Microalbuminuria in the paediatric age: current knowledge and emerging questions

Tsioufis, Costas; Mazaraki, Anastasia; Dimitriadis, Kyriakos; Stefanidis, Constantinos J.; Stefanadis, Christodoulos

doi:10.1111/j.1651-2227.2011.02291.x

Cited by 25 publications

(33 citation statements)

References 46 publications

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“…Children aged ,2 years were classified as low risk (preoperative ACR ,30 mg/g [3.4 mg/mmol]), medium risk (ACR $30 [3.4 mg/mmol] to ,300 mg/g [34 mg/mmol]), and high risk (ACR $300 mg/g [34 mg/ mmol]) (16). In children aged $2 years, we based thresholds on standard microalbuminuria definitions (19,20) To evaluate first postoperative ACR for early CS-AKI diagnosis, we classified patients into lower, middle, and upper tertile ACR concentrations (for each age group), because there is no standard postoperative albuminuria threshold.…”

Section: Acr Threshold Definitionsmentioning

confidence: 99%

The Association of Albumin/Creatinine Ratio with Postoperative AKI in Children Undergoing Cardiac Surgery

Zappitelli

Coca

Garg

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives This study determined if preoperative and postoperative urine albumin/creatinine ratios (ACRs) predict postoperative AKI in children undergoing cardiac surgery (CS).Design, setting, participants, & measurements This was a three-center, prospective study (2007)(2008)(2009)) of 294 children undergoing CS (n=145 aged ,2 years). Urine ACR was measured preoperatively and 0-6 hours after intensive care unit arrival. AKI outcomes were based on the Acute Kidney Injury Network serum creatinine (SCr) criteria (stage 1 AKI, $50% or 0.3 mg/dl SCr rise from baseline; and stage 2 or worse AKI, $SCr doubling or dialysis). AKI was predicted using preoperative and postoperative ACRs and postoperative ACR performance was compared with other AKI biomarkers.Results Preoperative ACR did not predict AKI in younger or older children. In children aged ,2 years, first postoperative ACR $908 mg/g (103 mg/mmol) predicted stage 2 AKI development (adjusted relative risk, 3.4; 95% confidence interval, 1.2-9.4). In children aged $2 years, postoperative ACR $169 mg/g (19.1 mg/mmol) predicted stage 1 AKI (adjusted relative risk, 2.1; 95% confidence interval, 1.1-4.1). In children aged $2 years, first postoperative ACR improved AKI prediction from other biomarker and clinical prediction models, estimated by net reclassification improvement (P#0.03), but only when serum cystatin C was also included in the model. ConclusionsPostoperative ACR is a readily available early diagnostic test for AKI after pediatric CS that performs similarly to other AKI biomarkers; however, its use is enhanced in children aged $2 years and in combination with serum cystatin C.

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Section: Acr Threshold Definitionsmentioning

confidence: 99%

The Association of Albumin/Creatinine Ratio with Postoperative AKI in Children Undergoing Cardiac Surgery

Zappitelli

Coca

Garg

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…On the other hand, these results are different from those reported by Okpere et al 2012 (13) who reported significantly higher gender specific prevalence of microalbuminuria in females (45.3%) compared to males (20.4%); and their results are similar to the findings recorded by Jones et al 2002 in the USA, who reported a gender specific prevalence of 9.7% in females and 6.1% in males (15) . The higher prevalence of microalbuminuria (MA) in girls than boys could be attributed to the accompanied bigger muscle mass and urinary creatinine excretion of the latter resulting in their smaller albumin creatinine ratio (ACR) values (16) . In the present study, birth weight was significantly lower in group 1 normoalbuminuria in comparison to group 2 microalbuminuria (3.17±0.35 vs 3.47±0.14 respectively) (p=0.050).…”

