Microalbuminuria is a late event in patients with hypertension: Do we need a lower threshold?

Wahab, Mohamed Abdel Kader Abdel; Saad, Mohamed Mohamed; Baraka, Khaled Abdel Ghany

doi:10.1016/j.jsha.2015.12.003

Cited by 5 publications

(4 citation statements)

References 21 publications

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“…To date, many studies have reported UACR cut-off values for diseases that are associated with diabetic diabetes, e.g., MA cut-offs of 19.25 mg/g Cr [19] for hypertension; 10.7 mg/g Cr [20], 15.6 mg/g Cr [21], 10.7 mg/g Cr [22], and 10.0 mg/g Cr [23] for diabetic retinopathy (DR); and 4.8 mg/g Cr [6] for metabolic syndrome. However, only four studies that investigated the cut-off values for type 2 diabetes [15], CKD [16], and DN [17,18] have been conducted.…”

Section: Uacr Cut-off Values For Diseases Associated With Diabetesmentioning

confidence: 99%

“…The confounding factor of MA has a ten-times wider range for definitions, e.g., UACR 30-300 mg/g Cr, and thus can allow the detection of various diseases associated with diabetes, because it was designed for multi-purpose use. To find the cut-offs for various diseases associated with diabetes, previous studies [13,15,16,[18][19][20][21][22] analyzed AUC-ROCs and used multivariate logistic regression analysis. However, continuous Re-RX can detect the UACR cut-off values for an indication of early DKD and various diseases that are associated with diabetes, without prior knowledge such as distributions/or assumptions of medical datasets.…”

Section: Significance and Clinical Relevance Of This Studymentioning

confidence: 99%

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Detection of Lower Albuminuria Levels and Early Development of Diabetic Kidney Disease Using an Artificial Intelligence-Based Rule Extraction Approach

Hayashi

2019

Diagnostics

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The aim of the present study was to determine the lowest cut-off value for albuminuria levels, which can be used to detect diabetic kidney disease (DKD) using the urinary albumin-to-creatinine ratio (UACR). National Health and Nutrition Examination Survey (NHANES) data for US adults were used, and participants were classified as having diabetes or prediabetes based on a self-report and physiological measures. The study dataset comprised 942 diabetes and 524 prediabetes samples. This study clarified the significance of the lower albuminuria (UACR) levels, which can detect DKD, using an artificial intelligence-based rule extraction approach. The diagnostic rules (15 concrete rules) for both samples were extracted using a recursive-rule eXtraction (Re-RX) algorithm with continuous attributes (continuous Re-RX) to discriminate between prediabetes and diabetes datasets. Continuous Re-RX showed high test accuracy (77.56%) and a large area under the receiver operating characteristics curve (75%), which derived the two cut-off values (6.1 mg/g Cr and 71.00 mg/g Cr) for the lower albuminuria level in the UACR to detect early development of DKD. The early cut-off values for normoalbuminuria (NA) and microalbuminuria (MA) will be determined to help detect CKD and DKD, and to detect diabetes before MA develop and to prevent diabetic complications.

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Section: Uacr Cut-off Values For Diseases Associated With Diabetesmentioning

confidence: 99%

Section: Significance and Clinical Relevance Of This Studymentioning

confidence: 99%

Detection of Lower Albuminuria Levels and Early Development of Diabetic Kidney Disease Using an Artificial Intelligence-Based Rule Extraction Approach

Hayashi

2019

Diagnostics

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“…Urinary albumin level is a risk factor for CKD or CKD progression ( 52 , 53 ). However, in recent years, many studies have suggested that urinary albumin excretion below the defined microalbuminuria range (i.e., in the normal-to-mildly increased albumin range) is an independent risk factor for renal disease ( 54 , 55 ), and some studies have proposed the lowering of albuminuria levels that require intervention from 30 mg/24 h to 8–10 mg/24 h ( 56 , 57 ). These studies have led to an increasing demand for rapid and easy-to-use screening tests to detect low albumin levels in the general population ( 35 ).…”

