (p = 0.034), and vibration sense (p = 0.038). Interestingly, glycosylated haemoglobin was not a significant determinant of albuminuria in either analysis.     

老年2型糖尿病患者纤维蛋白原与尿微量白蛋白的相关性研究

目的探讨老年2型糖尿病患者正常范围内血浆纤维蛋白原(FIB)与尿微量白蛋白(UMA)的相关性。方法收集2012年10月至2014年10月上海市第五人民医院收治的869例老年2型糖尿病患者的临床资料。将患者按FIB四分位数分为Q1组(<2.42 g/L)、Q2组(2.42~2.89 g/L)、Q3组(2.90~3.61 g/L)、Q4组(≥3.62 g/L),分析FIB与尿白蛋白与肌酐比值(UACR)的相关性。结果随着FIB水平升高,UACR水平显著升高(P<0.05)。Pearson相关分析显示,在男性和女性患者中FIB与年龄、糖尿病病程、肌酐和UACR均呈显著正相关(P<0.01)。多元逐步回归分析显示FIB是UACR的独立影响因素(P<0.01)。Logistic多元回归分析显示,在校正性别、年龄、糖尿病病程、体重指数(BMI)、收缩压、舒张压、空腹血糖(FPG)、HbAlC、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、肌酐、丙氨酸氨基转移酶(ALT)、吸烟史和饮酒史因素后,Q4组发生微量白蛋白尿和大量白蛋白尿的危险性分别是Q1组的4.536倍(95%CI 2.516~8.175,P<0.01)和13.314倍(95%CI 2.925~60.612,P<0.01),Q3组发生微量白蛋白尿和大量白蛋白尿的危险性分别是Q1组的2.177倍(95%CI 1.273~3.724,P<0.01)和4.098倍(95%CI 1.101~19.226,P<0.05)。以UACR 30 mg/g和300 mg/g为分界值,分别行FIB与UACR的ROC曲线所得FIB的最佳切点值分别为3.18 g/L和3.22 g/L。结论老年2型糖尿病患者血浆FIB与UMA密切相关,可能是糖尿病肾病的预测指标之一。     

Incidence of diabetic nephropathy in patients with type 2 diabetes mellitus at a tertiary healthcare setting in Ethiopia

Background and aimsDiabetic nephropathy (DN) is a leading cause of morbidity and mortality in diabetic patients representing a huge health and economic burden. Despite the increasing number of patients with Diabetes Mellitus in Ethiopia, the incidence of diabetic nephropathy in patients with DM has not been well established. Therefore, this study aimed to estimate the incidence and predictors of DN in patients with T2DM at tertiary healthcare setting, Ethiopia.MethodsAn institution based retrospective follow study was conducted from March 1 to April 28, 2019. Kaplan-meier survival curve together with log rank test were used. Cox proportional hazard model was used at 5% level of significance to determine the net effect of each explanatory variable on diabetic nephropathy. An assumption was check by schoenfeld residual test.ResultsThe incidence rate of diabetic nephropathy was 3.6% per 100 person-years (95% CI = 2.49–11.47). The median time to develop nephropathy was 100(95% CI, 96.7–107) months. Predictors of diabetic nephropathy were males (AHR: 2.7, 95%CI: 1.39, 5.23), long duration of diabetes (AHR: 1.03, 95%CI: 1.01, 1.06), HbA1c> 7% (AHR: 1.74, 95% CI: 1.67, 3.12), high density lipoprotein (AHR: 0.37, 95% CI: 0.16, 0.83), and mixed anti-diabetic therapy (AHR: 0.07, 95% CI: 0.01, 0.59).ConclusionThe incidence of diabetic nephropathy among T2DM patients was relatively high. Males, longer duration of diabetes, HbA1c, and fasting blood glucose were increase the risk of diabetic nephropathy.     

