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Objective: The current cross-sectional study determines the prevalence and associated factors of microalbuminuria in a focused population in Eastern India. Methods: The study was conducted in Kolkata from June to December 2022 among type 2 diabetes mellitus (T2DM) patients. Patients with T2DM aged more than 18 were included in the study, and those with overt albuminuria (>300 mg/day), congestive cardiac failure, urinary tract infection, pregnancy, human immunodeficiency virus, hepatitis B, or hepatitis C infection were excluded. Results: Among 297 T2DM patients, 130 (43.8%) had high albumin creatinine ratio (> 30 mg/g). Diabetic patients with elevated blood pressure (BP > 130/80 mm Hg) were 1.68 times (95% CI, 1.12-2.53) at risk of developing microalbuminuria. Similarly, patients with a diabetes duration of 5 years or more were 1.48 (95% CI 1.09-2.02) times more likely to develop microalbuminuria. Logistic regression also concluded that elevated blood pressure (BP > 130/80 mm Hg, P = .027) and duration of diabetes (>5 years, P = .016) were predictive of microalbuminuria. Conclusion: The current study observes a high prevalence of microalbuminuria among diabetes patients. This indicates the need for the implementation of preventive strategies for diabetic nephropathy, especially among patients with long-standing diabetes and elevated blood pressure. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is an important independent risk factor for the development of cardiovascular and renal disease which has been the cause of death in majority of the diabetic population. Albuminuria has been shown to predict cardiovascular morbidity and mortality in diabetics. Objective: The purpose of this study was to correlate microalbuminuria and left ventricular diastolic dysfunction (earliest manifestation of heart disease) in type 2 diabetes mellitus to aid in subclinical diagnosis, risk stratification, and prompt management of cardiovascular disease in diabetic patients. Methods: This study assessed the incidence of left ventricular diastolic dysfunction (LVDD) using echocardiography and its correlation with microalbuminuria and with other parameters like age, gender, BMI, duration of diabetes mellitus, and glycosylated hemoglobin in 90 normotensive, type 2 diabetic patients in a tertiary care hospital in Western India. Results: The prevalence of LVDD in our study is 59% (n = 53). The mean age of the study subjects was 60.7 years. Out of 59 subjects with BMI ≥ 25 kg/m2, diastolic dysfunction was seen in 31 patients. The mean duration of diabetes mellitus in our study is 11.5 years. Good glycemic control, i.e., HbA1c ≤ 7.0, was seen in 13 patients with LVDD. Out of 53 subjects with LVDD, 48 (90.5%) subjects had microalbuminuria. Conclusion: There is a significant correlation between microalbuminuria and LVDD in type 2 diabetes mellitus, independent of other parameters studied (age, sex, BMI, glycemic control, and duration of diabetes). [ABSTRACT FROM AUTHOR]

Background: Hypertension is a serious public health issue in the general population, with a considerable proportion of cases inadequately being treated. Methods: This hospital-based prospective study was carried out at our tertiary care teaching hospital between November 2019 and November 2021. One hundred patients who were recently diagnosed to have hypertension were studied. Results: The age of the subjects ranged from 31 to 78 years with a mean age of 49 years. Of these, 40% were in the 40-49 years' age group; there were 68 males. The body mass index (BMI, Kg/m2) distribution of the study subjects showed 22% with normal weight, 62% in overweight and 16% in obese category. Microalbuminuria was evident in 28% of newly diagnosed hypertensives. The sex-wise distribution of microalbuminuria revealed that 17 of 68 males (25%) and 11 of 32 females (34.4%) had microalbuminuria. Conclusions: The chronicity of hypertension, age and BMI were the main factors determining microalbuminuria. [ABSTRACT FROM AUTHOR]

Introduction: Uric acid is produced during the metabolism of nucleotide and adenosine triphosphate and contains the final product of human purine metabolism. It acts both as an antioxidant and pro-inflammatory marker and has a positive association with visceral fat in overweight subjects. The aim of the present study is to find an association of uric acid level with certain anthropometric parameters in subjects having type 2 diabetes. Materials and Methods: The study included 124 urban drug-naive diabetic Indian subjects above 18 years of age from the general population of the city of North India. Uric acid concentrations were estimated by the uricase method. Fasting plasma glucose (FPG) concentrations were estimated by the glucose oxidase-peroxidase method. Anthropometric measurements and information on lifestyle factors and disease history were collected through in-person meeting. Results: All participants of the study subjects had a body mass index (BMI) of more than 23.5. BMI, waist-to-hip ratio (WHR), waist-to-height ratio, waist circumference, neck circumference, weight, age, sagittal abdominal diameter (SAD), skinfold thickness, and body roundness index were positively correlated with the serum uric acid level. The correlation of weight, BMI, SAD, and WHR was statistically significant. Conclusion: We found that serum uric acid level increases as body fat content increases. Statistical data show remarkable results for a significant correlation of uric acid level with BMI, WHR, SAD, and FPG. Hypertrophy occurs as a result of inflammatory processes and oxidative stress when the supply of energy starts to exceed the storage capacity of adipocytes, as a result, adipokines such as interleukin (IL)-1, IL-6, and tumor-necrosis factor-alpha are released more frequently which lead to low-grade chronic inflammation. Uric acid levels are much lean toward visceral obesity than overall body fat content. [ABSTRACT FROM AUTHOR]

