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Zhang Y, Pan Y, Cai X, Jing J, Yan H, Wang S, Meng X, Mei L, Zhang Y, Li S, Wei T, Zhou Y, Wang Y. Association between Urine Albumin-to-creatinine Ratio and Intracranial Atherosclerotic Plaque in Chinese Adults - Results from the PRECISE Study. J Atheroscler Thromb 2023; 30:1828-1837. [PMID: 37197951 DOI: 10.5551/jat.64156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
AIMS Intracranial plaque may cause stroke in the absence of luminal stenosis. Although urine albumin-to-creatinine ratio (ACR) has been proved an established risk factor for cardiovascular disease, stroke and carotid atherosclerosis, little is known on the relationship between urine ACR and intracranial plaque. METHODS Subjects with history of stroke or coronary heart disease (CHD) were excluded in the PRECISE study. The intracranial plaque was assessed by vessel wall magnetic resonance imaging (MRI). Subjects were stratified according to ACR tertiles. Logistic regression and ordinal regression were performed to analyze the association between ACR and the presence of intracranial plaque or sum of the stenosis score for each artery. RESULTS 2962 individuals were included with the mean age of 61.0±6.6 years. The median ACR was 11.7mg/g (interquartile range 7.0-22.0 mg/g), and the mean estimated glomerular filtration rate (eGFR) based on combination of creatinine and cystatin C was 88.5±14.8 ml/min·1.73m2. 495 (16.7%) participants had intracranial plaque. The highest ACR tertile with ACR >16.00mg/g was independently associated with the presence of intracranial plaque (OR 1.38, 95% CI: 1.05-1.82, p=0.02) and the odds of higher intracranial plaque burden (common OR 1.39, 95% CI: 1.05-1.83, p=0.02) after adjustment of confounding factors. No significant association was observed between eGFR and intracranial plaque presence or intracranial plaque burden. CONCLUSIONS Among a low-risk community-dwelling population without prior stroke or CHD in China, ACR was independently associated with intracranial plaque presence and plaque burden measured by vessel wall MRI.
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Affiliation(s)
- Yin Zhang
- Department of Nephrology, Beijing Tiantan hospital, Capital Medical University
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University
- China National Clinical Research Center for Neurology Disease
| | - Xueli Cai
- Department of Neurology, Lishui Hospital, Zhejiang University School of Medicine
| | - Jing Jing
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University
- China National Clinical Research Center for Neurology Disease
| | - Hongyi Yan
- China National Clinical Research Center for Neurology Disease
| | - Suying Wang
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of Medicine
| | - Xia Meng
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University
- China National Clinical Research Center for Neurology Disease
| | - Lerong Mei
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of Medicine
| | - Yanli Zhang
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University
| | - Shan Li
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of Medicine
| | - Tiemin Wei
- Department of Cardiology, Lishui Hospital, Zhejiang University School of Medicine
| | - Yilun Zhou
- Department of Nephrology, Beijing Tiantan hospital, Capital Medical University
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University
- China National Clinical Research Center for Neurology Disease
- Advanced Innovation Center for Human Brain Protection, Capital Medical University
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences
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Cavalcante JEA, de Sousa ELH, de Oliveira Rodrigues R, de Almeida Viana G, Duarte Gadelha D, de Carvalho MMD, Sousa DL, Silva AJX, Filho RRBX, Fernandes VO, Montenegro Júnior RM, de Sousa Alves R, Meneses GC, Sampaio TL, Queiroz MGR. Interleukin-18 promoter −137 G/C polymorphism (rs187238) is associated with biochemical markers of renal function and cardiovascular disease in type 2 diabetes patients. Clin Biochem 2020; 80:1-7. [DOI: 10.1016/j.clinbiochem.2020.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/17/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022]
