Relation between Urinary Albumin Excretion and Skin Involvement in Patients with Psoriasis

Abstract

The increase in urinary albumin excretion rate (AER), a hallmark of both diabetic nephropathy and hypertension, has also been described in patients affected with diffuse psoriasis. The aim of this study was to investigate whether such an increase is independent of the coexistence of diabetes or hypertension and whether it may be related to the extension and severity of skin lesions. Median AER, determined by radioimmunoassay, was significantly higher in a group of 32 normotensive nondiabetic psoriatic patients than in 36 age- and sex-matched controls (9.6 vs. 5.3 μg/min; p = 0.0006). AER was related with grading of skin involvement (r = 0.65; p = 0.001); patients with the most widespread skin lesions (psoriasis area and severity index: PASI > 11) were characterized by a significantly raised median AER (14.9 μg/min) compared with those with PASI scores between 4 and 11 (9.8 μg/min) or less (5.6 μg/min) and controls (F = 10.58; p = 0.0001), independent of other covariates such as age, sex and blood pressure (p = 0.0001). This latter finding was confirmed by the prevalence of microalbuminuria (AER > 20 μg/min) which was present in 2 out of 8 patients with PASI < 4, 0 out of 12 patients with PASI ranging between 4 and 11 and in 5 out of 12 psoriatics with PASI > 11 (p = 0.038 by two-tailed Fisher’s exact test).

Mediation of Systemic Vascular Hyperpermeability in Severe Psoriasis by Circulating Vascular Endothelial Growth Factor

“…Microalbuminuria, defined as mildly elevated levels of proteinuria (30-200 mg/L), has been reported in patients with mild-moderate psoriasis by Cecchi et al 19 The mean UPER in their cohort of patients with a PASI score greater than 11 was 28.8 mg/24 h, whereas the mean relapse UPER in our GPP group was 560 mg/24 h, which reduced to 140 mg/24 h during remission (reference value, Ͻ150 mg/24 h). The results of Cecchi and colleagues and our own data suggest the presence of renal microvascular hyperpermeability in psoriasis that increases with intensity of skin disease but reverses with successful treatment.…”

“…albuminuria indicates subclinical renal microvascular hyperpermeability, 18 whereas further studies 19 have demonstrated that the extent of albuminuria reflects the degree of psoriatic skin involvement. Microalbuminuria in psoriasis may result from the activity of a circulating permeability factor produced by lesional tissue.…”

Renal Abnormalities in Psoriatic Patients: A Review

“…Cecchi et al [21, 22]found a higher urinary concentration of N-acetyl-β- D -glucosaminidase; Madeddu et al [23]also observed a decreased urinary excretion of epidermal growth factor (EGF) in psoriatics (especially in males), whereas the glomerular filtration rate (GFR) was similar compared with age- and sex-matched controls. Urinary EGF correlated inversely with age and directly with urinary kallikrein excretion.…”

Psori̇ati̇k Eri̇trodermi̇ Ve Juveni̇l Romatoi̇d Arti̇ri̇tli̇ Olguda Süt Di̇şi̇ Denti̇syonunda Mi̇ne Hi̇poplazi̇si̇

“…Psorisisin toplumda görülme sıklığı % 1-3 arasındadır 7 . Çocuklarda, erişkinlere benzer şekilde psoriasisin en çok plak tipi (%68,6) görülür, lezyonlar saçlı deride, kulak arkasında, dirseklerde ve dizlerde izlenir 8,9 . Guttat tip psöriazis çocuklarda erişkinlerden daha fazla görülür.…”