Introduction: A number of metabolic disorders are linked to obesity, which is a global health concern. Although renal impairment is a serious side-effect of obesity, its connection to insulin resistance is still a subject of discussion. Aim: To assess the correlation between microalbuminuria and HbA1c levels, as well as the association between Insulin Resistance (IR) and renal function in obese individuals. Materials and Methods: The present study was a crosssectional study conducted in patients attending the obesity clinic, in Endocrinology department, of a tertiary hospital in Kerala, India. A total of 144 obese individuals participated, meeting age, Body Mass Index (BMI), and health-related. Insulin resistance was measured using Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), while renal function was measured using the Urine Albumin Creatinine Ratio (UACR). Correlation analysis was conducted to investigate relationships between variables. Results: The study found a weak association between UACR and HbA1c levels and insulin resistance (r-value=0.159, p-value=0.056). Subjects with insulin resistance had significantly higher levels of microalbuminuria. Despite these connections, the mean UACR levels remained within the typical reference range. Conclusion: This study emphasises the importance of early renal health screening in obese individuals, with HbA1c and microalbuminuria measurements as promising methods for preventing kidney impairment. To establish causation in the complex interplay between metabolic variables and renal function in obesity and insulin resistance, future research should focus on understanding the underlying mechanisms and conducting longitudinal examinations. [ABSTRACT FROM AUTHOR]

Context: Anthropometric parameters can play an important role in monitoring the progression and management of diabetes mellitus (DM). This study was planned to highlight the relationship of abdominal volume index (AVI) with glycemic control and the microvascular complication of albumin excretion. Aims: We aimed to study the association of AVI with glycemic control and urine albumin excretion in patients of type 2 DM. Settings and Design: This was a descriptive, observational, cross-sectional, hospital-based study. Subjects and Methods: The study conducted in a tertiary care health center of North India recruited thirty consecutive patients of type 2 DM attending the Medicine outpatient department. Anthropometric assessment was made, and samples for blood biochemistry including glycated hemoglobin (HbA1c) and urine albumin excretion were taken. Statistical Analysis Used: The association of AVI with degree of glycemic control and urine albumin levels was expressed as correlation coefficients (r) by using Spearman or Pearson correlation measures for qualitative and quantitative variables respectively. The ability of AVI to predict HbAlC and urine albumin-creatinine ratio was calculated by a simple linear regression technique. P <0.05 was considered statistically significant. Results: There was no statistical significance in the predictive ability of AVI and glycemic control, and microalbuminuria. Conclusions: Our study showed that AVI is not a reliable marker in diabetic patients to predict the degree of glycemic control and microalbuminuria. [ABSTRACT FROM AUTHOR]

Background Sickle cell disease causes microvascular occlusion in different vascular beds. In kidneys, it leads to occult glomerular dysfunction causing asymptomatic microalbuminuria, proximal tubulopathy causing hyposthenuria and increased free water loss and distal tubulopathy causing poor urine acidification. We studied the prevalence of various types of renal dysfunction, the ability of different tests to detect it at an early stage and the correlation of these parameters in children receiving hydroxyurea (HU). Procedure Fifty-six children (sample size calculated using SAS9.2 package) attending paediatric clinical services in a tertiary care hospital between 2 and 12 years of age diagnosed by high-performance liquid chromatography (HPLC) were enrolled. Their demographic and laboratory data including renal and urine parameters were collected. Parameters like fractional excretion of sodium (FeNa), trans tubular potassium gradient (TtKg) and free water clearance (TcH2O) were derived by calculations. Data were analysed using IBM SPSS Version 21.0 and Microsoft Office Excel 2007. Results We found a significant number of children to have microalbuminuria (17.8%), hyposthenuria (30.4%) and impaired renal tubular potassium excretion (TtKg) (81.3%). A significant correlation was found between the dose of HU with urine osmolality (p  < 0.0005) and free water clearance (p  = 0.002), while all parameters showed a significant correlation with compliance with HU. Derangement in urine microalbumin and TcH2O correlated significantly with low mean haemoglobin levels (<9 g/dl). Conclusion Renal dysfunction is common in children with SCD and can be detected early using simple urine parameters and can be prevented with an early and appropriate dosage of HU with good compliance. [ABSTRACT FROM AUTHOR]

