Distribution Pattern of Urine Albumin Creatinine Ratio and the Prevalence of High-Normal Levels in Untreated Asymptomatic Non-Diabetic Hypertensive Patients

Ohmaru, Natsuki; Nakatsu, Takaaki; Izumi, Reishi; Mashima, Keiichi; Toki, Misako; Kobayashi, Asako; Ogawa, Hiroyasu; Hirohata, Satoshi; Ikeda, Satoru; Kusachi, Shozo

doi:10.2169/internalmedicine.50.5075

Cited by 4 publications

(7 citation statements)

References 38 publications

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“…The reported prevalence of microalbuminuria in hypertensive patients based on several studies is 6.6% to 36.1%8101112. The present results were similar to these published studies, although there seems to be a somewhat higher prevalence of microalbuminuria in Japanese hypertensive patients9. Such a difference may be attributed to different age and/or severity and duration of hypertension between our patient cohort and those studied previously.…”

Section: Discussionsupporting

confidence: 89%

“…Such a difference may be attributed to different age and/or severity and duration of hypertension between our patient cohort and those studied previously. Indeed, urinary albumin has been correlated with several factors including age and systolic blood pressure9. Furthermore, the higher prevalence of microalbuminuria in Japanese hypertensive patients as compared to Caucasian hypertensive patients suggests ethnic differences in the pathophysiological process involved in microalbuminuria caused by hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have established microalbminuria, which is association with arterial hypertension, metabolic syndrome, and diabetes mellitus with a prevalence rate of 6.6–36.1%89101112, as an important cardiovascular risk factor4567. Left ventricular hypertrophy and increased carotid artery intima-media thickness, both subclinical cardiovascular diseases, are associated with microalbuminuria in individuals at increased risk of cardiovascular disease131415.…”

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confidence: 99%

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The prevalence, characteristics and clinical significance of abnormal albuminuria in patients with hypertension

Murai

Tanaka

Dohi

et al. 2014

Sci Rep

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Kidney function and cardiovascular disease are closely connected and albuminuria is a proven marker of cardiovascular risk. The present study investigated the prevalence and characteristics of albuminuria in patients with hypertension. Outpatients with essential hypertension under medical treatment were enrolled in this study (n = 350, 70.0 ± 11.4 years old). Urine samples were collected for the measurement of albumin concentration, which are expressed as the ratio of urine albumin to creatinine concentration (mg/g Cr). Cross-sectional analyses were also performed of the relationships between urinary albumin and other variables. Urinary albumin was detected in 88.3% of patients, while only 35.4% showed abnormal albuminuria (≥30 mg/g Cr). The presence of abnormal albuminuria was independently correlated with systolic blood pressure, B-type natriuretic peptide, and C-reactive protein by multivariate analysis (P < 0.05). Furthermore, multivariate regression analysis identified systolic blood pressure, serum creatinine, B-type natriuretic peptide, and C-reactive protein as the only factors showing independent correlation with urinary albumin (P < 0.05). Thus, approximately 35% of hypertensive patients had abnormal albuminuria. Urinary albumin was closely associated with blood pressure, C-reactive protein, and B-type natriuretic peptide, indicating that the severity of albuminuria parallels that of systemic inflammation, cardiac load, and blood pressure.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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The prevalence, characteristics and clinical significance of abnormal albuminuria in patients with hypertension

Murai

Tanaka

Dohi

et al. 2014

Sci Rep

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“…22,26,27 Although some of the associations in multivariate models were not significant, the confidence intervals were wide with borderline lower boundaries and odds ratio estimates higher than one, indicating that the association might be clinically relevant. By relying on the conventional definition of MAU, the clinician may miss an opportunity to identify a proportion of patients at increased risk for future cardiovascular events.…”

Section: Discussionmentioning

confidence: 95%

“…In a Japanese study, high normal albuminuria, defined as ACR 420 to o30 μg mg − 1 , was found in 20% of untreated subjects with essential hypertension. 22 However, the sample size was small (n = 332) and there were many exclusions (for example, those with coronary heart disease, arrhythmia, cardiomyopathy and cerebrovascular diseases). In addition, MAU was estimated from single random urine specimen, a method that has been shown to overestimate MAU prevalence.…”

