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Query: UMLS:C0730345 (microalbuminuria)
 4,018 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Microalbuminuria (MA), a microvascular irregularity of the blood-urine interface within kidney glomeruli, may reflect the renal sign of global endothelial dysfunction, and has been associated with an elevated risk of serious cardiovascular events including stroke. This relationship appears graded, with higher levels of MA being independently associated with a greater magnitude of vascular risk over time. Furthermore, the presence of MA appears to independently predict poorer clinical outcomes following acute stroke. Screening for MA is relatively easy and inexpensive and could be effective in identifying stroke patients at risk for unfavorable outcomes. Reduction of subclinical albuminuria in stroke patients could be a clinically relevant endpoint worthy of pursuit by pharmacological treatment since the antiproteinuric effects of several established therapies appear to parallel better cardiovascular prognosis including better stroke outcomes, among subjects at high vascular risk. This review depicts the compelling epidemiological and clinical evidence relating MA to stroke, and presents the rationale for conducting future studies to assess the role of MA as a potential therapeutic target in persons with, or at risk for stroke.
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PMID:Microalbuminuria: risk factor and potential therapeutic target for stroke? 1851 28

This study was performed to determine the prevalence and the prognostic significance of microalbuminuria in patients admitted to intensive care unit (ICU) after spontaneous intracerebral hemorrhage (ICH). From May 2004 to April 2006, we studied 59 consecutive ICH patients verified using computed tomography and admitted to our ICU within a day after stroke. General clinical, neurologic data, and Glasgow Coma Scale (GCS) were recorded at admission to ICU. Urine was collected at admission to ICU for measuring the urinary microalbumin/creatinine ratio. At hospital discharge, neurologic outcome was assessed using Glasgow Outcome Scale. Among 59 patients, 37 (63%) had unfavorable neurologic outcomes (death, persistent vegetative state, and severe disability). The prevalence rate of microalbuminuria was 85% [95% confidence interval (CI), 76-94]. The areas under the receiver operator characteristic curves showed that the urinary microalbumin/creatinine ratio [0.81 (95% CI, 0.70-0.92)] and the GCS score [0.78 (95% CI, 0.66-0.90)] at admission were significant predictors of unfavorable neurologic outcome at hospital discharge. The threshold value, sensitivity, specificity, and likelihood ratio for the urinary microalbumin/creatinine ratio were 200 mg/g, 51% (95% CI, 39-64), 96% (95% CI, 90-100), and 11.3 (95% CI, 7.9-16.0); and those for the GCS score were 11, 46% (95% CI, 36-61), 96% (95% CI, 90-100), and 10.1 (95% CI, 7.2-14.1), respectively. This study confirmed a high prevalence of microalbuminuria in ICH patients in ICU, and suggested that the urinary microalbumin/creatinine ratio >200 mg/g was comparable to the GCS score <11 at admission to the ICU with regard to its prognostic characteristics after ICH.
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PMID:Admission microalbuminuria and neurologic outcomes in intensive care unit patients with spontaneous intracerebral hemorrhage. 1858 Mar 45

Aim of the study was to investigate association of gene candidate polymorphisms encoding elements of the renin-angiotensin system and participating in regulation of vascular tone with development of microalbuminuria in patients with hypertensive disease. We examined 93 patients (52 women, 41 men, mean age 58.3+/-1.12 years, mean duration of hypertension 15.6+/-1.16 years) with hypertensive disease. Two patients had arterial hypertension (AG) with I, 22 with II, 63 with III degree of blood pressure (BP) elevation. Thirty four patients smoked, 2 had stroke in anamnesis, 33 had ischemic heart disease, in 58 heredity burdened with cardiovascular diseases was noted. In 38 patients hypertrophy of left ventricular myocardium was revealed. As gene-candidates we considered AGT, ACE, AT2R1, CYP11B2, MTHFR, PPARA, PPARG2, NOS3. Patients with microalbuminuria had significantly higher systolic and diastolic BP levels. Groups did not differ significantly according sex, age, disease duration, glucose level. There were no significant differences in involvement of other target organs - hypertrophy of left ventricular myocardium and atherosclerosis of carotid arteries. Patients with microalbuminuria had significantly higher level of blood cholesterol. Patients with and without microalbuminuria differed only in frequencies of genotypes of polymorphic marker A(-153)G of AT2R1 gene. Genotype AA predisposed to development of nephropathy--odds ratio (OR) 4.71 (95CI 1.78-12.97), while genotype AG was protective (OR 0.20 95%CI 0.07 to 0.56, p=0.031). According to results of multifactorial analysis independent factors affecting increase of risk of development of nephropathy in the studied group were level of systolic BP and carriage of genotype AA of polymorphic marker A(-153)G of AT2R1 gene.
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PMID:[Genetic aspects of development of microalbuminuria in patients with hypertensive disease]. 1907 77