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Xu L, Lin X, Guan M, Liu Y. Correlation Between Different Stages of Diabetic Nephropathy and Neuropathy in Patients with T2DM: A Cross-Sectional Controlled Study. Diabetes Ther 2018; 9:2335-2346. [PMID: 30302722 PMCID: PMC6250626 DOI: 10.1007/s13300-018-0519-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Early detection of diabetic peripheral neuropathy (DPN) is critical in patients with type 2 diabetes mellitus (T2DM) due to the lack of targeted therapy for DPN. We have investigated the relationship between different stages of diabetic nephropathy and DPN in an attempt to elucidate whether albuminuria can be used as an early warning signal of DPN progression. METHODS A total of 217 T2DM patients who met the inclusion criteria were recruited from the Department of Endocrinology, Nanfang Hospital between January 2016 and June 2016. These patients were placed in groups based on urinary albumin excretion rate (UAER) and estimated glomerular filtration rate. Nerve conduction studies, the Semmes-Weinstein monofilament test (SWMT) and the vibration perception threshold (VPT) test were conducted. Multiple linear regression analysis, multivariate logistic regression and receiver-operating characteristic (ROC) analysis were performed to investigate the relationship between different stages of diabetic nephropathy and DPN in these patients. RESULTS Significant differences were observed in the conduction velocity (CV) and amplitude of sensory/motor nerve potential among the T2DM patients at different stages of diabetic nephropathy (all p < 0.05). The UAER and duration of diabetes were found to be independent factors associated with the mean CV and amplitude of sensory/motor nerve potential (all p < 0.05). A disease duration of > 10 years (p = 0.025) and a higher total cholesterol value (p = 0.024) were found to be significantly associated with abnormal SWMT results. A UAER of > 300 mg/24 h (p = 0.007) and a diastolic blood pressure of > 100 mmHg (p = 0.042) were associated with a higher risk for abnormal VPT. A UAER of > 300 mg/24 h (p < 0.001) and a disease duration of > 10 years (p = 0.02) were observed to be significantly correlated with DPN. The ROC analysis showed that the optimal cutoff values of UAER and duration as indicators of DPN were 90.5 mg/24 h and 9.5 years, respectively (both p < 0.001). CONCLUSIONS The results suggest that diabetic nephropathy is closely associated with the development of DPN in T2DM patients and that UAER and disease duration can be used as warning indicators of DPN progression. CHINESE CLINICAL TRIALS REGISTER NUMBER ChiCTR-ROC-16007701.
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Affiliation(s)
- Lingling Xu
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, China.
| | - Xiaopu Lin
- Department of Huiqiao Building, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Meiping Guan
- Department of Endocrinology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yingshan Liu
- Department of Endocrinology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Pai YW, Lin CH, Lee IT, Chang MH. Prevalence and biochemical risk factors of diabetic peripheral neuropathy with or without neuropathic pain in Taiwanese adults with type 2 diabetes mellitus. Diabetes Metab Syndr 2018; 12:111-116. [PMID: 29042249 DOI: 10.1016/j.dsx.2017.09.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/26/2017] [Indexed: 12/20/2022]
Abstract
AIMS To investigate the prevalence and risk factors for diabetic peripheral neuropathy with or without neuropathic pain in Taiwanese. METHODS A cross-sectional, hospital-based observational study was conducted. We enrolled 2837 adults with type 2 diabetes mellitus. Diabetic peripheral neuropathy with or without pain were diagnosed using 2 validated screening tools, namely the Michigan Neuropathy Screening Instrument and Douleur Neuropathique 4 questionnaire. RESULTS In our sample, 2233 participants had no neuropathy, 476 had diabetic peripheral neuropathy without pain, and 128 had diabetic peripheral neuropathy with neuropathic pain, representing an overall diabetic peripheral neuropathy prevalence of 21.3%, and the prevalence of neuropathic pain in diabetic peripheral neuropathy was 21.2%. Multivariate analysis revealed that older age (P<0.001), treatment with insulin (P=0.004), microalbuminuria (P=0.001) or overt proteinuria (P<0.001) were independently associated with diabetic peripheral neuropathy, whereas older age (P<0.001), elevated glycated haemoglobin (P=0.011), lower high-density lipoprotein cholesterol (P=0.033), and overt proteinuria (P<0.001) were independently associated with diabetic peripheral neuropathy with neuropathic pain. CONCLUSIONS During clinical visits involving biochemical studies, the risk for diabetic peripheral neuropathy with neuropathic pain should be considered for people with older age, elevated glycated haemoglobin, low high-density lipoprotein cholesterol and overt proteinuria, with particular attention given to increased levels of albuminuria while concerning neuropathic pain.
