Microalbuminuria and Potential Confounders: A review and some observations on variability of urinary albumin excretion

Ce, Mogensen; Vestbo, E.; Poulsen, Per Løgstrup; Christiansen, Christian; Damsgaard, Else Marie; Eiskjær, Hans; Frøland, Anders; Hansen, Klavs Würgler; Nielsen, S; Pedersen, Margrethe Mau

doi:10.2337/diacare.18.4.572

Cited by 219 publications

(131 citation statements)

References 56 publications

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“…A limitation of our study is that MA was assessed on one overnight sample. It is well known that there is considerable intra-individual variability in urinary albumin excretion in time (33). As a consequence, the prevalence of MA in our study may have been significantly both underestimated as well as overestimated.…”

Section: Discussionmentioning

confidence: 52%

An insulin-like growth factor-I gene polymorphism modifies the risk of microalbuminuria in subjects with an abnormal glucose tolerance

Rietveld

Hofman²,

Pols³

et al. 2006

eur j endocrinol

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Objective: Microalbuminuria (MA) is related to cardiovascular disease both in diabetic patients and non-diabetic subjects. Design: We investigated whether a polymorphism near the promoter region of the IGF-I gene was related to the development of MA. Methods: For this study, 1069 participants of the Rotterdam study were selected (440 participants with an abnormal glucose tolerance (AGT), 220 participants with type 2 diabetes and 254 subjects with pre-diabetes, and 595 subjects with a normal glucose tolerance (NGT). Results: 787 subjects were carriers of the wild type IGF-I genotype (73.6%) and 282 subjects were variant carriers (26.4%) of this IGF-I gene polymorphism. Compared to subjects with NGT the risk for microalbuminuria was higher (Odds Ratio (OR): 3.1 (95% CI: 1.2-7.7); P ¼ 0.02) in variant carriers with AGT than in carriers of the wild type of this IGF-I gene polymorphism (OR: 2.2 (95% CI: 1.2 -4.0); P ¼ 0.009). Compared with wild type carriers with AGT, the relative risk for MA was unadjusted and non-significantly increased in variant carriers with AGT (1.6; 95% CI: 0.8 -2.9). However, after adjustment for possible confounding factors (age, gender, mean blood pressure, fasting insulin, fasting glucose and smoking) this risk became significant (OR: RR 2.1; 95% CI:1.1 -4.4; P ¼ 0.04). Conclusions: In subjects with AGT, a higher risk for MA was observed in variant carriers than in carriers of the wild type genotype of this IGF-I gene polymorphism. Since MA is primarily associated with cardiovascular disease in subjects with AGT, our study suggests that variant carriers have a higher risk for cardiovascular disease than carriers of the wild type when they develop an AGT. European Journal of Endocrinology 154 715-721

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Section: Discussionmentioning

confidence: 52%

An insulin-like growth factor-I gene polymorphism modifies the risk of microalbuminuria in subjects with an abnormal glucose tolerance

Rietveld

Hofman²,

Pols³

et al. 2006

eur j endocrinol

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“…Although the A/C ratio is accepted as an alternative to detect the presence of microalbuminuria, urinary creatinine excretion depends on the amount of muscle mass, which is variable for several biological parameters (gender, age, body weight, exercise). 37 This could be a reason that these studies did not find an interaction of CRP and blood pressure, which is also related to these parameters, with the risk of microalbuminuria.…”

Section: Discussionmentioning

confidence: 97%

C-Reactive Protein Modifies the Relationship Between Blood Pressure and Microalbuminuria

