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

Adoptive immunotherapy in patients with advanced cancer produces significant regression of metastatic disease in selected patients, but it is complicated by severe side effects. Prevention of these complications is still limited because their precise mechanisms remain unknown. For this reason we have investigated renal function and hemodynamic parameters in 16 patients with renal cell carcinoma before and during treatment with a combination of high doses of both recombinant interleukin-2 (rIL2) and recombinant alpha-interferon. After patients had received three injections of combined immunotherapy, there was a decrease in mean blood pressure (-20%), glomerular filtration rate (-25%), urine output (-50%), and fractional sodium excretion (-0.8%). This was associated with an increase in heart rate (+30%), plasma creatinine level (+30%), fractional potassium excretion (+14%) and microalbuminuria (+130%). However, renal plasma flow remained constant. The increment in microalbuminuria may reflect an alteration of glomerular capillary permeability. The reduction in GFR may be accounted either for a decrease in efferent to afferent arteriolar resistance ratio, leading to a decrease in glomerular capillary pressure, or for a decrease in ultrafiltration coefficient, or both. Nonsteroidal antiinflammatory drugs, such as ketoprofen, used to minimize side effects, could considerably worsen renal function and should be avoided in patients treated by rIL2. Our results bring new insights into the pathogenesis of functional acute renal failure and provide a rational basis for the use of vasopressors in the treatment of cytokine-induced acute renal failure.
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PMID:Acute renal failure with preserved renal plasma flow induced by cancer immunotherapy. 194 80

Microalbuminuria predicts increased rate of hypertension and mortality in insulino-dependent diabetics. In non insulin-dependent diabetes, hypertension often exists before onset of diabetes. To study effects of preexisting hypertension on prevalence and occurrence of elevated urinary albumin excretion (UAE), we collected datas from 614 non insulin-dependent diabetics, in a cross sectional survey: age was 60 +/- 10.4 years, (range 40-75 years), body mass index (BMI) 29 +/- 5.8 kg/m2, hemoglobin A1C 8 +/- 1.9%, systolic blood pressure (SBP) 134 +/- 18 mmHg, diastolic blood pressure (DBP) 76 +/- 10 mmHg, and serum creatinine 91 +/- 44 mumol/l. In the whole group, prevalence of hypertension was 59%. Microalbuminuria (EUA 20-200 mg/l) was present in 25.9% of the cases, microalbuminuria (EUA greater than 200 mg/l) in 7.5%. Cases with hypertension existing before or at onset of diabetes were 243 (HT group), cases without hypertension at onset were 371 (non HT group). In HT group, prevalence of microalbuminuria in increasing class of duration of diabetes were: 31% (0-4 years), 25% (5-9 years), 35% (10-14 years), 21% (15-19 years). Prevalence of macroalbuminuria was respectively: 3%, 11%, 15% and 4%. In the non HT group, microalbuminuria was present in 14% of the cases (0-4 years), 24% (5-9 years), 30% (10-14 years), 25% (15-19 years); prevalences of macroalbuminuria were: 1%, 8%, 6%, 15%. Mean values of UAE, compared to values of the class 0-2 years, were significantly higher in class 12-14 years (32.3 +/- 8 vs 14.4 +/- 3.7 mg/l; p = 0.02] in the HT group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Effect of pre-existing hypertension on the prevalence and incidence of microalbuminuria in non insulin-dependent diabetic patients]. 195 56

The reproducibility of albumin concentration in first-morning samples of urine was assessed in 334 insulin-dependent diabetic patients aged 18-60 years. The albumin excretion rate was determined immunoturbidimetrically in three sterile, Albustix-negative, first-morning urine samples submitted over a week. An abnormally high mean value, greater than or equal to 2.5 mg albumin per mmol creatinine (Ua/Uc), was found in 33 patients (9.9%). These patients were older (mean 42 vs 34 years, P less than 0.01), had longer disease duration (18 vs 14 years, P less than 0.01) and higher HbA1c values (6.8 vs 6.3%, P less than 0.05) than those without microalbuminuria. Although triplicate samples were collected within 7 days, Ua/Uc showed considerable intraindividual variation, with a mean coefficient of variation of 49%. Despite this it was found that Ua/Uc values greater than 1 mg/mmol on the first specimen had a sensitivity of 97% and a specificity of 82% for detecting those with a three-sample mean value greater than 2.5 mg/mmol. Thus virtually all those with microalbuminuria (32/33) had a single first-morning result greater than 1 mg/mmol, and in those with a lower ratio microalbuminuria was excluded with more than 99% certainty.
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PMID:A simple approach to screening for microalbuminuria in a type 1 (insulin-dependent) diabetic population. 195 47

