Albuminuria in ischemic heart disease

Nielsen, S; Petersen, Jørgen S.; Magid, Erik

doi:10.1080/00365519909168338

Cited by 4 publications

(4 citation statements)

References 30 publications

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“…It has been shown that UOER increases in parallel with urinary albumin excretion rate (UAER) in physiological proteinuria [9] and in patients with acute cardiovascular diseases [12]. In a study of 171 patients with Type II diabetes it was found that a substantial proportion of patients with normal UAER had increased UOER [11].…”

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Orosomucoid in urine predicts cardiovascular and over-all mortality in patients with Type II diabetes

et al. 2002

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Patients with Type II (non-insulin-dependent) diabetes mellitus have an increased risk of cardiovascular and all-cause mortality compared to the background population [1,2]. Microalbuminuria is a well-known predictor of increased mortality in patients with Type II diabetes [2±6]. The excess mortality is mainly caused by cardiovascular diseases [1,2,6].Orosomucoid is a glycoprotein (41 000 M r , content of carbohydrate 42 %) with a low isoelectric point of 2.7 [7]. Orosomucoid is synthesized in the liver and its serum concentrations are raised in conditions of inflammation and tissue repair [8]. The specific function of the protein is not known. In renal physiological investigations orosomucoid has been classified as a marker of increased glomerular permeability [9]. Diabetologia (2002) Abstract Aims/hypothesis. Urinary orosomucoid excretion rate is increased in a substantial proportion of patients with Type II (non-insulin-dependent) diabetes mellitus and normal urinary albumin excretion rate. The aim of this study was to determine whether increased urinary orosomucoid excretion rate is predictive of increased mortality in patients with Type II diabetes.Methods. In a cohort study including 430 patients with Type II diabetes, baseline urinary samples were analysed for orosomucoid and albumin. Mean follow-up was 2.4 years. Results. We found that 188 (44 %) patients had normal and 242 (56 %) patients had increased urinary orosomucoid excretion rates. During the study period 41 patients died; out of these 23 patients died of cardiovascular diseases. Odds ratio for all-cause mortality was 2.50 (95 % CI 1.00±6.22) and odds ratio for cardiovascular mortality was 9.81 (1.31±73.6) having increased urinary orosomucoid excretion rate at baseline (odds ratios adjusted for age, sex, duration of diabetes, cardiovascular diseases, weight, medication, HbA 1 c , plasma creatinine and urinary albumin excretion rate). Urinary albumin excretion rate was an independent predictor of all-cause mortality when urinary orosomucoid excretion rate was not included in the analysis. Subgroup analysis revealed that 39 % of the patients with normal urinary albumin excretion rate (n = 251) had increased urinary orosomucoid excretion rates and that these patients had a higher cardiovascular mortality (p = 0.007) than patients with normal urinary albumin excretion rate and normal urinary orosomucoid excretion rates. Conclusion/interpretation. We found that urinary orosomucoid excretion rate predicted all-cause and cardiovascular mortality in patients with Type II diabetes independently from other risk factors. [Diabetologia (2002)

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Orosomucoid in urine predicts cardiovascular and over-all mortality in patients with Type II diabetes

et al. 2002

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“…We were particularly interested in seeing whether proteinuria during inflammation was continuous, as is commonly assumed, or intermittent (episodic), a possibility raised by unconfirmed observations in patients with acute cardiac diseases (15,16 ). As we observed in case D (Fig.…”

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confidence: 92%

“…We used a high-frequency (hourly) sampling strategy to monitor the sepsis patients because we anticipated marked and rapid intraindividual variations based on our earlier observations in patients with acute cardiac disease (15 ). Our subsequent studies showed that orosomucoid is a prominent component of proteinuria in acute heart disease (16 ). Our interest in studying the excretion of urinary orosomucoid in states of acute inflammation was further strengthened by our recent finding that the urinary orosomucoid excretion rate is a strong risk marker for cardiovascular mortality in patients with type 2 diabetes and appears to be a marker of low-grade inflammation in this chronic condition (17,18 ).…”

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Monitoring Urinary Orosomucoid in Acute Inflammation: Observations on Urinary Excretion of Orosomucoid, Albumin, α1-Microglobulin, and IgG

