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Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, Herrington WG, Hill G, Inker LA, Kazancıoğlu R, Lamb E, Lin P, Madero M, McIntyre N, Morrow K, Roberts G, Sabanayagam D, Schaeffner E, Shlipak M, Shroff R, Tangri N, Thanachayanont T, Ulasi I, Wong G, Yang CW, Zhang L, Levin A. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int 2024; 105:S117-S314. [PMID: 38490803 DOI: 10.1016/j.kint.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 03/17/2024]
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Chou YJ, Yang CC, Chang SJ, Yang SSD. Albuminuria Is Affected by Urinary Tract Infection: A Comparison between Biochemical Quantitative Method and Automatic Urine Chemistry Analyzer UC-3500. Diagnostics (Basel) 2023; 13:3366. [PMID: 37958262 PMCID: PMC10650489 DOI: 10.3390/diagnostics13213366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
The automated urine reagent strip test is a cost-effective tool for detecting albuminuria in patients. However, prior research has not investigated how urinary tract infections (UTIs) affect the test's accuracy. Therefore, this study aims to assess the impact of UTIs on albuminuria diagnosis using both the biochemical quantitative method and the test strip method of the Fully Automatic Urine Chemistry Analyzer, UC-3500 (Sysmex, Kobe, Japan). From March to December 2019, we prospectively collected midstream urine from adult female UTI patients before and after one week of cephalexin treatment. The urine samples were subjected to culture, routine urinalysis, and albuminuria diagnosis using the biochemical quantitative method and UC-3500. Albuminuria was defined as a urine albumin to creatinine ratio (UACR) ≥ 30 mg/g in the biochemical quantitative method. The results were compared between the two methods. Among fifty-four female patients (average age: 50.5 ± 4.4 years) with UTIs, 24 (44.44%) had transient albuminuria. The quantitative UACR significantly decreased after one week of antibiotic treatment (median: 53 mg/g to 9 mg/g; median difference: -0.54, p < 0.0001). UC-3500 exhibited a higher false positive rate for diagnosing albuminuria during UTIs (42%) compared to after treatment (19%). Its agreement with the biochemical quantitative method was moderate during UTI (κ = 0.49, 95% confidence interval [CI]: 0.24-0.73) and good after treatment (κ = 0.65, 95% CI: 0.45-0.86). UC-3500's accuracy in diagnosing albuminuria is influenced by UTIs, leading to either transient albuminuria or a false positive reaction of the test strip. UTI should be excluded or treated before its application in albuminuria screening.
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Affiliation(s)
- Yi-Ju Chou
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan;
| | - Chun-Chun Yang
- Department of General Laboratory, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan;
| | - Shang-Jen Chang
- Department of Urology, National Taiwan University Hospital, Taipei 10002, Taiwan;
| | - Stephen Shei-Dei Yang
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan;
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
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Divya, Darshna, Sammi A, Chandra P. Design and development of opto-electrochemical biosensing devices for diagnosing chronic kidney disease. Biotechnol Bioeng 2023; 120:3116-3136. [PMID: 37439074 DOI: 10.1002/bit.28490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/03/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Abstract
Chronic kidney disease (CKD) is emerging as one of the major causes of the increase in mortality rate and is expected to become 5th major cause by 2050. Many studies have shown that it is majorly related to various risk factors, and thus becoming one of the major health issues around the globe. Early detection of renal disease lowers the overall burden of disease by preventing individuals from developing kidney impairment. Therefore, diagnosis and prevention of CKD are becoming the major challenges, and in this situation, biosensors have emerged as one of the best possible solutions. Biosensors are becoming one of the preferred choices for various diseases diagnosis as they provide simpler, cost-effective and precise methods for onsite detection. In this review, we have tried to discuss the globally developed biosensors for the detection of CKD, focusing on their design, pattern, and applicability in real samples. Two major classifications of biosensors based on transduction systems, that is, optical and electrochemical, for kidney disease have been discussed in detail. Also, the major focus is given to clinical biomarkers such as albumin, creatinine, and others related to kidney dysfunction. Furthermore, the globally developed sensors for the detection of CKD are discussed in tabulated form comparing their analytical performance, response time, specificity as well as performance in biological fluids.