Objectives: Hypertension is one of the essential modifiable risk factors in causing stroke, renal disease, cardiovascular diseases, and peripheral artery disease. Epicardial fat tissue is regarded as endocrine organ and is metabolically active as it produces angiotensinogen and free fatty acids which are proinflammatory cytokines and are atherogenic. The presence of microalbuminuria has been associated with endothelial dysfunction that predisposes to cardiovascular events. The aim of this study is to determine the association of epicardial fat tissue with age, sex, serum creatinine, left ventricular (LV) mass, serum albumin, low-density lipoprotein (LDL), and triglycerides in patients with essential hypertension. Materials and Methods: One hundred patients with essential hypertension were divided into two groups each having 50 patients. Group A included urinary albumin creatinine ratio (UACR) <30 mg/g. Group B included UACR >30 mg/g. Age, body mass index, blood pressure, creatinine, urea, albumin, LDL, triglycerides, and epicardial adipose tissue thickness (EAT) were evaluated and compared between two groups. All patients underwent UACR, transthoracic echocardiography to determine EAT, LV mass, and ejection fraction. Results: In our study, EAT ranged from 2 mm to 6.9 mm, with mean value of 3.21 mm and 5.12 mm in Groups A and B, respectively. Mean EAT values were found to be higher in Group B compared to A and was found to be statistically significant. Similarly, LDL, triglycerides, serum albumin levels, and LV mass showed significant difference among two groups. Serum albumin level in Group B was significantly reduced than the patients with normal urine albumin creatinine ratio. Conclusion: EAT serve as an important indicator in patients with essential hypertension to determine target organ damage and to stratify high risk group. [ABSTRACT FROM AUTHOR]

Background: Hypertension affects about one billion individuals worldwide. The prevalence of hypertension has increased over the past decade, reaching an alarming level of 25% among the general population in the United States and an even higher percentage in Europe. It is an established risk factor for the development of cerebral, cardiac, and renal events. Microalbuminuria, defined as urine albumin excretion of 30 - 300gm/L of 24 hrs urine or 20 - 200 mg/min in a random or timed urine sample is now considered as an early marker of progressive renal damage and also an independent risk factor for Cardio vascular disease (CAD). The present study was conducted in order to test the usefulness of estimating microalbuminuria in non-diabetic essential hypertension patients as early as at the time of diagnosis of hypertension. Materials and Methods: This is cross sectional study. The study was conducted during the period May 2018 to July 2019 in the Department of General Medicine, Tertiary Care Hospitals in South India. Results: The percentage of normal, high normal and microalbuminuria in the control group are 36%, 52% and 12% respectively while that in hypertension group is 12%, 42% and 46% respectively. There was a significant positive correlation between prevalence of microalbuminuria and blood pressure values, both systolic and diastolic blood pressure Conclusion: Microalbuminuria, a marker of CVD and Chronic Kidney Disease (CKD) burden, is a useful non-invasive screening tool in identifying the hypertensive patients with a high risk of developing cardiac and renal complications. [ABSTRACT FROM AUTHOR]

Introduction: Renal dysfunction and progression to end stage renal disease is well known in human immunodeficiency virus (HIV) infection. We studied the role of microalbuminuria and urinary NGAL levels in children with HIV infection for the prediction of renal dysfunction. Design and Methods: A cross-sectional study was carried out and 60 HIV infected children, aged (18 months to 15 years) were screened for microalbuminuria by nephelometry and for uNGAL by ELISA. Thirty healthy children were screened for uNGAL for normative data in Indian children. Results: The prevalence of microalbuminuria in studied population was 3.3%. The mean uNGAL and uNGAL/creatinine in study population was higher than controls (26.94 ± 93.12 ng/ml vs. 88.94 ± 345.20 mcg/g, and 15.53 ± 37.52 ng/ml vs. 30.12 ± 78.66 ng/ml; P = 0.003, P = 0.002). Children with lower CD4 counts had significant higher mean Albumin Creatinine Ratio (ACR) and mean uNGAL; P = 0.03, P = 0.01. Conclusions: uNGAL and urine microalbumin are useful biomarkers of early tubular and glomerular injury in children with HIV infection. [ABSTRACT FROM AUTHOR]

Introduction: Essential hypertension is a systemic disease which affects endothelial basement membrane. Changes in Glycosaminoglycans (GAG) distribution pattern on glomerular basement membrane has been noted in hypertension. Hence it seems likely that an increase excretion of GAG levels may be an indicator of reduction in renal function. The qualitative or quantitative determination of urinary GAGs may be of value and could constitute a non invasive marker to assess the renal damage in essential hypertension. Aim: Differential analysis of urinary GAGs in essential hypertensive patients. Materials and Methods: This analytical case-control observational study which was conducted from November 2014 to June 2016 in Department of Biochemistry, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India. The study group included 50 male patients with age group of 30-60 years, clinically diagnosed with essential hypertension. Control group included 50 healthy male individuals with age group of 30-60 years, blood donors visiting to hospital blood bank. Random urine sample was collected. Urine creatinine was estimated by Jaffe's method, urine GAGs by Dimethyl methylene blue (DMMB) dye method and urine microalbumin by particle enhanced Turbidimetric inhibition immunoassay method. Correlation was tested with Spearman's correlation coefficient. Level of significance was set for p-value <0.05 with confidence interval of 95%. Results: In present study, urinary GAGs levels in essential hypertensive study group was 14.57±10.16 mg/dL and in control group was 10.09±6.04 mg/dL. Urinary GAGs levels in essential hypertensive group was significantly high (p-value=0.890) when compared with normotensive control group. But no statistical significant correlation was found between urine GAGs and urine microalbumin in hypertensive study group. Conclusion: Estimation of urine glycosaminoglycans in essential hypertensive patients is a simple, rapid and cost effective test which asseses the glomerular function. It can be used as one of the early marker for diagnosis of nephropathy before microalbuminuria sets in. [ABSTRACT FROM AUTHOR]