中国内地2型糖尿病合并高血压患者微量白蛋白尿检出率调查

目的调查内分泌科及心内科门诊中糖尿病合并高血压患者微量白蛋白尿（MA）检出率。方法多中心连续收集2型糖尿病合并高血压患者共2473例,采用统一调查表记录患者糖尿病、高血压控制情况及相关并发症,测量血压。采用Micral-Ⅱ试纸半定量比色法筛查尿微量白蛋白。结果2型糖尿病合并高血压患者MA的检出率为42．9％,大量白蛋白尿检出率17．0％。多因素回归分析显示,患者年龄、收缩压水平、空腹血糖水平以及BMI与糖尿病合并高血压患者MA的发生独立相关;除上述因素外,尚有糖尿病病程、应用利尿剂与大量白蛋白尿的发生独立相关。结论在2型糖尿病合并高血压患者中MA检出率极高,MA筛查及强力降压治疗甚为重要。     

2型糖尿病患者合并非糖尿病肾病的临床诊断

目的　分析 2型糖尿病 (DM )患者合并非糖尿病肾病 (NDRD)与糖尿病肾病 (DN )在临床表现、病程、病理改变的异同 ,以指导临床诊断与治疗。方法　 2型DM患者 3 4例分为两组 ,合并NDRD组 2 2例 ,单纯DN组 12例。对两组发病年龄、糖尿病病程、蛋白尿、血尿、肾功能、高血压、视网膜病变、肾脏病理等资料进行对比分析。结果　DM病程在NDRD组短于DN组 ;两组蛋白尿程度相似 ;血尿伴蛋白尿的发生率在NDRD组略多于DN组 ;肾功能损害在NDRD组更显著 ;伴高血压者DN组多于NDRD。视网膜病变并发率在DN组为 10 0 % ,且为Ⅱ～Ⅳ期病变 ,NDRD组仅有 2例伴发Ⅱ期病变。 3 0例患者行肾穿刺活检 ,12例呈不同阶段的DN ,18例伴发不同类型的肾小球肾炎。结论　糖尿病合并非糖尿病肾病者平均糖尿病病程多 <5年 ;突然出现大量蛋白尿、水肿、而肾功能正常者 ;单纯肾性血尿 ,或血尿加蛋白尿者 ;肾功能迅速减退者 ;不伴视网膜病变者 ;肾小管功能受损显著者 ,应考虑为DM并发非糖尿病性肾病     

Oxidative stress parameters as possible urine markers in patients with diabetic nephropathy

ObjectiveReactive oxygen species play a crucial role in the pathogenesis of diabetic nephropathy (DN). The present study was performed to assess oxidative stress parameters—thiobarbituric acid reactive substances (TBARS), reactive carbonyl derivates (RCDs), and total sulfhydryl groups (TSHGs)—in serum and urine of patients with DN.MethodsAll parameters were determined in patients with type 2 and type 1 diabetes mellitus and microalbuminuria (DMT2-MIA, DMT1-MIA, respectively) and patients with type 2 diabetes mellitus and macroalbuminuria (DMT2-MAA) compared to healthy controls.ResultsSerum and urine TBARS levels were higher in all patients with DN and microalbiminuria compared to the control group. RCD levels significantly increased in serum of patients with DMT2 relative to the controls as well as in urine of patients with DMT2-MAA and DMT1-MIA. In all groups of patients, TSHGs decreased in serum but not in urine of patients with DMT2-MAA.ConclusionUrine TBARS, RCDs, and TSHGs could be proposed as possible markers for oxidative damage of kidney in DN.     