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Affiliation(s)
- Divya
- Laboratory of Bio-Physio Sensors and Nanobioengineering School of Biochemical Engineering, Indian Institute of Technology (BHU) Varanasi, Varanasi, Uttar Pradesh, India
| | - Darshna
- Laboratory of Bio-Physio Sensors and Nanobioengineering School of Biochemical Engineering, Indian Institute of Technology (BHU) Varanasi, Varanasi, Uttar Pradesh, India
| | - Aditi Sammi
- Laboratory of Bio-Physio Sensors and Nanobioengineering School of Biochemical Engineering, Indian Institute of Technology (BHU) Varanasi, Varanasi, Uttar Pradesh, India
| | - Pranjal Chandra
- Laboratory of Bio-Physio Sensors and Nanobioengineering School of Biochemical Engineering, Indian Institute of Technology (BHU) Varanasi, Varanasi, Uttar Pradesh, India
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Xue Z, Mao P, Peng P, Yan S, Zang Z, Yao C. Terahertz spectra of proteinuria and non-proteinuria. Front Bioeng Biotechnol 2023; 11:1119694. [PMID: 36873349 PMCID: PMC9982117 DOI: 10.3389/fbioe.2023.1119694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/10/2023] [Indexed: 02/19/2023] Open
Abstract
In clinical practice, proteinuria detection is of great significance in the diagnosis of kidney diseases. Dipstick analysis is used in most outpatient settings to semi-quantitatively measure the urine protein concentration. However, this method has limitations for protein detection, and alkaline urine or hematuria will cause false positive results. Recently, terahertz time-domain spectroscopy (THz-TDS) with strong hydrogen bonding sensitivity has been proven to be able to distinguish different types of biological solutions, which means that protein molecules in urine may have different THz spectral characteristics. In this study, we performed a preliminary clinical study investigating the terahertz spectra of 20 fresh urine samples (non-proteinuria and proteinuria). The results showed that the concentration of urine protein was positively correlated with the absorption of THz spectra at 0.5-1.2 THz. At 1.0 THz, the pH values (6, 7, 8, and 9) had no significant effect on the THz absorption spectra of urine proteins. The terahertz absorption of proteins with a high molecular weight (albumin) was greater than that of proteins with a low molecular weight (β2-microglobulin) at the same concentration. Overall, THz-TDS spectroscopy for the qualitative detection of proteinuria is not affected by pH and has the potential to discriminate between albumin and β2-microglobulin in urine.
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Affiliation(s)
- Zhenrui Xue
- Department of Transfusion Medicine, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ping Mao
- Department of Transfusion Medicine, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Clinical Laboratory, Sichuan Provincial Crops Hospital of Chinese People's Armed Police Forces, Leshan, Sichuan, China
| | - Ping Peng
- Department of Transfusion Medicine, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Shihan Yan
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, China.,Chongqing School, University of Chinese Academy of Sciences (UCAS Chongqing), Chongqing, China
| | - Ziyi Zang
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, China
| | - Chunyan Yao
- Department of Transfusion Medicine, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Sukhram SD, Zarini GG, Shaban LH, Vaccaro JA, Huffman FG. Microalbuminuria and Hypertension among Immigrants with Type 2 Diabetes: A Community-Based Cross-Sectional Study. J Pers Med 2022; 12:jpm12111777. [PMID: 36579508 PMCID: PMC9697914 DOI: 10.3390/jpm12111777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 01/01/2023] Open
Abstract
PURPOSE This study examined the association of microalbuminuria (MAU), as determined by albumin-to-creatinine ratio (ACR), with hypertension (HTN) among Turkish immigrants with type 2 diabetes (T2D) living in deprived neighborhoods of The Hague, Netherlands. METHODS A total of 110 participants, physician-diagnosed with T2D, aged ≥ 30 years were recruited from multiple sources from The Hague, Netherlands in a cross-sectional design. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using automated office blood pressure equipment. Urine albumin was measured by immunoturbidimetric assay. Urine creatinine was determined using the Jaffe method. MAU was defined as ACR ≥ 3.5 mg/mmol for females and/or ACR ≥ 2.5 mg/mmol for males. RESULTS MAU was present in 21% of Turkish immigrants with T2D. Adjusted logistic regression analysis indicated that the odds of having MAU were 6.6 times higher in hypertensive than those that were normotensive (p = 0.007; 95% confidence interval [CI]: 1.19, 36.4). CONCLUSION These findings suggest that HTN and MAU may be assessed as a standard of care for T2D management for this population. Prospective studies of diabetes outcomes are recommended to further verify these findings.
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Affiliation(s)
- Shiryn D. Sukhram
- Department of Biology, College of Staten Island, City University of New York, Staten Island, New York, NY 10314, USA
- Correspondence:
| | - Gustavo G. Zarini
- Clinical & Scientific Research, Oxford Biomedical Technologies, West Palm Beach, FL 33404, USA
| | - Lemia H. Shaban
- Department of Food Science and Nutrition, College of Life Sciences, Kuwait University, Safat, Kuwait City 13060, Kuwait
| | - Joan A. Vaccaro
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
| | - Fatma G. Huffman
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
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Zhang Q, Wang G, Zong X, Sun J. Performance evaluation of Hipee S2 point-of-care testing urine dipstick analyser: a cross-sectional study. BMJ Open 2022; 12:e063781. [PMID: 36302575 PMCID: PMC9621178 DOI: 10.1136/bmjopen-2022-063781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE With advances in mobile technology, smartphone-based point-of-care testing (POCT) urinalysis hold great potential for disease screening and health management for clinicians and individual users. The purpose of this study is to evaluate the analytical performance of Hipee S2 POCT urine dipstick analyser. DESIGN A multicentre, hospital-based, cross-sectional study. SETTING Analytical performance of the POCT analyser was conducted at a clinical laboratory, and method comparison was performed at three clinical laboratories in China. PARTICIPANTS Urine samples were collected from 1603 outpatients and inpatients at three hospitals, and 5 health check-up population at one of the hospitals. OUTCOME MEASURES All tests were performed by clinical laboratory technicians. Precision, drift, carry-over, interference and method comparison of Hipee S2 were evaluated. Diagnostic accuracy of semiquantitative albumin-to-creatinine ratio (ACR) for albuminuria was carried out using quantitative ACR as the standard. RESULTS The precision for each parameter, assessed by control materials, was acceptable. No sample carry-over or drift was observed. Ascorbate solution with 1 g/L had an inhibitory effect for the haemoglobin test. Agreement for specific gravity (SG) varied between moderate to substantial (κ values 0.496-0.687), for pH was moderate (κ values 0.423-0.569) and for other parameters varied between substantial to excellent (κ values 0.669-0.991), on comparing the Hipee S2 with laboratory analysers. The semiquantitative microalbumin and creatinine were highly correlated with the quantitative results. The sensitivity of semiquantitative ACR to detect albuminuria was 87.2%-90.7%, specificity was 70.7%-78.4%, negative predictive value was 85.3%-87.9% and positive predictive value was 73.9%-83%. CONCLUSIONS Hipee S2 POCT urine analyser showed acceptable analytical performance as a semiquantitative method. It serves as a convenient alternate device for clinicians and individual users for urinalysis and health management. In addition, the POCT semiquantitative ACR would be useful in screening for albuminuria.