Background: Vitamin D deficiency is documented to be more prevalent in Type 2 Diabetes Mellitus (T2DM) and is associated with diabetic nephropathy. Aim and Objective: To investigate the vitamin D status in T2DM patients with and without nephropathy in eastern part of southern India. Material and Methods: This crosssectional study included 150 study subjects. Routine laboratory measurements were done using commercially available kits on Vitros 5,1 FS auto analyzer from Ortho Clinical Diagnosis (OCD), United Kingdom, based on the principle of Reflectance Photometry. Serum 25-hydroxyvitamin D was measured by using chemiluminescence immunoassay methods. Results were analysed using IBM-SPSS version 20. Results: Vitamin D levels were observed to be lower in the diabetic nephropathy (18.44 ± 8.69 ng/mL) as compared to control (26.55 ± 7.88 ng/mL) and T2DM (19.64 ± 9.93 ng/mL) subjects and were correlated significantly with HbA1c and microalbumin. A markedly higher proportion of study subjects with vitamin D deficiency as well as insufficiency in T2DM and diabetic nephropathy group. Conclusion: Patients with type 2 diabetes and diabetic nephropathy had a low serum vitamin D level than healthy control. Vitamin D estimation in such patients may aid in the diagnosis and treatment as well as to prevent further complication. [ABSTRACT FROM AUTHOR]

Introduction: The estimated prevalence of Hypomagnesemia in Type 2 Diabetes Mellitus (T2DM) ranges between 14% to 48% in various studies. Hypomagnesemia has been found to be associated with increased insulin resistance in patients of T2DM. Aim: The aim was to estimate fasting serum magnesium levels in the patients of T2DM and to correlate serum magnesium with glycaemic status and nephropathy status. Materials and Methods: It was a cross-sectional study conducted at KIMS, Bhubaneswar between October 2017 to September 2019 which included a total of 187 T2DM patients. The glycaemic status was assessed by HbA1c and subdivided into good (HbA1c <7%), intermediate (HbA1c 7-9%) and poor control (HbA1c >9%). The nephropathy status was assessed by urine Albumin-Creatinine Ratio (ACR) and subdivided into macroalbuminuria (Urine ACR >300 mg/g), microalbuminuria (Urine ACR 30-299 mg/g) and non-nephropathy (Urine ACR <30 mg/g) groups. Student t-test and One-way ANOVA test were used to find the significance of mean pattern of serum magnesium in different groups and Pearson correlation coefficient test was used to correlate serum magnesium with glycaemic and nephropathy status. Results: Out of 187 patients, 49 (26.2%) patients were found to have hypomagnesemia. In the poor glycaemic status group, 30% of patients had hypomagnesemia as compared to 26% in the intermediate and 19% in the good glycaemic status group. In the macroalbuminuria group, 41.3% patients had hypomagnesemia as compared to 17.6% in the microalbuminuria group and 4.5% in the non-nephropathy group. Conclusion: There was a weak negative correlation (r=-0.04) between serum magnesium and glycaemic status which was not statistically significant (p=0.62). There was a negative correlation (r=-0.17) between serum magnesium and nephropathy status which was found to be statistically significant (p=0.02). [ABSTRACT FROM AUTHOR]

Background There is lack of simple inexpensive tests to accurately predict clinical outcomes in critically ill patients. Objective To assess prognostic value of microalbuminuria in critically ill patients and its comparison with APACHE II, SOFA scores in predicting in-hospital mortality. Method and material Prospective observational study in 50 critically ill patients admitted to ICU. Severity of illness was assessed by APACHE-II, SOFA scores. Microalbuminuria was measured at 0, 8, 24, 48, 72, 96, 120 hours and trend compared with APACHE-II, SOFA scores. Statistical analyses were done using SPSS and STATA software. p < 0.05 was considered statistically significant. Results Mean age was 48.18 ± 17.34 years with male:female ratio of 2.6:1. Cerebrovascular accidents (22%), chronic liver disease (16%), sepsis (16%) were common aetiologies. Majority (70%) of patients had microalbuminuria. In-hospital mortality was higher in patients having microalbuminuria at admission than those without (48.6% vs. 40.0%). Microalbuminuria levels showed rising trend in non-survivors. Linear regression and correlation between microalbuminuria and APACHE-II, SOFA scores showed significant statistical co-relation (p = 0.0011, p = 0.002 respectively). Conclusion The degree as well as increasing trend in microalbuminuria has significant co-relation with scoring systems (APACHE II and SOFA) in predicting mortality and may serve as an important prognostic tool in critically ill patients. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is a major cause of morbidity and mortality among individuals with HIV infection. Screening for proteinuria in HIV-infected children will help in early detection and treatment, and thus prevention and progression to CKD to end-stage kidney disease (ESRD). We screened 139 HIV-infected children aged 18 months to 18 years for proteinuria by urinary dipstick and confirmed by spot urine protein-to-creatinine ratio. If proteinuria was absent by the above methods, patients were screened for microalbuminuria by urinary albumin to creatinine ratio. We found proteinuria in 11.5% and microalbuminuria in 10.6% of our study population. The prevalence of proteinuria was higher in the advanced stages; 8.05% in stage 1, 12.12% in stage 2 and 26.32% in stages 3 + 4. [ABSTRACT FROM AUTHOR]