电话教育对糖尿病视网膜病变筛查的影响

目的 研究电话教育和邮寄教育材料对糖尿病患者完成视网膜病变筛查的影响.方法 300例既往未进行过糖尿病视网膜病变筛查的门诊2型糖尿病患者采用计算机完全随机法分为对照组、邮寄组和电话组,每组各100例.对照组患者进行常规诊疗,邮寄组与电话组患者除常规诊疗外,分别予邮寄糖尿病教育材料1次、电话进行糖尿病教育1次,比较3组患者在纳入研究后6个月内完成糖尿病视网膜病变筛查的情况.所有入组对象均完成人口与社会学资料登记并且记录在整个研究过程中的平均空腹血糖、餐后血糖及糖化血红蛋白情况.结果 3组患者性别、年龄、常住地、受教育程度、经济收入、就诊难易程度、自身对血糖控制的满意程度、对糖尿病视网膜病变的知晓情况、体重指数、糖尿病病程、空腹血糖、餐后血糖、糖化血红蛋白、慢性并发症情况均无统计学差异（P＞0.05）.3组患者视网膜病变筛查的完成率分别为26.0％（25/96）、16.2％（16/99）、45.7％（43/94）,差异具有统计学意义（x2=21.105,P＜0.05）.与对照组相比,电话组视网膜病变筛查完成率提高了75.8％（P＜0.01）,邮寄组的完成率较低,尚未达统计学差异（P＞0.05）.女性、受教育程度较高、糖尿病病程较长的患者更可能完成视网膜病变筛查.结论 电话教育是一种有效的促进糖尿病患者完成视网膜病变筛查的方法.     

低分子蛋白尿对2型糖尿病肾病病程进展的提示作用

目的　观察低分子蛋白尿对 2型糖尿病微量蛋白尿患者进展到临床糖尿病肾病的预后判断作用。　方法　对 6 6例 2型糖尿病伴微量蛋白尿患者的尿α1$C微球蛋白 (α1 MG)、视黄醇结合蛋白 (RBP)、N 乙酰 β D 氨基葡萄糖苷酶 (NAG)和 β2 微球蛋白 (β2 MG)排泄量进行检测 ,然后对患者进行 (4 18± 0 6 1)年随诊 ,根据随诊期间患者是否进展到临床糖尿病肾病将患者分为进展组和未进展组。　结果　 6 6例患者中有 18例在随诊期间进展到临床糖尿病肾病 ,进展组初始尿α1 MG、RBP、NAG水平显著高于未进展组 (α1 MG :4 33± 2 15、1 5 0± 0 2 7mg/L ;RBP :6 3 6± 36 6、18 8±19 6ng/mmol;NAG :14 2± 1 4 4、2 4 5± 2 0 9U/mmol;均为P <0 0 1) ,但尿 β2 MG水平两组间差异无显著性。进展组中初始尿α1 MG有 83 3%、RBP有 88 9%、NAG有 4 4 4 %高于正常值 ,显著高于未进展组 (P <0 0 1) ,但两组间初始尿 β2 MG异常者百分比差异无显著性。随诊期间两组患者平均糖化血红蛋白、血脂、血压均无明显差别。　结论　 2型糖尿病微量蛋白尿患者尿α1 MG、RBP、NAG的测定有助于预测患者是否可能进展到临床糖尿病肾病 ,尿α1 MG、RBP、NAG水平的升高可能是早期糖尿病肾病的临床特征之一 ,值得进一步研     

糖尿病患者尿内皮素排量变化及其临床意义

目的　为研究尿内皮素（ Ｕ Ｅ Ｔ） 与糖尿病肾损害的可能关系和作用。方法　以放免法直接检测５２ 例正常人、３０ 例糖尿病、２８ 例早期糖尿病肾病和２５ 例糖尿病肾病患者 Ｕ Ｅ Ｔ 排量。结果各疾病组 Ｕ Ｅ Ｔ 排量显著高于正常人组（ Ｐ＜ ０ ．０１） 。糖尿病组尿白蛋白排泄率＜ ２０μｇ／ ｍｉｎ 时， Ｕ Ｅ Ｔ排量已显著增高。 Ｕ Ｅ Ｔ 与尿β２ 微球蛋白排量显著性正相关（ Ｐ＜ ０ ．０５） ，与血浆内皮素水平、内生肌酐清除率无相关。结论　糖尿病患者 Ｕ Ｅ Ｔ 水平随糖尿病肾病的严重程度而明显增高。 Ｕ Ｅ Ｔ 排量增高可作为糖尿病早期肾损害的敏感指标。     