et al. 2004

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Abstract-C-reactive protein (CRP) and microalbuminuria reflect intimately related components of the atherosclerotic disease process. Epidemiological studies found only modest associations between CRP and microalbuminuria. Blood pressure, one of the components of the metabolic syndrome in the general population, is the main determinant of microalbuminuria in diabetes and hypertension. We questioned whether CRP modifies the relationship of blood pressure and other cardiovascular risk factors with microalbuminuria in a cross-sectional study in 8592 inhabitants from Groningen, The Netherlands. The crude data showed an increase in the prevalence of microalbuminuria with increasing CRP quartiles (4.8, 9.6, 14. Key Words: cardiovascular diseases Ⅲ blood pressure Ⅲ risk factors Ⅲ kidney Ⅲ albuminuria C -reactive protein (CRP), a sensitive marker of (sub)clinical inflammation, is thought to represent the state of chronic low-grade inflammation of the arterial vessel wall at atherosclerotic sites. 1 CRP consistently predicts cardiovascular (CV) outcome. [2][3][4] Microalbuminuria is also an established risk marker for future cardiovascular events in various populations. 5,6 The appearance of low levels of albumin in the urine is thought to be the consequence of generalized endothelial damage along the vascular tree, including the glomerulus. 7 Blood pressure has been shown to be the main determinant of microalbuminuria in diabetes and hypertension. 8 Many other CV risk factors, which cluster within the metabolic syndrome, have been shown to relate to microalbuminuria in the population. 9,10 Because CRP and microalbuminuria reflect closely related components of the same disease processes, one might anticipate a strong relationship between them. However, studies that investigated this relationship in large populations only found weak associations. 11,12 Interdependence between CRP and other cardiovascular risk factors with the risk of microalbuminuria may have been overlooked.We questioned whether elevated serum CRP levels modify the relation of blood pressure and other CV risk factors with microalbuminuria. Methods Study DesignThis study is part of the PREVEND study (Prevention of REnal and Vascular ENdstage Disease) in Groningen, The Netherlands. PREVEND investigates the natural course of microalbuminuria in relation to renal and cardiovascular morbidity and mortality in the general population. All inhabitants aged 28 to 75 years (nϭ85 421) were asked to send in a morning urine sample and to complete a brief questionnaire on demographics and renal and cardiovascular morbidity. A total of 40 856 subjects responded. Pregnant women and subjects using insulin were excluded. All subjects with an albumin concentration of Ͼ10 mg/L in their morning urine sample plus a random sample of the population with a morning urine albumin excretion Ͻ10 mg/L were invited to our outpatient clinic. A detailed overview of this protocol is described elsewhere. 13 All subjects completed an extensive questionnaire on demographics, renal and cardio...

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“…Even in the absence of factors identified with variation in albumin excretion, such as increased physical activity, the level of albumin excretion can vary by 40% from day to day and more variation is induced by the use of ACR. 46,56 This variation would most likely have had the effect of attenuating the relationships between urinary albumin and systolic blood pressure and may cause some misclassification of the level of MAU. As with all crosssection studies a causal relationship between elevated SBP and elevated ACR can not be inferred from the data.…”

Section: Discussionmentioning

confidence: 99%

Microalbuminuria in urban Zimbabwean women

Chifamba

et al. 2000

J Hum Hypertens

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The prevalence of microalbuminuria (MAU) in African populations has not been reported, nor has the relationship between MAU and hypertension been reported for these populations. We collected spot urine samples from 370 women, 25 years and older as a part of a population-based, cross-sectional blood pressure survey in an urban community in Zimbabwe and analysed the samples for albumin and ␤ 2 -microglobulin. The ageadjusted prevalence of hypertension was 30% for women 25 years and older in this community. After excluding the samples with hematuria (11%), the prevalence of MAU (3.0 р albumin-to-creatinine ratio (ACR, mg/mmol) Ͻ25.0) in the study population was 9%. When age-adjusted to the population in the community, the prevalence was 8% among women 25 years and older. The prevalence of MAU was substantially higher in

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Microalbuminuria and Potential Confounders: A review and some observations on variability of urinary albumin excretion

Cited by 219 publications

References 56 publications

An insulin-like growth factor-I gene polymorphism modifies the risk of microalbuminuria in subjects with an abnormal glucose tolerance

An insulin-like growth factor-I gene polymorphism modifies the risk of microalbuminuria in subjects with an abnormal glucose tolerance

C-Reactive Protein Modifies the Relationship Between Blood Pressure and Microalbuminuria

Microalbuminuria in urban Zimbabwean women

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