Background: The present study is an attempt to explore the association between kitchen indoor air pollutants and physiological profiles in kitchen workers with microalbuminuria (MAU) in north India (Lucknow) and south India (Coimbatore).Methods: The subjects comprised 145 control subjects, 233 kitchen workers from north India and 186 kitchen workers from south India. Information related to the personal and occupational history and health of the subjects at both locations were collected using a custom-made questionnaire. Worker lung function was measured using a spirometer. Blood pressure was monitored using a sphygmomanometer. Urinary MAU was measured using a urine analyzer. Indoor air monitoring in kitchens for particulate matter (PM), total volatile organic compounds (TVOC), carbon dioxide (CO2) and carbon monoxide (CO) was conducted using indoor air quality monitors. The size and shape of PM in indoor air was assessed using a scanning electron microscope (SEM). Fourier transform infrared (FTIR) spectroscopy was used to detect organic or inorganic compounds in the air samples.Results: Particulate matter concentrations (PM2.5 and PM1) were significantly higher in both north and south Indian kitchens than in non-kitchen areas. The concentrations of TVOC, CO and CO2 were higher in the kitchens of north and south India than in the control locations (non-kitchen areas). Coarse, fine and ultrafine particles and several elements were also detected in kitchens in both locations by SEM and elemental analysis. The FTIR spectra of kitchen indoor air at both locations show the presence of organic chemicals. Significant declines in systolic blood pressure and lung function were observed in the kitchen workers with MAU at both locations compared to those of the control subjects. A higher prevalence of obstruction cases with MAU was observed among the workers in the southern region than in the controls (p < 0.01).Conclusions: Kitchen workers in south India have lower lung capacities and a greater risk of obstructive and restrictive abnormalities than their north Indian counterparts. The study showed that occupational exposure to multiple kitchen indoor air pollutants (ultrafine particles, PM2.5, PM1, TVOC, CO, CO2) and FTIR-derived compounds can be associated with a decline in lung function (restrictive and obstructive patterns) in kitchen workers with microalbuminuria. Further studies in different geographical locations in India among kitchen workers on a wider scale are required to validate the present findings. [ABSTRACT FROM AUTHOR]

The aim of our study was to find out the antiproteinuric effect of enalapril angiotensin-converting enzyme (ACE inhibitor) alone or in combination with cilnidipine in patients with type-2 diabetes mellitus. The study was conducted on 71 patients with type-2 diabetes mellitus patients with hypertension and microalbuminuria. They were divided into two groups randomly as follows: Group I (enalaprilalone, n = 36) and Group II (enalapril with cilnidipine, n = 35). In both the groups, baseline 24 h urinary albumin was estimated and was repeated every 3 months upto 1-year. After 1-year follow-up, reduction in microalbuminuria was found to be greater in Group II. In Group I microalbuminuria came down by 25.68 ± 21.40 while in Group II it reduced by 54.88 ± 13.84 (P < 0.001). We conclude that in diabetic population, cilnidipine has an additive effect in microalbuminuria reduction over and above the well-proven effect of ACE inhibitors. [ABSTRACT FROM AUTHOR]

Objective: To study the prevalence of covert or early renal involvement among human immunodeficiency virus (HIV) positive children.Methods: A cross-sectional observational study was carried out on 250 HIV positive children (2-18 y) on follow-up in a tertiary care hospital from January 2014 through June 2015. Those who met the study criteria were evaluated for microalbuminuria and glomerular and tubular dysfunctions.Results: Fifty-one out of two hundred fifty (20%) children were found to have microalbuminuria though none had any other evidence of renal dysfunction. The incidence of microalbuminuria in children on Anti Retroviral Therapy (ART) and those not on ART was 20% and 21% respectively. Neither was there any difference in those with a CD4 count ≤500/cu mm compared with those with counts >500/cu mm. However, the overall CD4 counts were significantly lower in children with microalbuminuria.Conclusions: Microalbuminuria was detected in 20% of asymptomatic HIV positive children suggesting early glomerular dysfunction and need for regular screening and follow-up. [ABSTRACT FROM AUTHOR]