Increased urinary albumin excretion aggregates with atherosclerotic risk factors in type 2 (non-insulin-dependent) diabetes mellitus

Supranormal urinary albumin excretion (microalbuminuria) is an early indicator of microangiopathy, i.e. diabetic nephropathy, and is associated with higher cardiovascular mortality in both type 1 and type 2 diabetes. The relationship between the presence of microalbuminuria and some atherosclerotic risk factors has been evaluated in 318 (170 male, 148 female) type 2 (non-insulin-dependent) diabetic subjects [age 63±10 years; known duration of diabetes 10.9±8.8 years; age at diabetes diagnosis 52±11 years; systolic blood pressure (BP) 150±23 mmHg; diastolic BP 86±11 mmHg (mean±SD)]. In early morning urine samples, albumin (immunonephelometry) and creatinine were assayed. On the basis of the albumin/creatinine ratio (A/C, mg/mmol), patients were categorized as normoalbuminuric (Na; A/C<2.0;n=159, 50%), microalbuminuric (ma; A/C 2–20;n=135, 42.5%) or macroalbuminuric (Ma; A/C >20;n=24, 7.5%). The three groups were closely matched for age, age at diagnosis, duration of diabetes, and fasting plasma and urinary glucose levels. Systolic and diastolic BP rose progressively with increasing urinary A/C ratio levels. While high-density lipoprotein (HDL) cholesterol was unaffected by albuminuria, total cholesterol (218±45 vs 198±43 mg/dl,P<0.001) and low-density lipoprotein (LDL) cholesterol (145±42 vs 131±38 mg/dl,P<0.05) levels were higher in microalbuminuric than in normoalbuminuric patients. Further, a significant correlation (r=0.16,P<0.01) existed between albuminuria and triglyceride concentrations. Prevalence of arterial hypertension, defined as BP160/95 mmHg and/or drug treatment (Na, 51%; ma, 65%; Ma, 78%;P<0.001) and obesity, defined as body mass index (BMI)>30 (Na, 15%; ma, 26%; Ma, 32%;P<0.05) rose with increasing A/C ratios. Both coronary heart disease (30% vs 15%) and intermittent claudication (18% vs 7%) were more frequent in microalbuminuric than in normoalbuminuric subjects. Finally, multiple stepwise regression analysis showed that urinary albumin excretion is significantly and independently associated with coronary heart disease and intermittent claudication, also taking into account hypertension and other established cardiovascular risk factors. In type 2 diabetes microalbuminuria tends to aggregate with risk factors for atherosclerotic vascular disease, e.g. increased prevalence of hypertension and obesity, elevated total and LDL cholesterol, and raised triglycerides levels. These abnormalities may only explain the excess of cardiovascular morbidity and mortality in part. Microalbuminuria per se may be an important and independent cardiovascular risk factor.     

依那普利对糖尿病者肾血流动力学及尿白蛋白的影响

本文比较了２８例老年糖尿病合并微白蛋白尿患者服依那普利（ｅｎａｌｐｒｉｌ）４周前后尿微量白蛋白、血及尿β２－微球蛋白、肾小球滤过率（以内生肌酐清除率表示）等变化。结果显示服药后尿微白蛋白排泄减少、内生肌酐清除率下降；将２８例分成正常（尿白蛋白＜２５ｍｇ／２４ｈ）及亚临床微白蛋白尿组（２５～１００ｍｇ／２４ｈ），发现前组服药后尿白蛋白排泄率无变化，而后组明显减少；按内生肌酐清除率将２８例分成正常组（＜１２０ｍｌ／ｍｉｎ）和升高组（＞１２０ｍｌ／ｍｉｎ），发现前组服药后内生肌酐清除率无改变，而后组明显降低。因此依那普利对老年糖尿病伴有尿微白蛋白和（或）内生肌酐清除率升高患者的肾脏有更明显的保护作用。     