The metabolic syndrome, also known as the cardiometabolic syndrome (CMS), is a state of metabolic and vascular dysregulation that is associated with activation of the renin-angiotensin-aldosterone system (RAAS). Clinical components of the CMS include central or visceral obesity, hypertension (HTN), dyslipidemia, insulin resistance/hyperinsulinemia, and microalbuminuria that collectively convey increases in oxidative stress, inflammation, and subsequent endothelial dysfunction. The cardio-renal inflammation and oxidative stress enhanced in the CMS increases the risk for cardiovascular disease (CVD) and renal disease end-points such as stroke, congestive heart failure, and chronic kidney disease (CKD). The development of proteinuria is known to herald progressive kidney disease (e.g. CKD) and both are now well accepted as CVD risk factors. Evidence suggests a role for visceral obesity, insulin resistance/hyperinsulinemia, HTN, and other components of the CMS lead to an increased risk for proteinuria and progressive loss of renal function. Intervention with agents that block the RAAS (e.g. ACE inhibitors and Angiotensin type 1 receptor blockers) have been shown to reduce proteinuria, CKD progression, and CVD events. Herein, we will examine the relationship between RAAS intervention and reductions in CKD and CVD events.
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PMID:Renin-angiotensin-aldosterone system intervention in the cardiometabolic syndrome and cardio-renal protection. 1912 93

Because diabetes mellitus was not being adequately treated according to guidelines in an academic general medicine clinic, 2 of the authors (W.S.A. and A.H.G.) instituted an educational program to see if we could improve the appropriate management of diabetes mellitus in the academic general medicine clinic. Following this educational program, we investigated the appropriate management of 196 unselected patients with diabetes mellitus, mean age 61 years, who were followed up for at least 1 year in an academic general medicine clinic. The blood pressure was reduced to <130/80 mm Hg in 161 of 196 diabetics (82%). The hemoglobin A1c was reduced to <7.0% in 134 of 196 diabetics (68%). Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were used to treat 50 of 51 diabetics (98%) with coronary artery disease (CAD), ischemic stroke, or peripheral arterial disease; 33 of 35 diabetics (94%) with a glomerular filtration rate <60 mL/min/1.73 m; 54 of 57 diabetics (94%) with microalbuminuria, and 21 of 22 diabetics (96%) with electrocardiographic left ventricular hypertrophy. Aspirin was used to treat 50 of 51 diabetics (98%) with CAD, ischemic stroke, or peripheral arterial disease. beta-Blockers were used to treat 36 of 39 diabetics (92%) with CAD. Statins were used to treat 168 of 196 diabetics (86%). Smoking cessation counseling was documented in 39 of 53 smokers (74%). Of 196 diabetics, 196 (100%) had a neurological examination, 129 (66%) were referred to an ophthalmologist for an eye examination, and 125 (64%) were referred to a podiatrist for foot care. These data show that an educational program on the appropriate management of diabetes mellitus improved the management of diabetes mellitus in an academic general medicine clinic.
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PMID:Prevalence of appropriate management of diabetes mellitus in an academic general medicine clinic. 1926 67

Endothelial dysfunction is a fundamental step in the atherosclerotic disease process. Its presence is a risk factor for the development of clinical events, and may represent a marker of atherothrombotic burden. Also, endothelial dysfunction contributes to enhanced plaque vulnerability, may trigger plaque rupture, and favors thrombus formation. The assessment of endothelial vasomotion is a useful marker of atherosclerotic vascular disease. There are different methods to assess endothelial function: endothelium-dependent vasodilatation brachial flow-mediated dilation, cerebrovascular reactivity to L-arginine, and the determination of some biomarkers such as microalbuminuria, platelet function, and C-reactive protein. Endothelial dysfunction has been observed in stroke patients and has been related to stroke physiopathology, stroke subtypes, clinical severity and outcome. Resting ankle-brachial index (ABI) is also considered an indicator of generalized atherosclerosis, and a low ABI is associated with an increase in stroke incidence in the elderly. Despite all these data, there are no studies analyzing the predictive value of ABI for new cardiovascular events in patients after suffering an acute ischemic stroke. ARTICO is an ongoing prospective, observational, multicenter study being performed in 50 Spanish hospitals. The aim of the ARTICO study is to evaluate the prognostic value of a pathological ABI (<or=0.9) in the presence of a major cardiovascular event during a 1-year follow-up after first-ever ischemic stroke. Secondary objectives include the evaluation of the predictive value for major cardiovascular events of the carotid intima-media thickness, carotid duplex findings, and certain biomarkers. Data from the ARTICO study will increase the knowledge of patient outcome after ischemic stroke and may help to improve our ability to detect patients at high risk of stroke recurrence or major cardiovascular events.
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PMID:Endothelial dysfunction, vascular disease and stroke: the ARTICO study. 1934 31