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Affiliation(s)
- Yen-Wei Pai
- Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City 40705, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City 40705, Taiwan
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City 40705, Taiwan; Department of Medicine, School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei City 112, Taiwan; Department of Medicine, School of Medicine, Chung Shan Medical University, No.110, Sec.1, Jianguo N. Rd., Taichung City 40201, Taiwan
| | - Ming-Hong Chang
- Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City 40705, Taiwan; Department of Neurology, School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei City 112, Taiwan.
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Moon S, Yoo HJ, Ahn YH, Kim GH, Yu JM, Park JS. Synergistic interaction between prolonged increased glycemic exposure and mildly increased urinary albumin excretion on diabetic retinopathy. Medicine (Baltimore) 2018; 97:e9351. [PMID: 29504969 PMCID: PMC5779738 DOI: 10.1097/md.0000000000009351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The association of mild increase in urinary albumin excretion with diabetic retinopathy (DR) in clinical studies is controversial. The aim of this study is to clarify the interaction between increased glycemic exposure and mild increase in urinary albumin excretion on risk of DR.Data were collected from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2012. Overall, data from 953 participants without microalbuminuria (477 men and 476 women) were assessed. Logistic regression analysis was constructed to evaluate the association between DR and related clinical parameters, including urinary albumin-creatinine ratio (UACR, mg/g creatinine). The biological interaction of glycemic status and UACR on DR was evaluated by 3 indices: RERI, the relative excess risk due to the interaction; AP, the attributable proportion due to the interaction; and S, the additive interaction index of synergy.We found that UACR, glycated hemoglobin (HbA1c), and diabetic duration were deeply associated with increased risk of DR (UACR, odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.02-1.07; HbA1c, OR = 1.16, 95% CI = 1.04-1.30; diabetic duration, OR = 1.06, 95% CI = 1.04-1.07). Furthermore, our interaction analysis demonstrated that synergistic interaction between HbA1c and UACR on development of DR was prominent in participants with diabetic duration of ≥10 years (adjusted RERI = 0.92, 95% CI = 0.10-1.74; adjusted AP = 0.29, 95% CI = -0.82-1.41; adjusted S = 1.76, 95% CI = 1.27-2.25), but not subjects with shorter diabetic duration.These findings imply that there is the interaction between prolonged hyperglycemic exposure and increased urinary albumin excretion may exert additive synergistic effect on vascular endothelial dysfunction in the eye, even before the appearance of overt diabetic nephropathy.
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Affiliation(s)
- Shinje Moon
- Department of Internal Medicine, Hallym University College of Medicine
| | - Hyung-Joon Yoo
- Department of Internal Medicine, Hallym University College of Medicine
| | - You-Hern Ahn
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Gheun-Ho Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jae Myung Yu
- Department of Internal Medicine, Hallym University College of Medicine
| | - Joon-Sung Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
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da Costa PM, Cortez AF, de Souza F, Mares GDS, dos Santos BDM, Muxfeldt ES. Prognostic impact of baseline urinary albumin excretion rate in patients with resistant hypertension: a prospective cohort study. J Hum Hypertens 2018; 32:139-49. [DOI: 10.1038/s41371-017-0013-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/01/2017] [Accepted: 10/03/2017] [Indexed: 11/09/2022]
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Gao T, Yu W, Liu C. Mechanisms of ischemic stroke in patients with intracranial atherosclerosis: A high-resolution magnetic resonance imaging study. Exp Ther Med 2014; 7:1415-1419. [PMID: 24940449 PMCID: PMC3991508 DOI: 10.3892/etm.2014.1600] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 02/14/2014] [Indexed: 11/22/2022] Open
Abstract
