The Potential of Albuminuria as a Biomarker of Diabetic Complications

Raja, Pappitha; Maxwell, Alexander P.; Brazil, Derek P.

doi:10.1007/s10557-020-07035-4

Cited by 21 publications

(23 citation statements)

References 126 publications

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“…Albuminuria is thought to be the result of pathogenic events targeting the vasculature, the glomerulus, and tubular cells [35][36][37]. In this study we show that FMD does not change ACR levels in the overall group, but only in patients with microalbuminuria.…”

Section: Discussionmentioning

confidence: 43%

A six-month periodic fasting reduces microalbuminuria and improves metabolic control in patients with type 2 diabetes and diabetic nephropathy: a randomized controlled study

Sulaj

Kopf

Rauchhaupt

et al. 2021

Preprint

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AimNovel dietary interventions focused on fasting, have gained scientific and public attention. Periodic fasting has emerged as a dietary modification promoting beneficial effects on metabolic syndrome. This study aimed to assess whether periodic fasting reduces albuminuria in patients with type 2 diabetes and diabetic nephropathy and determine whether a reduction in albuminuria relates to activation of nephropathy-driven pathways.MethodsForty patients with type 2 diabetes (HbA1c 7.8±0.2% [62.1±2.3 mmol/mol]) and increased albumin-to-creatinine ratio (ACR) were randomized to fasting-mimicking diet (FMD) (n=21) or Mediterranean diet (n=19) for six months with three-month follow-up. Primary endpoint was the difference of the change in ACR from baseline to after six months between study groups. Subgroup analysis for patients with micro-versus macroalbuminuria at baseline was performed. Secondary endpoints comprised HOMA-IR, circulating markers of dicarbonyl detoxification (MG-H1, glyoxalase-1 and hydroxyacetone), lipid oxidation (acylcarnitines), DNA-damage/repair, (yH2Ax) and senescence (suPAR). Comparison was done by ANCOVA adjusted for age, sex, weight loss and baseline values of the respective outcome.ResultsDifference of change in ACR between FMD and control group after six months was 110.3mg/g (95% CI 99.2, 121.5mg/g; P=0.45) in all patients, -30.3mg/g (95% CI -35.7, -24.9mg/g; P≤0.05] in patients with microalbuminuria, and 434.0mg/g (95% CI 404.7, 463.4mg/g; P=0.23) in those with macroalbuminuria at baseline. FMD led to change in HOMA-IR of -3,8 (95% CI -5,6, -2.0; P≤0.05) and in suPAR of - 156.6pg/ml (95% CI -172.9, -140.4pg/ml; P≤0.05) after six months, while no change was observed in markers of dicarbonyl detoxification or DNA-damage/repair. Change in AC profile was related to patient responsiveness to ACR improvement. At follow-up only HOMA-IR reduction (−1.9 [95% CI -3.7, -0.1], P≤0.05) was sustained.ConclusionsWhen accompanied by intensive diabetes care, FMD improves microalbuminuria, HOMA-IR and suPAR levels. Lack of changes in markers of dicarbonyl detoxification and DNA-damage/repair might explain the relapse of albuminuria at follow-up.Trial registrationGerman Clinical Trials Register (Deutsches Register Klinischer Studien DRKS), DRKS-ID: DRKS00014287

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Section: Discussionmentioning

confidence: 43%

A six-month periodic fasting reduces microalbuminuria and improves metabolic control in patients with type 2 diabetes and diabetic nephropathy: a randomized controlled study

Sulaj

Kopf

Rauchhaupt

et al. 2021

Preprint

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“…15 Pappitha Raja found a positive correlation between albuminuria and dysregulation of glomerular pore size. 16 On the basis of these references, findings of our study may be explained as follows. .…”

Section: Discussionmentioning

confidence: 76%

A study of microalbuminuria in patients with type 2 diabetes mellitus, visiting tertiary care center Sangli