Primary aldosteronism is the most common cause of secondary hypertension, accounting for about 10% of all forms of high blood pressure. Life-time pharmacological therapy is the treatment of choice for primary aldosteronism due to idiopathic adrenal hyperplasia (IHA), while adrenalectomy is effective in curing most patients with an aldosterone producing adenoma (APA). Far from being a benign form of hypertension, primary aldosteronism is characterized by the development of cardiovascular renal and metabolic complications, including left ventricular hypertrophy, myocardial infarction, atrial fibrillation and stroke, microalbuminuria, renal cysts as well as metabolic syndrome, glucose impairment and diabetes mellitus. We review recent clinical experience with the above mentioned complications and long-term outcomes of blood pressure normalization and cardiac, renal and gluco-metabolic complications in patients with primary aldosteronism, after medical treatment with mineralocorticoid receptor antagonists and surgical treatment. We conclude that removal of adrenal adenoma results in normalization of the renin-angiotensin-aldosterone system (RAAS) and of kalaemia and improvement of blood pressure levels in all patients. Complete resolution of hypertension is achieved in nearly half of treated patients. Moreover, unilateral adrenalectomy is the best treatment to have the regression of cardiovascular, renal and metabolic complications in patients with APA. On the other hand, targeted medical treatment with aldosterone antagonists improves blood pressure control and appears able to prevent the progression of cardiac and metabolic complications in patients with IHA.
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PMID:Management of primary aldosteronism: its complications and their outcomes after treatment. 1935 5

Not just since the results of ACCORD, ADVANCE and VADT were published, it is clear that lowering blood glucose alone does not reduce the cardiovascular risk of patients with type 2 diabetes. In fact, many studies also indicate that some treatment strategies may even have adverse effects. To treat type 2 diabetes appropriately, the co-morbidities such as diabetic dyslipidaemia, hypertension or nephropathy must also be taken into account. Thiazolidinediones reduce insulin resistance thus allowing to direct the treatment of type 2 diabetes towards its pathophysiologic origin. Due to their mechanism of action, thiazolidinediones not only lower blood glucose but have also beneficial effects on inflammatory and atherogenic parameters, blood pressure and microalbuminuria. Furthermore pioglitazone improves dyslipidaemia and reduces mortality, myocardial infarction and stroke in high risk patients. Effects of rosiglitazone on the cardiovascular risk are yet unclear. Numerous studies document the efficacy and safety of thiazolidinediones and provide a basis for an evidence-based therapeutic approach beyond blood glucose control.
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PMID:[Challenge in diabetes therapy: effects of glitazones beyond blood glucose control]. 1938 16

Diabetes mellitus is a major public health problem due to its increasing incidence in the general population and the morbidity and mortality associated with micro- and macrovascular complications. Patients with diabetes have a 2-5-fold increased risk of coronary heart disease, stroke and peripheral artery disease. The REACH registry is the largest observational study in the world designed to assess prognostic and therapeutic data in the population with elevated risk for atherothrombotic events. The results of this study show a high prevalence of obesity, diabetes mellitus and metabolic syndrome in the population with increased cardiovascular risk. Moreover, the data demonstrate that metabolic control of diabetes mellitus is clearly inadequate. Data from the REACH registry show endocrinologists and diabetologists that a multidisciplinary approach is imperative and that adequate management of diabetic patients should include stratification of cardiovascular risk, including assessment of associated conditions such as obesity, hypertension, dyslipidemia, microalbuminuria and smoking.
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PMID:[Implications of the REACH registry for endocrinologists]. 1963 34

Microalbuminuria was originally introduced to clinical practice as a useful marker of incipient diabetic nephropathy. The growing body of evidence suggests that increased urinary albumin excretion is related to the increased risk of cardiovascular events and all causes mortality in subjects with or without diabetes. More over, transient increases of albuminuria were found in numerous acute diseases, including trauma, meningitis, myocardial infarction and stroke. Microalbuminuria was found as an important prognostic variable in these settings, but the exact mechanism of its transient occurrence remains unknown. The measurement of daily albumin excretion is a relatively easy and inexpensive diagnostic tool. The predictive value of increased albuminuria is promising but requires further detailed studies. This paper reviews the relevance of microalbuminuria for cerebrovascular diseases, stressing the future research plans and clinical implications.
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PMID:Microalbuminuria in cerebrovascular diseases. 1981 Aug 38


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