Search

Εισαγωγή: Η μικροαλβουμινουρία (MA) αποτελεί στους ενήλικες δείκτη καρδιαγγειακού κινδύνου • ο ρόλος της ωστόσο στους εφήβους είναι ασαφής. Μέθοδοι: Σε 456 μαθητές (295 αγόρια, μέση ηλικία 14 έτη) μετρήθηκαν οι σωματομετρικές παράμετροι, η αρτηριακή πίεση και ο λόγος αλβουμίνη προς κρεατινίνη (Α/Κ) σε ένα δείγμα ούρων. Ως ΜΑ ορίστηκε Α/Κ= 22-221 mg/g για αγόρια και Α/Κ= 31-221 mg/g για κορίτσια. Μέσω ερωτηματολογίου αντλήθηκαν πληροφορίες για ατομικές συνήθειες και δημογραφικά χαρακτηριστικά. H στατιστική σημαντικότητα τέθηκε στο επίπεδο p A/Km συγκριτικά με αυτούς με Α/Κ

The prevalence of microalbuminuria (MA) in children and adolescents differs from the onein adults, and it is estimated to be about 5.7–7.3% in boys and 12.7–15.1% in girls. Thepercentage is greater in smaller age group, whereas a positive association is found betweenalbumin excretion rate and pubertal development stage in nondiabetic subjects. The dataso far suggest that impairment of glucose metabolism, obesity-related proatheroscleroticpathways and the impact of haemodynamic load constitute major determinants of albu-minuria development in the early years of life. In everyday practice if persistent MA ispresent at a young age, especially in the setting of diabetes, further investigation of cardio-vascular risk factors, a more careful follow-up and dietary⁄lifestyle interventions areneeded. Conclusion: Although the significance of MA in paediatric essential hypertension hasyet to be determined, its role in diabetic children and adolescents is established andalbuminuria assessment has been utilized as a screening test for the presence ofdiabetes-related kidney disease.INTRODUCTIONIt was more than 2000 years ago when the Greek physi-cian Hippocrates of Cos noted in his Aphorisms that afoamy urine, caused by the presence of protein, indicateschronic kidney disease (1). However, only in the early1980s, the medical community, in particular diabetologists,became interested in urinary leakage of small amounts ofthe specific serum protein albumin, named this conditionas microalbuminuria (MA). In the beginning, MA wasshown to be a predictor of nephropathy and cardiovascu-lar morbidity and mortality only in diabetic adult patients(2,3). Over the last 10 years, a significant number of scien-tific contributions have shown that increased urinary albu-min excretion (UAE) rate constitutes an independentpredictor of atherosclerotic cardiovascular disease in non-diabetic subjects, in the elderly, in the general population(4) as well as in hypertensive patients (5–9) altering theclinical positioning of MA in the recent guidelines anddiagnostic algorithms. Given that the roots of adult cardio-vascular disease extend back into the first decades of life,identification of MA has become of increased clinicalinterest in childhood.In the present review apart from a condensed summary ofthe cardiovascular importance of albuminuria in adults, wefocus on the prevalence and determinants of MA as wellas its clinical significance in the specific settings of obes-ity, diabetes mellitus and hypertension in the paediatricpopulation.DEFINITION OF MA IN CHILDREN AND ADOLESCENTSThere is no generally accepted normal range for UAE ratein children and adolescents, because currently, there arefew available data and most of the existing studies tend toassess albuminuria using mean values for UAE rate rangelike in adults (10–12). In large population-based studies,MA in children and adolescents is defined as an UAE rateof 30–300 mg⁄24 h in a 24-h urine collection, 20–200 lg⁄min in a night time collection and 3–30 mg⁄mmolcreatinine (30–300 mg⁄g creatinine) in a first-morningurine sample (13). As women excrete less creatinine thanmen and MA is based on a fixed amount of UAE per day,there are gender-specific criteria for a more precise

Both blood pressure (BP) non-dipping and nighttime hypertension have been associated with accelerated target-organ damage (TOD). However, increased nighttime BP in subjects with a dipping circadian BP profile has never been reported or associated with TOD. Here, we investigated the relationships of nighttime BP with indices of vascular and kidney damage in dipper hypertensive subjects. We studied 402 subjects with untreated stage I-II essential hypertension. According to ambulatory BP recordings, 127 dipper subjects were selected and subdivided into nighttime hypertensives (NH, n = 69) (nighttime BP ≥ 120/70) and nighttime normotensives (NN, n = 50) (nighttime BP

This study aimed to assess the predictive role of body mass index (BMI), waist circumference (WC) and the waist-to-hip ratio (WHR) for the incidence of coronary artery disease (CAD) in a cohort of essential hypertensive patients. We followed up 2266 essential hypertensive individuals (mean age, 57.8 years; males, 1083; office blood pressure (BP), 143/89 mm Hg) who were free of cardiovascular disease for a mean period of 6 years. All subjects had at least one annual visit and, at baseline, underwent blood sampling and a complete echocardiographic study to determine the left ventricular (LV) mass index. CAD was defined as a history of myocardial infarction or significant coronary artery stenosis that was revealed by angiography or a coronary revascularization procedure. The incidence of CAD throughout the follow-up period was 2.33%. Hypertensive individuals who developed CAD (n=53) had a greater baseline WC (101.1±11.7 vs. 96.4±12 cm, P=0.005), WHR (0.94±0.07 vs. 0.89±0.08 cm, P