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Affiliation(s)
- Qiang Zhang
- Clinical Laboratory, Branch of Tianjin Third Central Hospital, Tianjin, China
| | - Guoqing Wang
- Clinical Laboratory, Tianjin Stomatological Hospital, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
| | - Xiaolong Zong
- Clinical Laboratory, Tianjin Medical University Second Hospital, Tianjin, China
| | - Jinghua Sun
- Medical Laboratory Center, Chinese PLA General Hospital, Beijing, China
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The prevalence and risk factors of retinopathy and nephropathy in prediabetic population. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01105-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Fawzy M, Al Ageeli E, Al‑Qahtani S, Abu Alsel B, Kattan S, Alelwani W, Toraih E. MicroRNA‑499a (rs3746444A/G) gene variant and susceptibility to type 2 diabetes‑associated end‑stage renal disease. Exp Ther Med 2021; 23:63. [PMID: 34934434 PMCID: PMC8649846 DOI: 10.3892/etm.2021.10985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/01/2021] [Indexed: 11/20/2022] Open
Abstract
Diabetic nephropathy (DN) is a major risk factor for end-stage renal disease (ESRD). MicroRNAs (miRNAs/miRs) and their variants may be implicated in health and disease, including DN. The present study aimed to investigate the association of the miRNA-499a gene (MIR499A) A/G seed region variant (rs3746444) with DN-associated ESRD susceptibility in patients with diabetes mellitus, and to determine whether there was an association between the different genotypes and the patients' laboratory and clinical data. A case-control pilot study was conducted on 180 adult patients with type 2 diabetes mellitus. A total of 90 patients with ESRD on regular hemodialysis were considered as the cases, and 90 age-, sex- and ethnicity-matched diabetic patients with normo-albuminuria were considered as the controls. MIR499A genotyping was performed using a TaqMan Real-Time allele discrimination assay. Results demonstrated that the MIR499A rs3746444*G variant conferred susceptibility to the development of ESRD under co-dominant [(odds ratio (95% confidence interval): 2.49 (1.41-3.89) and 2.41 (1.61-6.68) for heterozygous and homozygous comparison, respectively], dominant [2.30 (1.18-3.90)] and allelic [1.82 (1.17-2.83)] models. Different genotypes of the specified variant did not exhibit significant associations with the clinic-laboratory data of the studied patients or the circulating miR-499a plasma levels. In conclusion, results of the present study suggested that MIR499A rs3746444 may be a susceptibility variant for DN-associated ESRD in the study population. However, larger sample size studies with different ethnicities are warranted to verify these findings.