Section: Discussionmentioning

confidence: 99%

Microalbuminuria in subjects with hypertension attending specialist blood pressure clinics

et al. 2015

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Albuminuria is associated with increased risk of cardiovascular disease and target organ damage in patients with diabetes mellitus. In nondiabetic hypertensive patients, the threshold at which microalbuminuria (MAU) increases risk is unclear and there is evidence that cardiovascular risk may be increased in individuals with MAU levels lower than the usual recommended screening thresholds. We compared two definitions of MAU (on the basis of three early morning urine samples) in a cohort of hypertensive patients attending two specialist clinics in Scotland: conventional (MAU(C)) albumin-to-creatinine ratio (ACR) >2.5-25 mg mmol(-1) in males or >3.5-25 mg mmol(-1) in females; and low-grade (MAU(L)) ACR 1.2-2.5 in males or 1.7-3.5 mg mmol(-1) in females. Of the 1059 subjects screened, 786 (74%) were nondiabetic, with estimated glomerular filtration rate ⩾30 ml min(-1) per 1.73 m(2) and without gross proteinuria (low-risk subset). The average age was 58±15 years, body mass index 30±6 kg m(-2) and 46% were males. The prevalence of MAU(C) was 11% and 9.5% in the overall and low-risk subset, respectively, whereas MAU(L) prevalence was 11.1% and 10% respectively. The prevalence of cardiovascular disease was higher (24%) with albuminuria (both MAU(C) and MAU(L)) compared with 14% among those without albuminuria. The use of MAU(L) doubled the number of hypertensive subjects with increased cardiovascular risk who can be targeted for more rigorous risk reduction strategies. Consideration should be given to reducing the current threshold for MAU.

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β‐Amyrin ameliorates diabetic nephropathy in mice and regulates the miR‐181b‐5p/HMGB2 axis in high glucose‐stimulated HK‐2 cells

Wang¹,

Zhang

et al. 2021

Environmental Toxicology

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Diabetic nephropathy (DN) is a diabetic complication that can cause renal failure. β‐amyrin has been identified to possess anti‐diabetic property. This study was designed to evaluate the potential role of β‐amyrin in DN and its underlying mechanism. Streptozotocin‐induced diabetic mice were used as the in vivo model, and high glucose (HG)‐stimulated human proximal tubular HK‐2 cells were utilized as the in vitro model. Renal histological changes in mice were assessed by hematoxylin–eosin and periodic acid‐Schiff staining. HK‐2 cell viability and apoptosis were detected by Cell Counting Kit‐8 assay and flow cytometry analysis, respectively. β‐amyrin was found to ameliorate kidney injury in DN mice and suppressed inflammatory response as well as apoptosis of HG‐stimulated HK‐2 cells. miR‐181‐5p expression in murine renal tissues and HK‐2 cells was detected by in situ hybridization (ISH) and fluorescence in situ hybridization (FISH). MiR‐181b‐5p, a previously identified target for diabetic kidney disease, was downregulated in renal tissues and HG stimulated HK‐2 cells, and β‐amyrin induced the upregulation of miR‐181b‐5p. Binding relationship between miR‐181b‐5p and high mobility group box 2 (HMGB2) was confirmed by luciferase reporter assay. MiR‐181b‐5p bound to 3′ untranslated region of HMGB2 to suppress its expression. As shown by immunohistochemical staining and immunofluorescence staining, HMGB2 was upregulated in the in vivo and in vitro models of DN, and β‐amyrin induced the downregulation of HMGB2. Moreover, HMGB2 overexpression neutralized the suppressive effects of miR‐181b‐5p elevation on the inflammatory response and apoptosis of HG‐treated HK‐2 cells. Overall, β‐amyrin ameliorates DN in mice and suppresses inflammatory response and apoptosis of HG‐stimulated HK‐2 cells via the miR‐181b‐5p/HMGB2 axis.

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Distribution Pattern of Urine Albumin Creatinine Ratio and the Prevalence of High-Normal Levels in Untreated Asymptomatic Non-Diabetic Hypertensive Patients

Cited by 4 publications

References 38 publications

The prevalence, characteristics and clinical significance of abnormal albuminuria in patients with hypertension

The prevalence, characteristics and clinical significance of abnormal albuminuria in patients with hypertension

Microalbuminuria in subjects with hypertension attending specialist blood pressure clinics

β‐Amyrin ameliorates diabetic nephropathy in mice and regulates the miR‐181b‐5p/HMGB2 axis in high glucose‐stimulated HK‐2 cells

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