Introduction: The relationship of renal haemodynamics with cardiac and aortic hameodynamics is still unclear. Hypothesis: We evaluated the relationship of increased renal resistive index (RRI) with Augmentation index (AIx) and cardiac haemodynamics by means of mitral annular early diastolic velocity (E/Ea) in untreated patients with essential hypertension. Methods: 76 newly diagnosed untreated non diabetic patients with stage I-II essential hypertension [35 males, aged 50 years, office blood pressure (BP) = 143/ 91 mm Hg], underwent ABPM, complete echocardiographic study for determination of E/Ea and blood sampling for assessment of metabolic profile. Moreover, data on renal resistive index (RRI), obtained by Doppler ultrasound sampling of the intrarenal arteries, as well as augmentation index (AIx), were retrospectively analyzed. Results: Based on the mean value of RRI (0.60), hypertensives were classified into those with high and low RRI. Hypertensives with high RRI values compared to those with low values were older (55.6±9.8 vs 44.4±11.6 years, p < 0.001), had lower 24-hour diastolic BP (77.5±7.7 vs 84.3±6.7 mmHg, p < 0.001), lower 24-hour HR (71.2±10.3 vs 76.2±9.2 bpm, p < 0.05), higher levels of AIx (27.2±8.2 vs 17.8±14.8 %, p < 0.01), and higher values of E/Ea (lateral) (7.7±1.8 vs 6.2±2.3, p < 0.05). In the total population, RRI was negatively related to 24-hour diastolic BP (r = -0.523, p < 0.001) and 24-hour HR (r = -0.281, p < 0.05), while it was positively associated with CRP (r = 0.335, p < 0.05), TChol (r = 0.296, p < 0.01), age (r = 0.443, r < 0.001), AIx (r = 0.413, p = 0.001) and E/Ea(lateral) (r = 0.465, p < 0.05). Multiple regression analysis revealed that 24-hour diastolic BP and E/Ea (lateral) were independent associated with RRI (R2 = 0.434, p < 0.05). Conclusions: Increased vascular resistance of intrarenal arteries is associated with impaired aortic and cardiac haemodynamics, as reflected by increased AIx and E/Ea (lateral) values. RRI may be considered a useful surrogate of haemodynamics in essential hypertension.

The prevalence of microalbuminuria (MA) in children and adolescents differs from the one in adults, and it is estimated to be about 5.7-7.3% in boys and 12.7-15.1% in girls. The percentage is greater in smaller age group, whereas a positive association is found between albumin excretion rate and pubertal development stage in nondiabetic subjects. The data so far suggest that impairment of glucose metabolism, obesity-related proatherosclerotic pathways and the impact of haemodynamic load constitute major determinants of albuminuria development in the early years of life. In everyday practice if persistent MA is present at a young age, especially in the setting of diabetes, further investigation of cardiovascular risk factors, a more careful follow-up and dietary/lifestyle interventions are needed.Although the significance of MA in paediatric essential hypertension has yet to be determined, its role in diabetic children and adolescents is established and albuminuria assessment has been utilized as a screening test for the presence of diabetes-related kidney disease.

Mediterranean diet has favorable effects on the cardiovascular system, whereas albuminuria is associated with atherosclerosis progression. The aim of the study was to assess the relationships of adherence rates to the Mediterranean diet with albumin to creatinine ratio (ACR), in a cohort of Greek adolescents who participated in the Leontio Lyceum ALbuminuria (3L) study. In a total of 365 adolescents 12–17 years of age included in 3L study, ACR values were determined in a morning-spot urine. The Mediterranean diet Quality Index for children and adolescents (KIDMED) was estimated and accordingly subjects were divided into those with high (⩾8), average (4–7) and low (⩽3) score. Adolescents with low (n=153, 42%) compared with those with average (n=187, 51.2%) and high (n=25, 6.8%) KIDMED score were characterized by greater ACR values (22.4 vs 13.4 vs 12.1 mg/g, P

The significance of microalbuminuria (MA) in paediatric essential hypertension has yet to be established. The Leontio Lyceum ALbuminuria Study (3L Study) was designed to determine the prevalence of MA among Greek schoolchildren and to evaluate these rates in relation to the children's anthropometric and lifestyle characteristics, and dietary habits.During April 2009, 498 students from the Leontio Lyceum, aged 12-17 years (7th-12th grade), were asked to participate in the 3L Study. For each child a questionnaire was completed that was developed for the purposes of the study to retrieve information on socio-demographic and lifestyle characteristics, as well as dietary habits (through a semi-quantitative Food Frequency Questionnaire), and physical activity status. Overweight and obesity were defined using the international body mass index cut-off points established for children and young people. Office blood pressure (BP) was measured on two different occasions and those students who had BP95th percentile for gender, age and height on both occasions were considered as hypertensives. Microalbuminuria was determined as albumin to creatinine ratioor=22 mg/g in boys andor=31 mg/g in girls in a morning spot urine sample using a quantitative assay (DCA 2000).The prevalence of MA was found to be 12.9% and that of childhood hypertension 5.2%. The prevalence of overweight status was 25.8% and 5.8% of the students were classified as obese. Low physical activity was reported by 7% of boys and girls, while 46.5% of the students reported participation in vigorous physical activities during a normal week. Based on the KIDMED score of each student, only 6% of them were classified as high adherers to a Mediterranean diet and 41.9% were classified as having very low diet quality.In this paper we present the aims, design and preliminary results of an epidemiological study on MA, hypertension, increased body size and lifestyle characteristics among Greek schoolchildren.

Little is known regarding the clinical course and prognosis of resistant hypertension (RHT). We evaluated predictors of persistent RHT and the associated cardiovascular risk. We studied 1,911 treated hypertensive patients (aged 59±11 years, 49% males) for a mean period of 3.9 years. At baseline