Smoking is associated with an excessive morbidity and mortality from a variety of diseases. The aim of this study was to find out the effects of smoking on renal function study in non-diabetic, normotensive subjects. A community-based, prospective, cross-sectional cohort study was conducted on 120 subjects; 80 (66.66%) were smokers and 40 (33.33%) age matched non-smokers; with age range of 30 to 70 years. Measurement of fasting sugar, urea, creatinine, lipids and one time screening of urinary albumin and urinary creatinine was done. Smokers had significantly higher urinary albumin and albumin creatinine ratio (ACR) (52.84 ± 46.42 mg/L, 93.98 ± 78.68 μg/mg) than non-smokers (19.25 ± 7.77 mg/L, 18.99 ± 6.65 μg/mg), respectively (P =< 0.001, P =< 0.001). Microalbuminuria and urinary ACR level were directly related to the amount of smoking (pack-years). Among smokers, 73 (91.25%) had microalbuminuria (>20 mg/L) and 64 (80%) had increased urinary ACR (>30 μg/mg). Smoker had significantly lower high-density lipoprotein level (36.66 ± 10.28 mg/dl) compared to non-smokers (41.22 ± 11.72 mg/dl) (P = 0.031). Urea, creatinine, creatinine clearance, total cholesterol, low density lipoprotein, triglyceride levels were comparable (p = NS). In conclusion, smokers have a 4-fold higher prevalence of microalbuminuria than non-smokers. [ABSTRACT FROM AUTHOR]

Background: Long-term renal deterioration is common in patients with posterior urethral valves (PUV), and early identification of detrimental factors can help in counselling patients as well as in guiding future therapy. The aim of our study was (1) to evaluate urinary transforming growth factor-β (TGF-β), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) levels and microalbuminuria before and after ablation of PUV and (2) to examine the effect of early induction of angiotensin-converting enzyme inhibitors (ACE-I) on renal recovery. Methods: The study included 30 patients with diagnosed PUV. Urinary cytokines were measured pre-operatively and post-operatively for 1 year. The study group was subdivided into two subgroups at 6 months after surgery. Group 1 included 16 patients whose urinary TGF-β level showed a declining trend. Group 2 included 14 patients whose urinary TGF-β showed a rising trend or plateaued; these patients were started on ACE-I therapy, which they received for at least 6 months. Results: Urinary TGF-β, TNF-α and microalbumin levels were high in patients with PUV. In Group 1 patients, urinary TGF-β TNF-α and microalbumin levels fell significantly following valve ablation and continued to decline for 12 months. In Group 2 patients, after an initial fall following valve ablation, urinary TGF-β, TNF-α and microalbumin showed a continued rise until 6 months post-surgery. After ACE-I therapy, there was 53.43 % fall in urinary TGF-β, 43.15 % fall in microalbuminuria, 28.57 % improvement in split renal function and 35.80 % improvement in GFR. Conclusions: Based on our results, urinary TGF-β, urinary TNF-α and microalbuminuria can be used as biomarkers for the early recognition of ongoing renal damage in patients with PUV. ACE-I plays a role in retarding renal damage in these patients. [ABSTRACT FROM AUTHOR]

Aim: To assess the prevalence of persistent microalbuminuria (MAU), its clinical correlates by dip stick method, its predictive value for potential kidney disease and the utility of this test as objective cue for health care seeking behavior in adult Indian patients with type 2 diabetes mellitus. Materials and Methods: Approximately 400,000 patients shall be enrolled in this multicentric, cross sectional study. Patients meeting eligibility criteria shall be screened for MAU through urine dipstick test using random daytime single spot urine specimen. Result shall be expressed either positive or negative based on the presence or absence of albumin in the urine and will be correlated with the corresponding random blood glucose. Height, weight, waist circumference and blood pressure shall be assessed. There will be three visits with a minimum interval of 28 days between two visits, to be completed within 180 days, and at least two of three urine tests measured in this period must show elevated albumin levels to diagnose MAU. Conclusion: Detection of MAU through the dipstick method is postulated to be a rapid, reliable test for early detection of diabetic nephropathy, which, in turn will help the physician to plan treatment strategy. Further, it will help to identify the disease burden on the individual and society, and may serve as an objective cue for improved health care seeking behavior, as well as a catalyst for health policy change. [ABSTRACT FROM AUTHOR]