High-resolution magnetic resonance imaging (HRMRI) has a unique ability to provide an evaluation of the intracranial artery wall. This study aimed to investigate the possible mechanisms of ischemic stroke in patients with intracranial atherosclerosis using HRMRI. HRMRI was performed on 55 patients (38 male and 17 female) with acute cerebral infarction to investigate the lumen-intruding plaque at the stenotic portion of the middle cerebral artery (MCA) and basilar artery (BA) and to attempt to identify the mechanisms of stroke. Penetrating artery disease (PAD) was diagnosed in 20 patients (36%) and large-artery atherosclerosis (LAA) was diagnosed in 35 patients, including 19 with parent artery plaques occluding a penetrating artery (POPA; 35%) and 16 with artery-to-artery embolisms (29%). Patients with PAD had a higher frequency of hypertension compared with that of the patients with LAA (80 versus 29%; P<0.001), and patients with LAA had a higher frequency of diabetes compared with that of the patients with PAD (40% versus 15%; P=0.054). Magnetic resonance angiography revealed mild to moderate stenosis in the patients with POPA, while border zone infarction and artery-to-artery embolism occurred in the majority of the patients with severe stenosis or occlusion of the MCA and BA. HRMRI has the ability to identify the mechanisms of intracranial atherosclerotic ischemic stroke through the detection of luminal plaques.
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Affiliation(s)
- Tianli Gao
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Wei Yu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Chunjie Liu
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
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Abstract
OBJECTIVE The aim of this study was to determine risk factors and prevalence of diabetic neuropathy (DN) among type II diabetic patients in Malaysian hospital setting. SUBJECTS AND METHODS a observational prospective longitudinal follow up study design was selected, total no of respondents were 1077 type 2 diabetes mellitus outpatients recruited via attended the diabetes clinics at Hospital Universiti Sains Malaysia (HUSM) in Kelantan. The diagnosis of neuropathy was confirmed by nerve conduction studies. Logistic regression analysis was used to assess the independent variables that affect the development of neuropathy. RESULTS The prevalence of nephropathy is 54.3%. Longitudinal logistic regression identified four predictive variables on the development and progression of diabetic neuropathy that are: duration of diabetes, retinopathy, HbA1c at second visit, and creatinine clearance third visit. CONCLUSION Findings of this study show high prevalence of diabetic neuropathy. HbA1c and creatinine clearance are two modifiable risk factors for the development of diabetic neuropathy.
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Chen H, Zheng Z, Huang Y, Guo K, Lu J, Zhang L, Yu H, Bao Y, Jia W. A microalbuminuria threshold to predict the risk for the development of diabetic retinopathy in type 2 diabetes mellitus patients. PLoS One 2012; 7:e36718. [PMID: 22590593 PMCID: PMC3349710 DOI: 10.1371/journal.pone.0036718] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 04/12/2012] [Indexed: 12/20/2022] Open
Abstract
Objective To test the hypothesis that a microalbuminuria (MA) threshold can help predict the risk for the development of diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM)_ patients. Design We conducted a cross-sectional study of 4739 subjects with T2DM and a prospective study of 297 subjects with T2DM in China respectively. Methods Clinical and laboratory data were collected and biologic risk factors associated with any DR were analysed. Results In the cross-sectional study, we found that MA was an independent risk factor for DR development; further, when the patients were divided into MA deciles, odds ratio (ORs) of DR for the patients in the sixth MA decile (10.7 mg/24 h) was 1.579-fold (1.161–2.147) compared to that for patients in the first MA decile. Furthermore, the OR of DR increased with a gradual increase in MA levels. Similarly, in the prospective study, during a mean follow-up of 4.5 years, we found that 51 patients (29.0%) of the 176 subjects with high MA level (10.7–30 mg/24 h) developed DR, while 17 patients (14.1%) of the 121 subjects with lower MA (<10.7 mg/24 h) developed DR, and the relative risk ratio of the development of DR is 2.13(95% CI, 1.58–3.62, P<0.001). Conclusion These data suggest that an MA threshold can predict the risk for the development of DR in type 2 diabetes mellitus, although it is still within the traditionally established normal range.