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Affiliation(s)
- Manal Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Essam Al Ageeli
- Department of Clinical Biochemistry (Medical Genetics), Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Saeed Al‑Qahtani
- Department of Physiology, Faculty of Medicine, Taibah University, Al Madinah Al Munawwarah 42353, Saudi Arabia
| | - Baraah Abu Alsel
- Department of Pathology, Northern Border University, Arar 1321, Saudi Arabia
| | - Shahad Kattan
- Department of Medical Laboratory, College of Applied Medical Sciences, Taibah University, Yanbu 46522, Saudi Arabia
| | - Walla Alelwani
- Department of Biochemistry, Faculty of Science, University of Jeddah, Jeddah 23445, Saudi Arabia
| | - Eman Toraih
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112‑2632, USA
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Mejia JR, Fernandez-Chinguel JE, Dolores-Maldonado G, Becerra-Chauca N, Goicochea-Lugo S, Herrera-Añazco P, Zafra-Tanaka JH, Taype-Rondan A. Diagnostic accuracy of urine dipstick testing for albumin-to-creatinine ratio and albuminuria: A systematic review and meta-analysis. Heliyon 2021; 7:e08253. [PMID: 34765776 PMCID: PMC8571083 DOI: 10.1016/j.heliyon.2021.e08253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/05/2021] [Accepted: 10/21/2021] [Indexed: 12/03/2022] Open
Abstract
Background The accuracy of urine dipsticks to detect increased albuminuria is uncertain. We aimed to assess the diagnostic accuracy of urine dipsticks for detecting albuminuria. Methods A systematic review of studies that assessed the diagnostic accuracy of urine dipstick testing for detecting albuminuria has been conducted (using as reference standard the albuminuria in a 24-hour sample or the albumin-to-creatinine ratio) in Scopus, PubMed, and Google Scholar. The risk of bias of the included studies has been assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Whenever possible, we performed meta-analyses for sensitivity and specificity. The certainty of the evidence has also been assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Results A total of 14 studies have been included in this review, having assessed all albumin-to-creatinine ratio (ACR) as assessed standard. Each study used different dipstick types. The resulting pooled sensitivity and specificity for each cutoff point were as follows: for ACR >30 mg/g (13 studies): 0.82 (95% confidence interval: 0.76–0.87) and 0.88 (0.83–0.91); for ACR 30–300 mg/g (7 studies): 0.72 (0.68–0.77) and 0.82 (0.76–0.89); and for ACR >300 mg/g (7 studies): 0.84 (0.71–0.90) and 0.97 (0.95–0.99), respectively. An overall high risk of bias, an important heterogeneity in all pooled analysis, and a very low certainty of the evidence have been found. Conclusions Pooled sensitivity and specificity of urine dipsticks have been calculated for different ACR cutoff points. However, the dipstick types differed across studies, and the certainty of the evidence was very low. Thus, further well-designed studies are needed to reach more confident estimates and to assess accuracy differences across dipstick types. Registration PROSPERO (CRD42019124637).
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Affiliation(s)
- Jhonatan R. Mejia
- Universidad Nacional del Centro del Perú, Sociedad Científica de Estudiantes de Medicina del Centro, Huancayo, Peru
| | | | | | | | | | - Percy Herrera-Añazco
- Instituto de Evaluación de Tecnologías en Salud e Investigación-IETSI, Lima, Peru
- Universidad Privada San Juan Bautista, Lima, Peru
| | | | - Alvaro Taype-Rondan
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
- Corresponding author.
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10
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Jasim RK, Hassan Z, Singh D, Boyer E, Gam LH. Characterization of urinary protein profile in regular kratom ( Mitragyna speciosa korth.) users in Malaysia. J Addict Dis 2021; 40:235-246. [PMID: 34747343 DOI: 10.1080/10550887.2021.1981122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Mitragyna speciosa (Korth.) also known as kratom or ketum has been traditionally used for its diverse medicinal value in Southeast Asia. Despite of its therapeutic value, kratom's safety profile remains deficiently elucidated. Our study aims to characterize the urinary protein profile of regular kratom users to determine its toxic effects on renal functioning. A total of 171 respondents (comprising of n = 88 regular kratom users, and n = 83 healthy controls) were recruited for this study. Urine specimens were collected and analyzed using SDS-PAGE, followed by LC/MS/MS analysis. Our results show albumin is the primary, and most abundant form of protein excreted in kratom user's urine specimens (n = 60/64), indicating that kratom users are predisposed to proteinuria. Kratom users had an elevated urinary protein (with an intensity of 66.7 kDa band), and protein: creatinine ratio (PCR) concentrations relative to healthy controls. However, kratom user's urinary creatinine concentration was found to be in the normal range as the healthy control group. While, kratom users who tested positive for illicit drug use had an elevated urinary albumin concentration. Our preliminary findings indicate that regular consumption of freshly brewed kratom solution over a protracted period (for an average of eleven years) seems to induce proteinuria, suggestive of an early stage of kidney injury. Hence, further studies are urgently needed to confirm our findings, and establish kratom's renal impairing effects.