The excretion of small quantities of urinary albumin (microalbuminuria = urinary albumin excretion rate, UAER = 20-200 micrograms/min) may predict renal function in both insulin-dependent and noninsulin-dependent diabetes. We compared radioimmunoassay with the immunoturbidimetric method to detect early increases in urine albumin concentration. More problems have been encountered in deciding which method of collecting urine best differentiate between early onset diabetic nephropathy and normality. Random urine samples collected at clinics are convenient but show wide variations in concentration and the effects of exercise. Such variations may be overcome by using a rest period and correcting for urine creatinine concentration. We studied 21 IDDM patients (12 female, 9 male), aged 13-33 years old (mean 21) and 11 nondiabetics (6 female, 5 male), aged 15-30 years old (mean 23). All gave negative results on testing with Albustix at clinic visits. All subjects passed urine immediately after they got up in the morning. The results disclosed: (1) The correlation coefficient of albumin excretion (micrograms/ml) in the urine collected overnight with that collected over 24 hours was good (r = 0.89, p less than 0.001). (2) When the albumin excretion rate of the urine collected overnight was expressed as microgram albumin/mg creatinine, the correlation was also as good as the 24-hr urine albumin excretion (microgram albumin/mg creatinine) (r = 0.87, p less than 0.001). (3) The results of our study support the use of urine samples collected overnight, corrected for creatinine, to estimate microalbuminuria.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Microalbuminuria in insulin-dependent diabetes mellitus: a comparison of specimen collection, analytic methods and relationship with glycemic control and blood pressure]. 198 84

In six kidney donors with normal baseline urinary albumin excretion (UAE) we studied the behavior of the UAE after 150 g of a meat protein meal and after a carbohydrate meal of equal caloric (1,370 kcal), water (1 liter) and sodium content (51 mEq). The mean creatinine clearance (Ccr) increased significantly after a protein load at the first (p less than 0.01) and second hour (p less than 0.05), while it did not change after the carbohydrate meal. The mean UAE increased significantly after the protein meal at the first (p less than 0.05) and second hour (p less than 0.05), while after the carbohydrate meal the mean values were increased at the first (p less than 0.05), second (p less than 0.05) and third hour (p less than 0.05). Furthermore, the mean values of UAE after the protein meal were significantly higher (p less than 0.05) than those found at the same time after the carbohydrate meal. Diuresis and natriuresis increased significantly after both meals. These findings show that the increased UAE after the protein meal may be due to a further increase in Ccr in the hyperfiltering remaining kidney, while the smaller increase in the UAE observed after the carbohydrate meal may be due to water load and increased urine flow, which impairs albumin tubular reabsorption. The prognostic importance of microalbuminuria after either meal is therefore uncertain.
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PMID:Effects of an acute protein load on urinary albumin excretion in kidney donors. 201 16

Type I glycogen storage disease (GSD-I) is due to the deficiency of glucose-6-phosphatase activity in the liver, kidney and intestine. Although kidney enlargement occurs in GSD-I, renal disease has not been considered a major problem until recently. In older patients (more than 20 years of age) whose GSD-I disease has been ineffectively treated, virtually all have disturbed renal function, manifested by persistent proteinuria; many also have hypertension, renal stones, altered creatinine clearance or a progressive renal insufficiency. Glomerular hyperfiltration is seen in the early stage of the renal dysfunction and can occur before proteinuria. In younger GSD-I patients, the hyperfiltration is usually the only renal abnormality found; and, in some patients, microalbuminuria develops before clinical proteinuria. The predominant underlying renal pathology is focal segmental glomerulosclerosis. Renal stones and/or nephrocalcinosis are also common findings. Amyloidosis and Fanconi-like syndrome can occur, but rarely. The risk factors for developing the glomerulosclerosis in GSD-I include hyperfiltration, hypertension, hyperlipidemia and hyperuricemia. Dietary therapy with cornstarch and/or nasogastric infusion of glucose, aimed at maintaining normoglycemia, corrects metabolic abnormalities and improves the proximal renal tubular function. Long-term trial will be needed to assess whether the dietary therapy may prevent the evolution or the progression of the renal disease.
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PMID:Type I glycogen storage disease: kidney involvement, pathogenesis and its treatment. 202 44

Microalbuminuria, i.e. elevated urinary albumin excretion rate between 20 and 200 micrograms/min, is a strong predictor of subsequent overt diabetic nephropathy. Screening for microalbuminuria is essential, since it has been shown that development of overt nephropathy can be delayed or even prevented by therapeutic measures such as strict metabolic control, early aggressive antihypertensive treatment, or restriction of protein intake. Several urine collection methods for the measurement of microalbuminuria have been proposed. In a prospective study with 40 diabetic outpatients we have compared albumin excretion in urine collected over 24 h, during a timed overnight period, and in a spot urine sample collected at random while the patient attended the outpatient clinic. In addition, the reproducibility of the three urine collection methods was assessed. For this purpose, each patient underwent 3 consecutive collections at an interval of at least 4 weeks. Our data indicate that calculation of an albumin/creatinine quotient in a spot urine probe is a reliable screening test for microalbuminuria. If this quotient is increased (greater than 2), timed overnight collection should be performed.
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PMID:[The practical assessment of micro-albuminuria as a marker for beginning diabetic nephropathy in: which urine sampling method?]. 202 35