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Affiliation(s)
- Haibing Chen
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Zhi Zheng
- Department of Ophthalmology, First People's Hospital of Shanghai Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Yan Huang
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Kaifeng Guo
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Junxi Lu
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Lei Zhang
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Haoyong Yu
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
- * E-mail:
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Satirapoj B, Nast CC, Adler SG. Novel insights into the relationship between glomerular pathology and progressive kidney disease. Adv Chronic Kidney Dis 2012; 19:93-100. [PMID: 22449346 DOI: 10.1053/j.ackd.2011.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 12/12/2011] [Accepted: 12/12/2011] [Indexed: 01/11/2023]
Abstract
Both glomerular and tubulointerstitial damage are important factors in the pathophysiology and progression of nephropathy. Glomerular injury is associated with tubulointerstitial inflammation, and many studies show that tubulointerstitial changes correlate well with progressive renal functional decline. Strong evidence supports the concept that once established, proteinuric glomerular injury can cause tubular injury. This review briefly summarizes the pathophysiological consequences of glomerular damage that are responsible for tubulointerstitial injury. It further focuses on tubule-derived renal injury biomarkers that may be used to monitor the progression of kidney disease. This monitoring is predicted to become increasingly useful as novel therapeutic interventions preventing progressive renal damage are introduced. In particular, biomarkers of kidney dysfunction, such as urinary podocytes, kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, hematopoietic growth factor-inducible neurokinin 1, or periostin, might be useful in the diagnosis or detection of early nephropathy and risk assessment of kidney disease. However, these biomarkers require further study before they are used in routine screening or in guiding patient therapy.
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Rosenson R, Fioretto P, Dodson P. Does microvascular disease predict macrovascular events in type 2 diabetes? Atherosclerosis 2011; 218:13-8. [DOI: 10.1016/j.atherosclerosis.2011.06.029] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 06/13/2011] [Accepted: 06/14/2011] [Indexed: 12/19/2022]
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Abstract
Diabetes mellitus is one of the most challenging health concerns of the 21st century. With at least 30% of the diabetic population remaining undiagnosed, effective and early diagnosis is of critical concern. Development of a diagnostic test, more convenient and reliable than those currently used, would therefore be highly beneficial. Urine as a diagnostic medium allows for non-invasive detection of biomarkers, including some associated with type 2 diabetes and its complications. This review provides a synopsis of those urinary biomarkers that potentially may provide a basis for the development of improved diagnostic tests. Three main pathways for the sourcing of potential makers are identified: kidney damage, oxidative stress and low-grade inflammation including atherosclerosis/vascular damage. This review briefly presents each pathway and some of the most relevant urinary biomarkers that may be used to monitor the development or progression of diabetes and its complications. In particular, biomarkers of renal dysfunction such as transferrin, type IV collagen and N-acetyl-beta-D-glucosaminidase might prove to be more sensitive than urinary albumin, the current gold standard, in the detection of incipient nephropathy and risk assessment of cardiovascular disease. Inflammatory markers including orosomucoid, tumour necrosis factor-alpha, transforming growth factor-beta, vascular endothelial growth factor and monocyte chemoattractant protein-1, as well as oxidative stress markers such as 8-hydroxy-2'deoxyguanosine may also be useful biomarkers for diagnosis or monitoring of diabetic complications, particularly kidney disease. However, the sensitivity of these markers compared with albumin requires further investigation.
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Affiliation(s)
- Agnès Matheson
- Minomic Pty Ltd, Frenchs Forest, New South Wales, Australia.