Section: Auxiliary Examination Of Ckd Patients With Nanoparticlesmentioning

confidence: 99%

Application of nanoparticles in the diagnosis and treatment of chronic kidney disease

et al. 2023

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With the development of nanotechnology, nanoparticles have been used in various industries. In medicine, nanoparticles have been used in the diagnosis and treatment of diseases. The kidney is an important organ for waste excretion and maintaining the balance of the internal environment; it filters various metabolic wastes. Kidney dysfunction may result in the accumulation of excess water and various toxins in the body without being discharged, leading to complications and life-threatening conditions. Based on their physical and chemical properties, nanoparticles can enter cells and cross biological barriers to reach the kidneys and therefore, can be used in the diagnosis and treatment of chronic kidney disease (CKD). In the first search, we used the English terms “Renal Insufficiency, Chronic” [Mesh] as the subject word and terms such as “Chronic Renal Insufficiencies,” “Chronic Renal Insufficiency,” “Chronic Kidney Diseases,” “Kidney Disease, Chronic,” “Renal Disease, Chronic” as free words. In the second search, we used “Nanoparticles” [Mesh] as the subject word and “Nanocrystalline Materials,” “Materials, Nanocrystalline,” “Nanocrystals,” and others as free words. The relevant literature was searched and read. Moreover, we analyzed and summarized the application and mechanism of nanoparticles in the diagnosis of CKD, application of nanoparticles in the diagnosis and treatment of renal fibrosis and vascular calcification (VC), and their clinical application in patients undergoing dialysis. Specifically, we found that nanoparticles can detect CKD in the early stages in a variety of ways, such as via breath sensors that detect gases and biosensors that detect urine and can be used as a contrast agent to avoid kidney damage. In addition, nanoparticles can be used to treat and reverse renal fibrosis, as well as detect and treat VC in patients with early CKD. Simultaneously, nanoparticles can improve safety and convenience for patients undergoing dialysis. Finally, we summarize the current advantages and limitations of nanoparticles applied to CKD as well as their future prospects.

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“…Progressive renal decline could be initiated at even 10% NA, 30% MA and 50% proteinuric states in DM patients [7]. Other vascular complications such as diabetic retinopathy and cardiovascular diseases may occur in diabetic patients in a normal to mildly increased albuminuric state; thus, recent studies have suggested a revised threshold for MA [8,9].…”

Section: Introductionmentioning

confidence: 99%

Poor Glycemic Control Can Increase the Plasma Kidney Injury Molecule-1 Concentration in Normoalbuminuric Children and Adolescents with Diabetes Mellitus

et al. 2021

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Diabetic nephropathy (DN) is a serious microvascular complication in childhood diabetes and microalbuminuria has been a solid indicator in the assessment of DN. Nevertheless, renal injury may still occur in the presence of normoalbuminuria (NA) and various tubular injury biomarkers have been proposed to assess such damage. This case-controlled study aimed to evaluate plasma and urinary neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 (KIM-1) levels in diabetic children particularly in those with normo- and high-NA stages and determine their role in predicting DN. Fifty-four children/adolescents with type 1 and 2 diabetes and forty-four controls aged 7–18 years were included. The baseline clinical and laboratory characteristics including plasma and urinary biomarkers were compared. The plasma KIM-1 levels were significantly higher in diabetic children than in the controls and in high-NA children than normo-NA children. Glycosylated hemoglobin (HbA1c) was identified as a significant risk factor for increased plasma KIM-1. The optimal cutoff for HbA1c when the plasma KIM-1 was > 23.10 pg/mL was 6.75% with an area under the curve of 0.77. For diabetic children with mildly increased albuminuria, the plasma KIM-1 complementary to MA may help increase the yield of detecting DN. Our findings also suggested an HbA1c cutoff of 6.75% correlated with increased plasma KIM-1.

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Microalbuminuria is a late event in patients with hypertension: Do we need a lower threshold?

Abstract: Many vascular changes, in the form of increased IMT, reduced vasodilator capacity, and increased arterial stiffness, preceded MA and any change in LV geometry. The results presented here strengthen the usefulness of adopting a lower cut-off to define MA.

Cited by 5 publications

References 21 publications

Detection of Lower Albuminuria Levels and Early Development of Diabetic Kidney Disease Using an Artificial Intelligence-Based Rule Extraction Approach

Detection of Lower Albuminuria Levels and Early Development of Diabetic Kidney Disease Using an Artificial Intelligence-Based Rule Extraction Approach

Application of nanoparticles in the diagnosis and treatment of chronic kidney disease

Poor Glycemic Control Can Increase the Plasma Kidney Injury Molecule-1 Concentration in Normoalbuminuric Children and Adolescents with Diabetes Mellitus

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