et al. 2005

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Background: Inflammation-associated proteinuria in acute, nonrenal disease is a common but poorly understood phenomenon. We performed an observational study of the urinary excretion of orosomucoid (␣ 1 -acid glycoprotein), albumin, ␣ 1 -microglobulin (protein HC), and IgG to obtain quantitative and temporal data on these 4 proteins. Methods: Urine samples were collected at daily intervals for up to 23 days from 6 patients with surgeryinduced inflammation and at hourly intervals for a 24-h period from 7 sepsis patients. Urinary protein concentrations were assessed by immunoturbidimetry. Results: During surgery-induced inflammation, the increase and decrease in orosomucoid excretion mirrored changes in plasma C-reactive protein. Values for all 4 urinary proteins were increased in sepsis patients. The observed maximum increases in urinary protein excretion relative to the upper reference values were 280-fold for orosomucoid, 98-fold for ␣ 1 -microglobulin, 33-fold for albumin, and 26-fold for IgG. Conclusions: Orosomucoid, usually present in plasma and urine in much lower concentrations than albumin, is increased in urine to concentrations equal to or higher than albumin in proteinuria associated with acute inflammation. The pathophysiologic mechanisms responsible for this markedly increased excretion are unknown. Monitoring of urinary excretion of orosomucoid and other specific proteins, expressed as protein/creatinine ratios, may provide a window for clinically rele-

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“…Microalbuminuria (i.e., moderately elevated albumin excretion rates, ranging from 20 to 200 g/min in humans) is a common feature during exercise, posttrauma (4,14) or after surgery (21), and in systemic inflammation (6), but also in congestive heart failure and following myocardial infarction (15,23). In the latter conditions, microalbuminuria has been attributed to permeability effects mediated via ANP.…”

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Transient and sustained increases in glomerular permeability following ANP infusion in rats

Axelsson

Rippe

2011

American Journal of Physiology-Renal Physiology

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Axelsson J, Rippe A, Rippe B. Transient and sustained increases in glomerular permeability following ANP infusion in rats. Am J Physiol Renal Physiol 300: F24 -F30, 2011. First published October 13, 2010 doi:10.1152/ajprenal.00347.2010.-The present study was performed to investigate the effects of systemic atrial natriuretic peptide (ANP) infusion on the glomerular permeability to macromolecules in rats. In anesthetized Wistar rats (250 -280 g), the left urether was cannulated for urine collection while simultaneously blood access was achieved. Rats were continuously infused intravenously with ANP [30 ng·kg Ϫ1 ·min Ϫ1 (Lo-ANP; n ϭ 8) or 800 ng·kg Ϫ1 ·min Ϫ1(Hi-ANP; n ϭ 10)] or 0.9% NaCl (SHAM; n ϭ 16), respectively, and with polydisperse FITC-Ficoll-70/400 (molecular radius 13-90 Å) and 51 Cr-EDTA for 2 h. Plasma and urine samples were taken at 5, 15, 30, 60, and 120 min of ANP infusion and analyzed by high-performance size-exclusion chromatography (HPLC) for determination of glomerular sieving coefficients () for Ficoll. GFR was also assessed ( 51 Cr-EDTA). In Hi-ANP, there was a rapid (within 5 min), but bimodal, increase in glomerular permeability. to high-molecularweight Ficoll thus reached a maximum at 15 min, after which returned to near control at 30 min, to again increase moderately at 60 and 120 min. In Lo-ANP, there was also a rapid, reversible increase in glomerular , returning to near control at 30 min, followed by just a tendency of a sustained increase in permeability, but with a significant increase in "large-pore" radius. In conclusion, in Hi-ANP there was a rapid increase in glomerular permeability, with an early, partly reversible permeability peak, followed by a (moderate) sustained increase in permeability. In Lo-ANP animals, only the initial permeability peak was evident. In both Lo-ANP and Hi-ANP, the glomerular sieving pattern observed was found to mainly reflect an increase in the number and radius of large pores in the glomerular filter. capillary permeability; Ficoll; glomerular filtration; glomerular sieving coefficient PLASMA VOLUME OVERLOAD, in conjunction with e.g., congestive heart failure, induces an increased secretion to the circulation of atrial natriuretic peptide (ANP) from the heart upon atrial stretch. By its natriuretic, diuretic, and vasodilating properties, ANP is believed to act physiologically as a compensatory hormone protecting against plasma volume expansion (9, 11, 29). Furthermore, in extrarenal tissues ANP induces a fluid shift from the vascular to the extravascular space, causing increases in hematocrit and plasma protein concentration in nephrecteomized rats (2). Although these effects can be related to vasodilatation, and hence, to increases in capillary surface area and in microvascular pressure, there is now good evidence that ANP directly affects capillary permeability to proteins (11,12,25,29,34) and microvascular hydraulic conductance (16).Microalbuminuria (i.e., moderately elevated albumin excretion rates, ranging from 20 to 200 g/min in humans) is a co...

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Albuminuria in ischemic heart disease

Cited by 4 publications

References 30 publications

Orosomucoid in urine predicts cardiovascular and over-all mortality in patients with Type II diabetes

Orosomucoid in urine predicts cardiovascular and over-all mortality in patients with Type II diabetes

Monitoring Urinary Orosomucoid in Acute Inflammation: Observations on Urinary Excretion of Orosomucoid, Albumin, α1-Microglobulin, and IgG

Transient and sustained increases in glomerular permeability following ANP infusion in rats

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