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Jiang CQ, Lam TH, Lin JM, Liu B, Yue XJ, Cheng KK, Tomlinson B, Wong KS, Cheung BM, Thomas GN. An overview of the Guangzhou biobank cohort study-cardiovascular disease subcohort (GBCS-CVD): a platform for multidisciplinary collaboration. J Hum Hypertens 2010; 24:139-50. [PMID: 19587700 DOI: 10.1038/jhh.2009.52] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Guangzhou Biobank Cohort Study (GBCS, n=30 519, age >or=50 years) was established to examine the effects of genetic and environmental influences on health problems and chronic disease development. Guangzhou is undergoing massive economic development, but from a baseline that had remained unchanged for millennia. The Cardiovascular Disease Subcohort (GBCS-CVD) consists of 2000 participants who have been intensively phenotyped including a range of surrogate markers of vascular disease, including carotid artery intima-media thickness, cerebral artery stenoses, arterial stiffness, ankle-to-brachial blood pressure index and albuminuria, as well as coagulatory and inflammatory markers. Plasma and leukocytes are stored in liquid nitrogen for future studies. Preliminary demographic data show the female volunteers are younger than the male ones, but present with greater levels of adiposity including central obesity (31 vs 16%). Women had more body fat (33 vs 24%) and associated levels of adipokines. Despite this, body mass index and hip circumferences were similar, which contrasts with Caucasian populations. Men had more physician-diagnosed vascular disease (6.1 vs 2.5%), hypertension (42 vs 34%) and hyperglycaemia (36.6 vs 29.6%) than the women, but were less insulin resistant. In men, smoking (40 vs 2%) and drinking alcohol (67 vs 50%) was more common and they also had lower energy expenditures. The genotype distributions of the 15 typed single nucleotide polymorphisms were all in Hardy-Weinberg equilibrium. This article describes the rationale and methodology for the study. Given the comprehensive characterization of demographic and psychosocial determinants and biochemistry, the study provides a unique platform for multidisciplinary collaboration in a highly dynamic setting.
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Petrica L, Petrica M, Vlad A, Bob F, Gluhovschi C, Gluhovschi G, Jianu CD, Ursoniu S, Schiller A, Velciov S, Trandafirescu V, Bozdog G. Cerebrovascular reactivity is impaired in patients with non-insulin-dependent diabetes mellitus and microangiopathy. Wien Klin Wochenschr 2007; 119:365-71. [PMID: 17634895 DOI: 10.1007/s00508-007-0809-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Accepted: 12/18/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cerebrovascular reactivity (CVR) is a hemodynamic parameter representing the increase in normal cerebral artery blood flow in response to a vasodilatory stimulus such as hypercapnia. MAIN PURPOSE The aim of the study was to assess CVR using transcranial Doppler ultrasound and the breath-holding test (BHT) in normotensive patients with non-insulin-dependent diabetes mellitus (NIDDM). The cerebrovascular response to hypercapnia was evaluated in relation to risk factors for cerebral microangiopathy. METHODS The study was carried out in a group of 34 normotensive NIDDM patients and a group of 31 sex- and age-matched normal controls. The NIDDM group was subdivided into 21 patients with microangiopathic complications (Group A, 12 men, 9 women; mean age 58.77 +/- 8.91 years) and 13 patients with no such complications (Group B, 8 men, 5 women; mean age 56.34 +/- 9.83 years). The control group comprised 17 men and 14 women (Group C, mean age 58.43 +/- 6.31 years). Exclusion criteria were hypertension and past or present symptomatic cerebrovascular disease. The BHT consisted of spontaneous hypercapnia induced by holding the breath for 20 seconds. CVR was estimated in relation to the increase in the mean flow velocity (MFV) compared with the basal velocity in both middle cerebral arteries during hypercapnia. RESULTS In Group A, the CVR was significantly decreased in 71.42% of patients, whereas in Group B only 30.76% of patients presented with mildly to moderately impaired CVR. Predictors for impaired % increase in the MFV during the BHT demonstrated by univariate regression analysis were: duration of diabetes (r = 0.802; P < 0.0001), fibrinogen (r = 0.574; P < 0.0001), C-reactive protein (r = 0.525; P < 0.001), proteinuria (r = 0.924; P < 0.0001) and serum creatinine (r = 0.969; P < 0.0001). Multivariate regression analysis showed as predictors: duration of diabetes (P < 0.0001), proteinuria (P < 0.0001) and serum creatinine (P < 0.0001). CONCLUSION CVR is impaired in normotensive NIDDM patients. These cerebral hemodynamic changes correlate significantly with the duration of DM, parameters of inflammation, proteinuria and serum creatinine.