Aim: To study renin angiotensin system (RAS) activity after posterior urethral valve ablation and the role of early induction of angiotensin converting enzyme‑inhibitors (ACE‑I) on the outcome of renal function. Materials and Methods: Thirty four children underwent valve ablation in which therapy with ACE‑I was started 40.5 ± 4.1 (range 32‑47 months) formed the study group. Post‑ACE‑I data were collected after mean duration of 18.2 ± 4.0 (12‑28 months). Plasma renin activity (PRA), urinary micro albumin, glomerular filtration rate (GFR), and serum creatinine, before and after therapy were monitored. Results: Therapy with ACE‑I resulted in a fall in micro albuminuria by 45.7% and 42.0% in patients without and with vesico ureteral reflux, respectively, and improvement in split renal function by 6.6% and 5.9% GFR respectively. A similar response was noted in patients without and with renal scars. Conclusion: The decline in renal function after valve ablation is accompanied by activation of RAS reflected in a gradual rise in PRA. Therapy with ACE‑I stabilizes and then improves renal function, thereby, retarding the pace of renal damage. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate microalbuminuria at mid-pregnancy, using the albumin-to-creatinine ratio (ACR), as a predictor of pre-eclampsia. Material and Methods: This prospective observational study was carried out on 144 normotensive women, aged < 35 years, body mass index < 25 kg/m2, and live singleton pregnancy between 24 and 28 weeks. In all, the ACR was measured in spot random urine samples. Normoalbuminuria was an ACR of <30 mg/g, whereas microalbuminuria was an ACR of 30-299 mg/g creatinine. All were followed till delivery. Primary outcome was the development of pre-eclampsia. The secondary outcome measures were preterm births and neonatal birthweight. Statistical analysis was done with Fisher's exact and t-tests. Results: Of all, 77.1% (111/144) had normoalbuminuria and 22.9% (33/144) had microalbuminuria. Of 33 microalbuminuric women, the mean blood pressure was significantly higher in those who subsequently developed pre-eclampsia ( P < 0.001). The mean ACR (mg/g) in this cohort was 60.6 ± 29.4. The mean ACR (mg/g) in women who subsequently developed pre-eclampsia was significantly higher than in women who remained normotensive ( P = 0.003). Of 33 microalbuminuric women, 12 (36.4%) developed pre-eclampsia, and eight (24.2%) had preterm births. The mean birthweight (kg ± standard deviation) was significantly lower in the microalbuminuria group (2.45 ± 0.6) as compared to the normoalbuminuria group (2.8 ± 0.37), P < 0.001. Conclusion: Microalbuminuria in mid-pregnancy may be a significant predictor of development of subsequent pre-eclampsia, preterm birth and low-birthweight babies. [ABSTRACT FROM AUTHOR]

Background: The relationship between uric acid and microalbuminuria in healthy adults without other cardiovascular risk factors may help to clarify the role of uric acid in cardiovascular disease. Objective: To study and compare the association of serum uric acid levels with microalbuminuria in normotensive and pre-hypertensive subjects without a history of cardiovascular disease or renal dysfunction. Materials and Methods: 350 subjects were included in study. All the routine investigations along with serum uric acid and urinary albumin were conducted. Microalbuminuria was detected by immunoprecipitation in a random urine sample. Serum uric acid level was estimated by Spectrophotometry. Results: The overall prevalence of prehypertension was 38.06% (Males, 39.10% and females, 35.56%). The total prevalence of microalbuminuria was 11.61% (9.9% of normotensives and 14.4% of pre-hypertensives). Hyperuricemia was seen in 10.32% of the total study population. Among normotensives, 9% of males and 8.6% of females and in pre-hypertensive subjects, 14% of males & 9.4% of females had hyperuricemia. Among the pre-hypertensives, those with microalbuminuria had a significantly higher (p<0.001) serum uric acid level (7.024 ± 1.023 mg/dl) as compared to those without microalbuminuria (5.089 ± 0.965 mg/dl). Conclusion: This study demonstrates a strong independent association between uric acid level and microalbuminuria in pre-hypertensive subjects without a history of cardiovascular disease, diabetes decreased renal function. [ABSTRACT FROM AUTHOR]

There is a large variation for estimation of albumin in urine between different laboratories. Clinical practice guidelines for the urine albumin measurements have been issued by professional organizations in several countries. These guidelines are not uniform in recommendations regarding sample type, time of sample collection, units of reporting, reference intervals used for interpretation, nor methods used to measure albumin. The aim of this article is to provide practical information regarding laboratory measurement, calculations, reporting and interpretation of urine albumin excretion. For laboratory estimation of urine albumin one can follow clinical practice guidelines suitable for their region or country or recommended by professional organization. There is lot of confusion about reporting of results in different units. Ideally, International System of Units should be adopted. Also there should be agreement all over the world to use single system of units for expressing results for urine albumin measurement. At present in India there are no such clear guidelines about laboratory measurement of urine albumin. [ABSTRACT FROM AUTHOR]