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Affiliation(s)
- Rana Khudhair Jasim
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Zurina Hassan
- Centre of Drug Research, Universiti Sains Malaysia, Penang, Malaysia
| | - Darshan Singh
- Centre of Drug Research, Universiti Sains Malaysia, Penang, Malaysia
| | - Edward Boyer
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lay-Harn Gam
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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ALTamimi JZ, AlFaris NA, Alshammari GM, Alagal RI, Aljabryn DH, Aldera H, Alrfaei BM, Alkhateeb MA, Yahya MA. Ellagic acid protects against diabetic nephropathy in rats by regulating the transcription and activity of Nrf2. J Funct Foods 2021. [DOI: 10.1016/j.jff.2021.104397] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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12
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Diagnostic accuracy of semiquantitative point of care urine albumin to creatinine ratio and urine dipstick analysis in a primary care resource limited setting in South Africa. BMC Nephrol 2021; 22:103. [PMID: 33743616 PMCID: PMC7981803 DOI: 10.1186/s12882-021-02290-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/02/2021] [Indexed: 11/21/2022] Open
Abstract
Background The prevalence of chronic kidney disease (CKD) is predicted to rise over the next few decades. In resource-limited settings access to central laboratory services is limited. Point-of-care (POC) urine dipstick testing offers the potential to detect markers of kidney damage (albuminuria) as well as markers of other disease processes. We evaluated the diagnostic accuracy of the semi-quantitative albumin-creatinine ratio (ACR) Sysmex UC-1000 POC urine dipstick system as well as the extent of other abnormal dipstick findings in urine. Methods 700 participants from a rural area in South Africa were screened for albuminuria. A spot urine sample was used to measure POC and central laboratory ACR. We determined the sensitivity, specificity, positive predictive value and negative predictive value of the POC ACR, and recorded dipstick parameters. Results The prevalence of albuminuria was 11.6% (95%CI; 9.3–14.2). Those with albuminuria had higher mean diastolic (82 vs 79 mmHg, p = 0.019) and systolic (133 vs 128 mmHg, p = 0.002) blood pressures and a higher proportion of diabetes mellitus (17.6 vs 4.9%, p < 0.001). The sensitivity of the POC ACR system was 0.79, specificity 0.84, positive predictive value 0.39 and negative predictive value 0.97. The sensitivity improved to 0.80, 0.85, 0.85 and 0.89 in those with elevated blood pressure, diabetes mellitus, HIV positive status, and those 65 years and older, respectively. Abnormalities other than albuminuria were detected in 240 (34.3%) of the samples; 88 (12.6%) were positive for haematuria, 113 (16.1%) for leucocytes, 66 (9.4%) for nitrites and 27 (3.9%) for glycosuria. Conclusion Our study shows that POC ACR has good negative predictive value and could be used to rule out albuminuria when screening for CKD. Additionally, a high proportion of participants had other urine abnormalities detected with dipsticks which may reflect kidney disease or co-morbid untreated genitourinary pathology such as urinary tract infections or endemic schistosomiasis with important implications for CKD. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02290-5.
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Alshehri AS. Kaempferol attenuates diabetic nephropathy in streptozotocin-induced diabetic rats by a hypoglycaemic effect and concomitant activation of the Nrf-2/Ho-1/antioxidants axis. Arch Physiol Biochem 2021:1-14. [PMID: 33625930 DOI: 10.1080/13813455.2021.1890129] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study examined the protective effect of Kaempferol against streptozotocin-induced diabetic nephropathy (DN) in rats and studies the underlying mechanisms. Rats were divided into 4 groups as control, control + Kaempferol, STZ, and STZ + Kaempferol. All treatments were conducted for 8 weeks daily after the induction of diabetes. Kaempferol prevented STZ-induced weight and food loss and attenuated renal damage and the alterations in all biochemical related parameters. Concomitantly, Kaempferol reduced renal levels of TNF-α and IL-6, cleaved caspase-3, p38, and Bax, suppressing JNK phosphorylation and NF-κB p65 transactivation, and upregulation of Bcl-2. In both control and STZ-diabetic rats, Kaempferol reduced fasting glucose levels, increased fasting insulin levels and HOMA-β, reduced the levels of ROS and MDA, stimulated SOD and GSH levels, and increased the expression of Nrf2 and HO-1. In conclusion, Kaempferol prevents STZ-induced diabetic nephropathy, mainly, by antioxidant potential, mediated by the upregulation of the Nrf-2/HO-1 axis.
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Affiliation(s)
- Ali S Alshehri
- Biology Department, College of Science, King Khalid University, Abha, Saudi Arabia
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14
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Kiapidou S, Liava C, Kalogirou M, Akriviadis E, Sinakos E. Chronic kidney disease in patients with non-alcoholic fatty liver disease: What the Hepatologist should know? Ann Hepatol 2021; 19:134-144. [PMID: 31606352 DOI: 10.1016/j.aohep.2019.07.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/19/2019] [Accepted: 07/08/2019] [Indexed: 02/04/2023]
Abstract
The association of non-alcoholic fatty liver disease (NAFLD) with several other diseases has gained increased interest during the recent years. Among them, the association with chronic kidney disease (CKD) has emerged as an important one regarding both its prevalence and significance. The early recognition of this association is important for the prognosis of patients with NAFLD and CKD. Apart from early diagnosis, the accurate assessment of renal function is also crucial in the clinical practice of hepatologists. Several methods have been used in the literature for the evaluation of kidney function in patients with NAFLD up to now. In this respect, calculators (or formulas) for the estimation of Glomerular Filtration Rate (eGFR) and Albumin to Creatinine Ratio (ACR) are simple, practical and easily available methods for this purpose. The aim of this review is to report on the epidemiology and pathophysiology of the relationship between NAFLD and CKD and to describe the different methods of kidney function assessment in patients with NAFLD. The collection of all relevant data regarding this association will provide hepatologists with pertinent knowledge on this topic and allow them to use the most accurate methods for the assessment of kidney function in these patients in their clinical practice.
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Affiliation(s)
- Stefania Kiapidou
- 4th Department of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, Konstantinoupoleos, Thessaloniki, Greece
| | - Christina Liava
- 4th Department of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, Konstantinoupoleos, Thessaloniki, Greece
| | - Maria Kalogirou
- 4th Department of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, Konstantinoupoleos, Thessaloniki, Greece
| | - Evangelos Akriviadis
- 4th Department of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, Konstantinoupoleos, Thessaloniki, Greece
| | - Emmanouil Sinakos
- 4th Department of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, Konstantinoupoleos, Thessaloniki, Greece.