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Affiliation(s)
- Ligia Petrica
- Department of Nephrology, University of Medicine and Pharmacy, Timisoara, Romania.
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Abstract
Background Foot complications are common in diabetic patients and are considered one of the most expensive diabetes (DM) complications to treat. The aim of this study was to determine the prevalence and risk factors for foot complications among diabetic patients in Al-Ain district, United Arab Emirates (UAE). Methods The study was part of a general cross-sectional survey carried out to assess the prevalence of DM complications in Al-Ain district, UAE. A sample of 513 diabetic patients with a mean age of 53 years (SD: ± 13) were randomly selected during 2003/2004. All completed an interviewer-administered questionnaire and underwent medical assessment including foot examination and assessment of presence of peripheral neuropathy (PN) and peripheral vascular disease (PVD). Results Forty nine percent of the study populations were diagnosed to have DM without presenting with symptoms of diabetes and 35% had hypertension. The majority (86%) had type 2 DM. Of the total sample, 39% (95% CI: 35.1-43.7%) had PN and 12% (95% CI: 8.8–14.4%) had PVD. There were no cases of amputation and only one case had previous history of lower extremity ulceration. Significant risk factors for PN and PVD were: male gender, poor level of education, UAE nationality, increased duration of diabetes, type 2 DM, presence of hypertension and microalbuminuria (MA). Conclusion Despite the low prevalence of foot ulceration and amputation among the study population, nevertheless, a substantial proportion had potential risk factors for foot complications.
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Affiliation(s)
- Fatma Al-Maskari
- Department of Community Medicine, Faculty of Medicine & Health Sciences, United Arab Emirates University, Al-Ain, PO Box 17666, UAE.
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Yoshikawa R, Wada J, Seiki K, Matsuoka T, Miyamoto S, Takahashi K, Ota S, Taniai K, Hida K, Yamakado M, Shikata K, Uehara Y, Urade Y, Makino H. Urinary PGDS levels are associated with vascular injury in type 2 diabetes patients. Diabetes Res Clin Pract 2007; 76:358-67. [PMID: 17007955 DOI: 10.1016/j.diabres.2006.09.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Accepted: 09/04/2006] [Indexed: 12/17/2022]
Abstract
BACKGROUND The presence of metabolic syndrome has been shown to be predictors of cardiovascular morbidity and mortality in patients with type 2 diabetes. In a cross-sectional clinical study, we investigated the association of metabolic syndrome with asymptomatic lacunar strokes and cardiovascular disease (CVD) and we compared its significance with urinary protein markers. METHODS We studied Japanese type 2 diabetes patients (n=233, men=124, women=109). The diagnosis of metabolic syndrome was made according to WHO and International Diabetes Federation (IDF) criteria. Cardiovascular events were recorded and asymptomatic lacunar lesions were evaluated with magnetic resonance imaging (MRI). We also measured urinary levels of albumin, type IV collagen, beta2-microglobulin (beta2MG), N-acetyl-beta-d-glucosaminidase (NAG) and lipocalin-type prostaglandin D synthase (PGDS). RESULTS The prevalence of metabolic syndrome is 31.3% (IDF) and 52% (WHO) in 233 patients and microalbuminuria was present in 62 subjects (26.6%). Metabolic syndrome (WHO) significantly associated with asymptomatic lacunar lesions (p=0.035, OR=2.854, CI 1.075-7.579), while metabolic syndrome (IDF) or urinary markers failed to associate with presence of asymptomatic lacunar lesions. The presence of metabolic syndrome or microalbuminuria did not show significant association with CVD; however, the elevation of beta2MG, NAG and PGDS showed significant association with CVD. By a logistic regression analysis using urinary proteins as independent variables, the presence of higher PGDS excretion independently associated with history of CVD (p=0.025, OR=3.847, CI 1.180-12.545). CONCLUSIONS In type 2 diabetes patients, the elevation of urinary PGDS secretion closely associated with cardiovascular events and may be a supplemental or additional marker to the criteria of metabolic syndrome.