Serum and urinary nitric oxide in Type 2 diabetes with or without microalbuminuria: relation to glomerular hyperfiltration

BACKGROUND: Glomerular hyperfiltration is considered as one of the pathophysiological mechanisms for the development of diabetic nephropathy. Oxidative stress is enhanced in patients with diabetes mellitus. Reportedly, nitric oxide (NO) might be involved in the pathogenesis of hyperfiltration. We investigated the relationship between hyperfiltration and NO system, and malondialdehyde (MDA) levels in Type 2 diabetics with/without microalbuminuria. METHODS: In 39 microalbuminuric, 29 normoalbuminuric Type 2 diabetic patients and 32 healthy controls, serum creatinine, nitrite, nitrate, urinary microalbumin, nitrite, nitrate, plasma MDA and estimated glomerular filtration rate (EGFR) values, calculated according to the Cockcroft and Gault formula, were recorded. RESULTS: Serum and urine NO levels were higher in both microalbuminurics and normoalbuminurics than controls. There were no significant differences in EGFR between groups. However, hyperfiltration was determined in 31% of normoalbuminurics and 20% of microalbuminurics. Serum and urine NO levels were higher in patients with hyperfiltration. Plasma MDA levels were significantly elevated in both microalbuminurics and normoalbuminurics when compared with controls. Serum glucose and microalbuminuria were positively correlated in microalbuminuric diabetics. Serum NO levels were also positively correlated with EGFR in both normoalbuminurics and microalbuminurics. HbA1c levels were positively correlated with both urinary albumin excretion and plasma MDA levels in normoalbuminuric diabetics. CONCLUSIONS: Hyperglycemia is associated with an increased NO biosynthesis and lipid peroxidation. Increased oxidative stress may contribute to the high NO levels in Type 2 diabetes. Furthermore, the high NO levels may lead to hyperfiltration and hyperperfusion, which in turn leads to an increase in urinary albumin excretion and thus causes progression of nephropathy in early Type 2 diabetes.     

Association of D-dimer with microalbuminuria in patients with type 2 diabetes mellitus

Background Microalbuminuria has been reported to be related to incidence of cardiovascular complications in diabetes. No consistent findings have been obtained on the relationships of microalbuminuria with blood coagulation and fibrinolysis. The purpose of this study was to determine whether microalbuminuria is associated with blood markers reflecting coagulation and fibrinolysis activities in patients with type 2 diabetes. Methods The relationships of albumin excretion rate (AER) with atherosclerosis-related variables, including blood coagulation and fibrinolysis markers, were investigated in patients with type 2 diabetes who showed normoalbuminuria (AER: less than 20 μg/min) and microalbuminuria (AER: 20 μg/min or higher and less than 200 μg/min). Results AER was significantly correlated with body mass index (BMI), maximum intima-media thickness of common carotid arteries, blood HDL cholesterol, uric acid, creatinine and D-dimer. On the other hand, AER showed no significant correlation with blood platelets, fibrinogen, thrombin–antithrombin III complex, plasmin–α2 plasmin inhibitor complex and plasminogen activator inhibitor-1. In multiple regression analysis, using age, sex, BMI, pulse pressure, hemoglobin A1c, HDL cholesterol, uric acid, creatinine, D-dimer and history of anti-thrombotic therapy as explanatory variables, only D-dimer showed a significant correlation with AER. The mean level of log-converted D-dimer after adjustment for age and sex was significantly higher in subjects with microalbuminuria than in those with normoalbuminuria. Conclusions D-dimer is associated with microalbuminuria in patients with diabetes and this suggests that glomerular dysfunction is in part mediated by hypercoagulability.