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15
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Navaneeth B, Suchetha M. A dynamic pooling based convolutional neural network approach to detect chronic kidney disease. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.102068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Résimont G, Piéroni L, Bigot-Corbel E, Cavalier E, Delanaye P. Urinary strips for protein assays: easy to do but difficult to interpret! J Nephrol 2020; 34:411-432. [PMID: 32328900 DOI: 10.1007/s40620-020-00735-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/03/2020] [Indexed: 11/29/2022]
Abstract
Urine samples can be readily obtained from patients in everyday clinical practice. Therefore, the availability of urine allows physicians to obtain relevant clinical information in a timely manner. Since the measurement of urinary protein levels is essential in diagnosing and treating a host of diseases, the potential detection of urinary proteins by urinary strips in an easy, quick, and cheap way is very attractive. However, to ensure optimal use of urinary strips, one needs to be aware of their characteristics and their limitations. In this review, we discuss the characteristics of the urinary strips available for testing urinary protein levels and for detecting urinary albumin. We then consider their analytical performances in their most widely used clinical applications (e.g., in pregnancy, chronic kidney disease, diabetes, and screening of the general population).
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Affiliation(s)
- Guillaume Résimont
- Service de Néphrologie-Dialyse-Transplantation, University of Liège, CHU Sart Tilman (CHU ULg), 4000, Liège, Belgium.
| | - Laurence Piéroni
- Département de Biochimie-Hormonologie, Pôle de Biologie-Pathologie, CHU Montpellier, Montpellier, France
| | - Edith Bigot-Corbel
- Laboratoire de Biochimie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liege, CHU de Liège, Liège, Belgium
| | - Pierre Delanaye
- Service de Néphrologie-Dialyse-Transplantation, University of Liège, CHU Sart Tilman (CHU ULg), 4000, Liège, Belgium.,Department of Nephrology-Dialysis-Apheresis, Hopital Universitaire Caremeau, Nimes, France
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17
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Kamińska J, Dymicka-Piekarska V, Tomaszewska J, Matowicka-Karna J, Koper-Lenkiewicz OM. Diagnostic utility of protein to creatinine ratio (P/C ratio) in spot urine sample within routine clinical practice. Crit Rev Clin Lab Sci 2020; 57:345-364. [PMID: 32058809 DOI: 10.1080/10408363.2020.1723487] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The spot (random) urine protein to creatinine ratio (P/C ratio) is an alternative, fast and simple method of detecting and estimating the quantitative assessment of proteinuria. The aim of the work was to review the literature concerning the usefulness of spot urine P/C ratio evaluation in the diagnosis of proteinuria in the course of kidney disease, hypertension, gestational hypertension, preeclampsia, immunological diseases, diabetes mellitus, and multiple myeloma, and in the diagnosis of proteinuria in children. We searched the PubMed and Google Scholar databases using the following keywords: proteinuria, spot urine protein to creatinine ratio, spot urine P/C ratio, protein creatinine index, PCR (protein to creatinine ratio), P/C ratio and methods, Jaffe versus enzymatic creatinine methods, urine protein methods, spot urine protein to creatinine ratio versus ACR (albumin to creatinine ratio), proteinuria versus albuminuria, limitations of the P/C ratio. More weight was given to the articles published in the last 10-20 years. A spot urine P/C ratio >20 mg/mmol (0.2 mg/mg) is the most commonly reported cutoff value for detecting proteinuria, while a P/C ratio value >350 mg/mmol (3.5 mg/mg) confirms nephrotic proteinuria. The International Society for the Study of Hypertension in Pregnancy recommends a P/C ratio of 30 mg/mmol (0.3 mg/mg) for the classification of proteinuria in pregnant women at risk of preeclampsia. A high degree of correlation was observed between P/C ratio values and the protein concentration in 24-h urine collections. The spot urine P/C ratio is a quick and reliable test that can eliminate the need for a daily 24-h urine collection. However, in doubtful situations, it is still recommended to assess proteinuria in a 24-h urine collection. The literature review indicates the usefulness of the spot P/C ratio in various disease states; therefore, this test should be available in every laboratory. However, the challenge for the primary care physician is to know the limitations of the methods used to determine the protein and creatinine concentrations that are used to calculate the P/C ratio. Moreover, the P/C ratio cutoff used should be determined in individual laboratories because it depends on the patient population and the laboratory methodologies.