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Affiliation(s)
- Ritsuko Yoshikawa
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Okayama, Japan
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Petrica L, Petrica M, Munteanu M, Vlad A, Bob F, Gluhovschi C, Gluhovschi G, Jianu C, Schiller A, Velciov S, Trandafirescu V, Bozdog G. Cerebral Microangiopathy in Patients with Non-insulin-dependent Diabetes Mellitus. Ann Acad Med Singap 2007. [DOI: 10.47102/annals-acadmedsg.v36n4p259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction: The aim of the study was to evaluate cerebral microangiopathy in type 2 non-insulin-dependent diabetes mellitus (NIDDM) patients and to establish potentially conducive factors.
Materials and Methods: A group of 34 patients with NIDDM and 31 gender- and age-matched normal controls (NC) were assessed by extracranial Doppler ultrasound, in order to evaluate the pulsatility index (PI) and the resistance index (RI) in the internal carotid arteries (ICAs); transcranial Doppler was utilised to assess the same parameters in the middle cerebral arteries (MCAs). All patients underwent screening for favouring factors for cerebral vascular remodelling.
Results: Of the 34 NIDDM patients, 21 patients (61.76%) (subgroup A) presented with microangiopathic complications [of these, 19 patients (90.46%) had diabetic nephropathy (DN)] versus 13 NIDDM patients (38.24%) (subgroup B) without complications. In subgroup A, 16 patients (76.19%) had PI >1 and RI >0.7 in the ICAs and MCAs (changes consistent with cerebral microangiopathy) versus 5 patients (35.46%) in subgroup B, and no modifications in NC. Of the 19 patients with DN, 14 patients (73.68 %) had impaired haemodynamic indices. Univariate regression analysis showed the following risk factors for the cerebral haemodynamics changes: fibrinogen (F) (OR = 3.11), C-reactive protein (CRP) (OR = 2.40), duration of DM (OR=2.40), proteinuria (OR = 1.80), serum creatinine (OR = 1.66). Multivariate regression analysis showed as predictors for impaired haemodynamic indices: duration of DM (HR =1.70), proteinuria (HR = 1.70). The haemodynamic indices in the ICAs correlated with duration of DM (r = 0.87, P <0.0001), F (r = 0.86; P <0.0001), CRP (r = 0.80; P <0.0001); in the MCAs with the duration of DM (r = 0.66, P <0.0001), F (r = 0.38; P <0.0001), CRP (r = 0.88; P <0.0001).
Conclusion: Cerebral microangiopathy has a high prevalence in NIDDM patients. These cerebral vascular changes correlate with the duration of DM, parameters of inflammation, and proteinuria.
Key words: Cerebral microangiopathy, Diabetic nephropathy, Doppler ultrasound, Non-insu-lin-dependent diabetes mellitus, Risk factors
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Affiliation(s)
- Ligia Petrica
- County Emergency Hospital, University of Medicine and Pharmacy, Timisoara, Romania
| | - Maxim Petrica
- County Emergency Hospital, University of Medicine and Pharmacy, Timisoara, Romania
| | - Mircea Munteanu
- County Emergency Hospital, University of Medicine and Pharmacy, Timisoara, Romania
| | - Adrian Vlad
- County Emergency Hospital, University of Medicine and Pharmacy, Timisoara, Romania
| | - Falciu Bob
- County Emergency Hospital, University of Medicine and Pharmacy, Timisoara, Romania
| | - Cristina Gluhovschi
- County Emergency Hospital, University of Medicine and Pharmacy, Timisoara, Romania
| | - Gheorghe Gluhovschi
- County Emergency Hospital, University of Medicine and Pharmacy, Timisoara, Romania
| | - Catalin Jianu
- County Emergency Hospital, University of Medicine and Pharmacy, Timisoara, Romania
| | - Adalbert Schiller
- County Emergency Hospital, University of Medicine and Pharmacy, Timisoara, Romania
| | - Silvia Velciov
- County Emergency Hospital, University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Gheorghe Bozdog
- County Emergency Hospital, University of Medicine and Pharmacy, Timisoara, Romania
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