Section: Discussionmentioning

confidence: 99%

Microalbuminuria in Obese Children and Adolescents and the Metabolic Syndrome

Elsedfy¹,

Toaima

Mohamed³

et al. 2017

IAM

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Insulin resistance is a common feature of childhood obesity and is considered to be an important link between adiposity and development of type 2 diabetes mellitus and cardiovascular disease. It is also a major contributing factor to renal injury. Microalbuminuria (albumin excretion 20-200 mg∕min or 30-300 mg∕gram creatinine) is now considered an early marker of renal damage in non-diabetic patients. Objectives: to evaluate the association of obesity and microalbuminuria among obese subjects and its relation to metabolic syndrome components. Methods: This cross-sectional study was conducted on sixty-two obese children and adolescents randomly recruited from the Obesity Clinic, Pediatric Hospital, Ain-Shams University. Anthropometric data were collected, fasting serum insulin, glucose and serum lipid profile were measured. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to calculate in vivo insulin resistance. Oral glucose tolerance test and urinary albumin concentrations were done. Results: Microalbuminuria was detected in 18 cases (29%) , metabolic syndrome in 4 cases (6.4%), impaired OGTT in 9.6%. Impaired fasting insulin and high serum insulin after 2 hours in OGTT in 3.2% of cases. Abnormal lipid profile was significantly associated with microalbuminuria. Conclusion: Microalbuminuria is strongly associated with impaired fasting insulin, and abnormal lipid profile.

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“…Possible explanation for high prevalence in adolescents might be the influence of orthostatic proteinuria [34]. A positive association was found between albumin excretion rate and pubertal developmental stage [35]. In addition, the problem of methodology [14,17], age, height dependency [36] and possible transient elevations [37] have to be mentioned.…”

Section: Microalbuminuria In Healthy Childrenmentioning

confidence: 99%

“…At present, the data suggests that impairment of glucose metabolism, obesity-related proatherosclerotic pathways and the impact of haemodynamic load represent major factors for microalbuminuria development in children [35]. If persistent microalbuminuria is present, further investigation of cardiovascular factors, careful follow-up and intensive lifestyle interventions should be performed [35].…”

Section: Microalbuminuria In Different Childhood Diseasesmentioning

confidence: 99%

“…If persistent microalbuminuria is present, further investigation of cardiovascular factors, careful follow-up and intensive lifestyle interventions should be performed [35]. Some authors also proposed screening of children for proteinuria or microalbuminuria, mainly in high-risk groups, as reversibility of organ damage in early stages is possible [53].…”

Section: Microalbuminuria In Different Childhood Diseasesmentioning

confidence: 99%

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Microalbuminuria in pediatric patients with hypertension

Varda¹

2013

Health

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Microalbuminuria in adults has been found to be an early indicator of both renal and systemic vascular disease, as well as significant cardiovascular risk predictor and therapeutic marker. Its role in essential hypertension in adults has also been well established. As diseases like hypertension and obesity have their roots in childhood and are already present in children, influencing the morbidity in adulthood, the role of microalbuminuria has been extensively investigated in children as well. Most investigations have been performed in diabetic children, confirming its clinical significance. There is also enough evidence to suggest that microalbuminuria in obese children should be taken as seriously as in children with diabetes. In children with hypertension rare studies also indicate that its presence identifies hypertensive children with higher risk, although the exact role has to be confirmed in prospective and larger studies. The mechanisms of microalbuminuria onset could be the result of renal damage secondary to hypertension or underlying renal and systemic endothelial dysfunction. Evidence from small intervention studies in children with microalbuminuria also suggests that early intervention with antihypertensive drugs is likely to be beneficial, pointing out the role of microalbuminuria as a therapeutic marker in children too. In addition, we have to stress the importance of follow-up of children with microalbuminuria, confirmation of its persistence and identification of progression. However, longitudinal prospective studies in children, investigating its future cardiovascular risk, are still lacking.

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Microalbuminuria in the paediatric age: current knowledge and emerging questions

Abstract: Although the significance of MA in paediatric essential hypertension has yet to be determined, its role in diabetic children and adolescents is established and albuminuria assessment has been utilized as a screening test for the presence of diabetes-related kidney disease.

Cited by 25 publications

References 46 publications

The Association of Albumin/Creatinine Ratio with Postoperative AKI in Children Undergoing Cardiac Surgery

The Association of Albumin/Creatinine Ratio with Postoperative AKI in Children Undergoing Cardiac Surgery

Microalbuminuria in Obese Children and Adolescents and the Metabolic Syndrome

Microalbuminuria in pediatric patients with hypertension

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