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Affiliation(s)
- Joanna Kamińska
- Department of Clinical Laboratory Diagnostics, Medical University of Białystok, Białystok, Poland
| | | | - Justyna Tomaszewska
- Scientific Student's Club at the Department of Clinical Laboratory Diagnostics, Medical University of Białystok, Białystok, Poland
| | - Joanna Matowicka-Karna
- Department of Clinical Laboratory Diagnostics, Medical University of Białystok, Białystok, Poland
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18
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O'Neill RA, Gallagher P, Douglas T, Little JA, Maxwell AP, Silvestri G, McKay G. Evaluation of long-term intravitreal anti-vascular endothelial growth factor injections on renal function in patients with and without diabetic kidney disease. BMC Nephrol 2019; 20:478. [PMID: 31878889 PMCID: PMC6933625 DOI: 10.1186/s12882-019-1650-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 11/29/2019] [Indexed: 01/10/2023] Open
Abstract
Background Administering anti-vascular endothelial growth factor (anti-VEGF) by intraocular injection has been shown to have a safe systemic profile. Nevertheless, incidents of acute kidney injury following anti-VEGF injection have been reported. We assessed the long-term effect of multiple intravitreal anti-VEGF injections on measures of renal function in patients with diabetes including rate of change of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (ACR). Methods A retrospective review of patients receiving diabetic macular oedema (DMO) treatment was undertaken. Serum creatinine, ACR, number of intravitreal anti-VEGF injections and clinical characteristics were collected from electronic healthcare records (EHR). A co-efficient of eGFR and ACR change with time was calculated over a mean duration of 2.6 years. Regression modelling was used to assess variation in the number of anti-VEGF injections and change in eGFR and ACR. Results The EHR of 85 patients with DMO (59% male, 78% type 2 diabetes mellitus [T2DM]) were reviewed. On average, 26.8 intravitreal anti-VEGF injections were given per patient over a mean duration of 31 months. No association between increasing number of anti-VEGF injections and rate of eGFR decline (beta = 0.04, 95% confidence intervals [CI]: − 0.02, 0.09; p = 0.22) or ACR change over time (beta = 0.02, CI: − 0.19, 0.23; p = 0.86) was detected, following adjustment for hypertension, cerebrovascular disease, T2DM, and medications taken. Conclusion Our data suggests regular long-term intravitreal VEGF inhibition does not significantly alter the rate of change in eGFR and/or ACR with increasing number of treatment injections.
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Affiliation(s)
| | | | - Tricia Douglas
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast, UK.,Optometry & Vision Science Research Group, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Julie-Anne Little
- Optometry & Vision Science Research Group, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | | | - Giuliana Silvestri
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast, UK
| | - Gareth McKay
- Centre for Public Health, Queens University Belfast, Belfast, UK.
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19
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Papassotiriou I, Nifli AP. Assessing performance in pre-season wrestling athletes using biomarkers. Biochem Med (Zagreb) 2018; 28:020706. [PMID: 29666559 PMCID: PMC5898958 DOI: 10.11613/bm.2018.020706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 03/07/2018] [Indexed: 11/01/2022] Open
Abstract
Introduction Although regular training introduces the desired changes in athletes' metabolism towards optimal final performance, literature is rarely focusing on the metabolic responses off-competition. Therefore, the aim of this study was to evaluate biochemical indices during typical preseason training in wrestling athletes. Materials and methods Twenty male freestyle and Greco-roman wrestlers (14 to 31 years) followed a typical session of the preparatory phase. Capillary blood glucose and lactate concentrations were assessed immediately before and after training. Protein, microalbumin, creatinine and their ratio were estimated the next day in the first morning urine. Results Pre-training lactate concentrations were lower in Greco-roman than in freestyle wrestlers (1.8 (1.4 - 2.1) vs. 2.9 (2.1 - 3.1) mmol/L). Exertion resulted in a significant increase in lactate concentrations, by 3.2 (2.6 - 4.1) mmol/L in Greco-roman wrestlers and 4.5 (3.4 - 5.3) mmol/L in freestylers. These changes were found to correlate with athlete's sport experience (rs = 0.71, P < 0.001). Glucose concentrations were also significantly increased by 0.5 (0.1 - 0.8) mmol/L, in correlation with lactate change (rs = 0.49, P = 0.003). Twelve subjects exhibited urine albumin concentrations at 30 mg/L, and thirteen creatinine concentrations around 17.7 mmol/L. The corresponding ratio was found abnormal in 4 cases, especially when creatinine excretion and body fat were low. Conclusions Wrestling training is associated with mobilization of both lactic and alactic anaerobic energy systems. The regular comprehensive monitoring of biochemical markers would be advantageous in determining the efficiency of the preparatory phase and the long-term physiological adaptations towards the competition phase, or athlete's overtraining.