Background. Chronic kidney disease (CKD) is associated with significant morbidity and mortality. US data show that 11-15.6% of population has CKD, but there is no data from India on early stages of CKD. The aim of this study was to estimate the prevalence of early stages of CKD using the Kidney Disease Quality Outcomes Initiative (KDOQI) guidelines in an Indian population. Methods. A cross-sectional study of Indian central government employees over 18 years of age was carried out. Data on anthropometric profile and investigations including routine urine exam, semi-quantitative microalbuminuria (MAU), serum creatinine, lipid profile and fasting blood glucose (FPG) were collected. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Diseases (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. Results. A total of 3398 subjects, with 2244 (66.04%) males and 1154 (33.96%) females, were studied. Of the subjects, 9.96% (n = 284) were found to have MAU >30 mg/L, and 11.47% (n = 327) had a deranged albumin: creatinine ratio (ACR) of 30-300 mg/g. Mean GFR was 98 mL/min/1.73 m2 (± 25.25) by the MDRD equation, and 100 mL/min/1.73 m2 (± 19.48) by CKD-EPI. Using the MDRD equation for GFR, 189 (6.62%) had stage I CKD, 154 (5.40%) had stage II CKD and 86 (3.02%) had stage III CKD. By using the CKD-EPI equation, the corresponding percentages were 192 (6.73%), 122 (4.28%) and 60 (2.11%), respectively. Age >40 years, FPG >126 mg/dL and hypertension were found to be independent risk factors for CKD. Conclusions. Of the apparently healthy adult Indian central government employees, 15.04% and 13.12% were found to have early stages of CKD using the MDRD and CKD-EPI criteria for GFR, respectively. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the prevalence and risk factors for microalbuminuria among south Indian type 2 diabetic patients attending a diabetes centre.Methods: One thousand four hundred and twenty five type 2 diabetic patients attending a diabetes centre in south India were recruited for the study. Urinary albumin concentration was measured by immunoturbodimetric assay. Microalbuminuria was diagnosed if the urinary albumin excretion was >30 mg/g of creatinine.Results: Overall prevalence of microalbuminuria was 36.3% (95% confidence interval 33.8 to 38.9). The prevalence of microalbuminuria increased with the increase in duration of diabetes. Multivariate regression analysis revealed age, diastolic blood pressure, glycated haemoglobin, fasting plasma glucose, and duration of diabetes to be associated with microalbuminuria.Conclusion: The overall prevalence of microalbuminuria in this south Indian clinic population and its risk factors are similar to that reported in Europeans. [ABSTRACT FROM AUTHOR]

Background: Microalbuminuria documents earliest evidence of diabetic nephropathy and is a major predictor of end stage renal disease. Uncontrolled hyperglycemia has been recognized to be associated with higher incidence of microvascular complications in Type II diabetes mellitus. Studies have shown that severity of nephropathy is correlated with microalbuminuria which depends on sustained mean hyperglycemic level over a prolonged period. Aims & Objective: To find the role of glycemic control in the presence of microalbuminuria in Type II diabetics. Materials and Methods: The study comprised of 60 Type II diabetes patients aged between 40-60 years attending Sri Devaraj Urs Medical College, Kolar. Divided into two groups each comprising of 30 individuals: Group I HbA1c < 7% - Controlled Diabetic group and Group II HbA1c > 7 % - Uncontrolled Diabetic Group. Compared with Control Group comprising of 30 age-matched healthy participants HbA1c<6%. Glycosylated Hemoglobin and Microalbuminuria were estimated in all the participants. The results were statistically analyzed by One-way ANOVA and chi-square test. Results: Uncontrolled diabetics showed higher incidence of microalbuminuria (53.33%) with mean HbA1C 8.47 ± 0.84 compared to Controlled diabetics (23.33%) with mean HbA1C 6.81 ± 0.19. Microalbuminuria also showed a direct relationship with glycemic status of an individual. Conclusion: Uncontrolled hyperglycemia is associated with higher incidence of micro vascular complications like nephropathy in diabetes. HbA1c is an indicator of long-term blood glucose concentrations. Microalbuminuria serves as a warning to achieve good glycemic control and prevent further worsening of diabetes related complications. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is associated with metabolic syndrome, nonalcoholic steatohepatitis, and kidney disease. BMI may not be the ideal measure of obesity when used to assess its effect on kidney disease as it does not discriminate for age, sex, ethnicity, muscle, bone, or fat mass., Objectives: To assess the prevalence microalbuminuria and identify independent risk factors for development of kidney disease in the obese Indian population., Methods: Age, weight, BMI, total body fat percentage, waist-to-hip ratio, hypertension, urinary albumin-to-creatinine ratio (UACR), and HbA1c were collected from 568 obese patients, presenting for bariatric surgery. Multivariate binary logistic regression was used to identify independent risk factors for kidney disease., Results: A total of 114 out of 568 (20.07%) obese patients had microalbuminuria (UACR range 30-283 μg/mg). HbA1C levels ≥ 6 (p = 0.01) and hypertension (p = 0.03) were the strongest independent variables for microalbuminuria. 14.67% with a BMI < 35 kg/m 2 , 21.30% with a BMI 35-50 kg/m 2 , and 19.44% with a BMI > 50 kg/m 2 had microalbuminuria. Increasing BMI however was not statistically significant (p = 0.75). Total body fat percentage (p = 0.51), waist-to-hip ratio (p = 0.96), age (p = 0.30), sex (p = 0.38), and BMI (p = 0.75) were found to be statistically insignificant., Conclusions: Kidney disease afflicts 1/5th of the obese Indian patients studied. Diabetes and hypertension remained as the most significant risk factors, while age, weight, increasing BMI, waist-to-hip ratio, or increasing body fat were found to be statistically insignificant for development and progression of kidney disease.