Amyloidosis of the kidney is the most threatening complication in familial Mediterranean fever (FMF), and colchicine has been shown to reduce its occurrence. In the preclinical stage of kidney amyloidosis, no proteinuria is observed by the standard Albustix method. However, whether these patients have normal or increased urinary albumin excretion is not known. The purpose of this study was to evaluate albumin excretion in FMF patients treated with colchicine and to compare these values to those of a normal control group. Twenty-two subjects with FMF were compared with 16 normal subjects matched with regard to age and body surface area. The two groups did not differ with regard to female/male ratio and arterial pressure. Urine samples were collected overnight while patients were recumbent and in the daytime while they were ambulant. After measuring albumin concentration (Ua) by radio-immunoassay and creatinine concentration through the standard method, the urinary albumin excretion rate (UaV) and urinary albumin creatinine ratio (Ua/c) were calculated. In the FMF group, three patients had microalbuminuria--defined as an albumin excretion rate higher than 20 micrograms/min. Two of them had this condition only in the early morning collection. These three patients were characterized by a longer duration of symptoms (18 vs. 9 years). No patient in the control group had microalbuminuria. The mean UaV in the FMF group did not differ significantly from that of the control group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Urinary albumin excretion in patients with familial Mediterranean fever: a pilot study. 203 23

The effects of inhibiting angiotensin converting enzyme with perindopril and aldosterone with spironolactone were tested in hypertensive patients over fifty. Accordingly, 75 patients with mild hypertension aged 50 to 70 were randomly divided into three groups for a double-blind 8 week comparison of the actions of placebo, 4 to 8 mg/day perindopril, and 37.5 to 75 mg/day spironolactone. Side-effects caused one patient to withdraw from placebo and one from spironolactone treatment. Mean blood pressure rose by 2.4 mm Hg after placebo but dropped by 7.4 and 8.6 after perindopril and spironolactone (P less than .01). Placebo, perindopril, and spironolactone did not alter blood glucose or plasma potassium, but induced, respectively, variations of -0.09, 0, and +0.34 mmol/L in cholesterol (P = .04), and -0.02, -0.05, and +0.27 mmol/L in triglycerides (P less than .01). After the three treatments, changes in angiotensin converting enzyme activity averaged -1, -6, and -1 mU/mL (P less than .01), in active renin -2, +18, and +28 pg/mL (P less than .01), and in aldosterone, +15, +8, and +95 pg/mL (P less than .01). Placebo, perindopril, and spironolactone did not alter microalbuminuria, but reduced urinary kallikrein activity by 0.9, 1.8, and 5.4 mU/mmol creatinine (P = .04). Although short-term administration of spironolactone raised renin and aldosterone markedly and lipids moderately (possibly because of volume contraction), the present results show that perindopril and spironolactone are both safe and effective for treating hypertension at the age of 50 or older.
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PMID:Are angiotensin converting enzyme inhibition and aldosterone antagonism equivalent in hypertensive patients over fifty? 205 95

For the early diagnosis of diabetic nephropathy, it is best to use the albumin excretion rate (AER). However, it is a complicated test to perform in the outpatient setting, and it is sometimes affected by inaccurate urine collection. Therefore, we have used the albumin/creatinine ratio, which is measured simply with randomly collected urine, for evaluation of microalbuminuria and found it to be of equal diagnostic value to the AER. The AER, albumin/creatinine ratio, and creatinine excretion rate were measured in 86 patients with NIDDN who were negative for proteinuria. Urine was obtained after bed rest and in the outpatients department (without rest). 1) The reproducibility of time-restricted urine sampling was investigated using the rate of creatinine excretion. The mean coefficient of variation was found to be 42%, and inaccurate urine sampling appeared to cause variation in the AER. 2) The AER and albumin/creatinine ratio obtained in the outpatient setting were higher than those after bed rest, and urine collection at the time of outpatient examination was considered to be more useful than that after bed rest. To check variations in urine collection at the time of outpatient examination, the albumin/creatinine ratio in random urine samples was superior on the basis of the correlation coefficients to urine obtained after bed rest. 3) The urinary creatinine excretion rate showed a significant sex difference (males: 0.823 +/- 0.152 mg/g. creat., females: 0.577 +/- 0.194 mg/g. creat) (p less than 0.001), but there was no significant difference for BMI and age. The relationship between each level of microalbuminuria and the creatinine excretion rate did not change significantly. 4) The following formula was used to calculate the albumin/creatinine ratio corresponding to the AER. Albumin/creatinine ratio formula; (see text) An AER of 30 micrograms/min thus corresponds to an albumin/creatinine ratio of 36 mg/g. creat. for males and 51 mg/g. creat. for females. 5) The percentage of positive results for microalbuminuria in patients with NIDDM showed that the albumin/creatinine ratio and the AER were equal as diagnostic criteria, when the sex difference was taken into consideration. Thus, the albumin/creatinine ratio is equal to the AER for evaluation of microalbuminuria, and it is a simple and convenient test to use in daily clinical practice.
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PMID:[Clinical evaluation of the albumin/creatinine ratio in outpatients with diabetes]. 206 14


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