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Affiliation(s)
- Ionas Papassotiriou
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece.,Department of Nutrition & Dietetics, Technological Educational Institute of Thessaly, Karditsa, Greece
| | - Artemissia-Phoebe Nifli
- Department of Nutrition & Dietetics, Technological Educational Institute of Thessaly, Karditsa, Greece.,Department of Biochemistry & Biotechnology, University of Thessaly, Larissa, Greece.,Biotechnology, Technological Research Center of Thessaly, Larissa, Greece
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20
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Akhavan-Khaleghi N, Hosseinsabet A. Evaluation of the longitudinal deformation of the left ventricular myocardium in subjects with impaired fasting glucose with and without increased glycated hemoglobin. Anatol J Cardiol 2018; 19:160-167. [PMID: 29363665 PMCID: PMC5864763 DOI: 10.14744/anatoljcardiol.2017.7957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Prediabetes comprises a heterogeneous group because of the poor concordance of its definition. The aim of our study was to evaluate the longitudinal deformation of the left ventricular (LV) myocardium at the two opposite ends of the prediabetes spectrum as defined by fasting blood sugar and glycated hemoglobin (HbA1c). METHODS Eighty consecutive subjects in a cross-sectional single-center study with impaired fasting glucose (IFG) (100-126 mg/dL) and without significant epicardial coronary artery stenosis seen on selective coronary angiography were included in our study and were divided into two groups based on their HbA1c levels (<5.7% and 5.7%-6.4%). The longitudinal deformation of the LV myocardium was compared between the two groups using two-dimensional speckle-tracking echocardiography (2DSTE). RESULTS The Student t-test, Mann-Whitney U test, or X2 test was used for data analysis, whichever was appropriate. The systolic strain (-16.1%±2.0 vs. -16.8%±2.4; p=0.214), systolic strain rate (-1.3±0.2 s-1 vs. -1.4±0.2 s-1; p=0.403), and early and late-diastolic strain rates (1.4±0.3 s-1 vs. 1.5±0.3 s-1; p=0.456 and 0.9±0.1 s-1 vs. 1.0±0.2 s-1; p=0.684, respectively) of the LV myocardium were not statistically different between the IFG subjects with and without increased HbA1c as detected using 2DSTE. CONCLUSION The longitudinal deformation of the LV myocardium as detected using 2DSTE in the subjects without significant epicardial coronary artery stenosis was not statistically significantly different between the IFG subjects with and without increased HbA1c.
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Affiliation(s)
| | - Ali Hosseinsabet
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran-I.R.-Iran.
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21
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Habartová L, Logerová H, Tomaník L, Marešová A, Setnička V. Electronic circular dichroism for the detection of microalbuminuria. Chirality 2018; 30:576-580. [PMID: 29443429 DOI: 10.1002/chir.22832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/03/2018] [Accepted: 01/16/2018] [Indexed: 12/15/2022]
Abstract
Over the past decades, chiroptical spectroscopy has proved its incomparable ability to elucidate the structure and spatial arrangement of chiral molecules. Systematic analysis of biomolecules in the natural environment of biofluids, however, remains challenging. In this study, we used chiroptical spectroscopy to monitor urinary levels of human serum albumin. Not only severe proteinuria but even just a slightly increased urinary excretion of albumin (microalbuminuria) may indicate serious health complications, especially for diabetic individuals. Given the chiral nature of albumin and its typical spectral pattern, it may be easily observable by chiroptical spectroscopy, particularly electronic circular dichroism. The performed chiroptical analysis of urine not only allowed the detection of clinically confirmed microalbuminuria but was also able to reveal this pathological condition in cases beyond the diagnostic capability of common clinical procedures. Thus, our approach suggests that electronic circular dichroism is a useful tool for the fast and reliable qualitative monitoring of microalbuminuria with the potential for a quantitative analysis in the future.
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Affiliation(s)
- Lucie Habartová
- Department of Analytical Chemistry, University of Chemistry and Technology Prague, Prague 6, Czech Republic
| | - Hana Logerová
- Department of Analytical Chemistry, University of Chemistry and Technology Prague, Prague 6, Czech Republic.,Department of Biochemistry, Cell and Molecular Biology, Third Faculty of Medicine, Charles University, Prague 10, Czech Republic
| | - Lukáš Tomaník
- Department of Analytical Chemistry, University of Chemistry and Technology Prague, Prague 6, Czech Republic
| | - Aneta Marešová
- Department of Analytical Chemistry, University of Chemistry and Technology Prague, Prague 6, Czech Republic
| | - Vladimír Setnička
- Department of Analytical Chemistry, University of Chemistry and Technology Prague, Prague 6, Czech Republic
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Microalbuminuria as a simple predictor of incident diabetes over 8 years in the Korean Genome and Epidemiology Study (KoGES). Sci Rep 2017; 7:15445. [PMID: 29133894 PMCID: PMC5684338 DOI: 10.1038/s41598-017-15827-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/26/2017] [Indexed: 01/06/2023] Open
Abstract
Microalbuminuria (MAU) is a common subclinical disease and related with cardiovascular outcome both in diabetic and non-diabetic patients. However, there is rare data about the effect of MAU on the development of diabetes. Thus, we aimed to investigate whether MAU is associated with the development of incident diabetes. A total of 3385 subjects without diabetes (1503 men and 1882 women; mean age, 53 years) who participated in the Ansung–Ansan cohort study from 2001–2002 (baseline) to 2011–2012 (fifth follow-up visit) were followed for a mean of 8 years. The prevalence of MAU at baseline was 10.8% (365 patients), and the incidence of newly developed diabetes during the follow-up period was 15.3% (56 patients) in subjects with MAU. The hazard ratio (HR) for development of diabetes was 1.43 (95% confidence interval (CI) 1.07–1.91, p-value 0.016), independent of traditional risk factors for diabetes including pre-diabetes, age, obesity, and family history. The impact of MAU on diabetes was also significant in the non-pre-diabetic population (HR 2.08, 95% CI 1.07–4.03, p-value 0.031). In conclusion, our results show that incident MAU is associated with future development of diabetes and could be an early marker for diabetes, even in the non-prediabetic population.
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