Belwalkar¹,

Jagtap²,

Mane³

et al. 2022

IJCBR

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Diabetic nephropathy is accompanied with significant micro vascular risk and is the leading cause of kidney disease. Hence there is an immense need to detect early for better quality of the care of affected patients and treat effectively those at high risk of diabetic kidney disease. Our study was aimed to assess the levels of microalbuminuria, glycated hemoglobin, urinary creatinine, urinary albumin to creatinine ratio (ACR) along with blood urea and serum creatinine in patients with type 2 DM, and to observe the incidence of microalbuminuria at tertiary care center; and correlate the presence of microalbuminuria to the duration of DM as well as with ACR. : Estimation of Blood sugar, Blood Urea, Serum Creatinine, Glycosylated hemoglobin (HbA1c), Urinary micro albumin and creatinine was done. Values of urinary creatinine, microalbumin, urinary albumin to creatinine ratio (ACR) showed highly significant (p<0.000) difference between the two age groups a) below 60 years and b) above 60 years of the age. Highly significant difference (p<0.000) was found among the results of the three groups based on duration of diabetes. We found microalbuminuria was more predominant in patients having age more than 60 years as well as in patients having more than 10 years of duration of DM. Routine screening for microalbuminuria in type 2 diabetic patients will certainly helpful for early detection of renal damage and thus to minimize the burden of diabetic complications due to renal involvement. Hence addition of microalbuminuria along with diabetic profile for medical checkup will help to assess microalbuminuria at frequent intervals.

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“…Our findings suggested that urine NAG could be considered a more promising indicator for detecting the development of DN early in children with diabetes in a pre-albuminuric state than the other five renal injury markers investigated in our study. Obesity remains a strong environmental factor triggering the onset of DM, yet tighter glycemic control appears to be more critical than maintaining normal weight in order to reduce early progression to DN [ 20 ]. After exploring the characteristics of the six renal injury markers among obese and non-obese children and children with and without diabetes, we suggest that urine NAG could be a more sensitive biomarker that is closely linked to glycemic status, and thus could be considered an early indicator of future development of DN.…”

Section: Discussionmentioning

confidence: 99%

High Glycated Hemoglobin Instead of High Body Mass Index Might Increase the Urine N-Acetyl-β-D-glucosaminidase Con-Centration in Children and Adolescents with Diabetes Mellitus

Suh

Kim

et al. 2022

Life

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Children with diabetes, and particularly those with obesity, have poor glycemic control. They are thus at higher risk of early microvascular complications. Renal tubulointerstitial markers are integral to evaluating diabetic nephropathy. Various biomarkers have been proposed, but their role in the obese pediatric population is uncertain. We investigated renal injury markers in children with diabetes, according to obesity, and determined their role as early predictors of diabetic nephropathy. Fifty-three children and adolescents, diagnosed with either type 1 or 2 diabetes mellitus, and 43 control children, aged 7–18 years, were included. Clinical and laboratory characteristics, including six renal injury markers, were compared among subjects according to body mass index and presence of diabetes mellitus. Urine neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and N-acetyl-β-D-glucosaminidase (NAG) showed significant difference between controls and diabetic children, whereas urine NAG was the only biomarker that was significantly lower either in non-obese or obese controls as compared to diabetic children. Urine NGAL, KIM-1, and NAG showed significant correlations with both HbA1c and urine ACR, whereas only urine NAG was significantly correlated with HbA1c even when groups were subdivided based on the presence of either obesity or diabetes. After adjusting for age, sex, body mass index, duration of known diabetes, and urine albumin-to-creatinine ratio, HbA1c remained a significant risk factor for elevated urine NAG. Urine NAG could be a useful indicator of tubulointerstitial damage in children with diabetes in the pre-albuminuric state. Tighter glycemic control appears to be crucial for avoiding early progression to diabetic nephropathy.

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The Potential of Albuminuria as a Biomarker of Diabetic Complications

Cited by 21 publications

References 126 publications

A six-month periodic fasting reduces microalbuminuria and improves metabolic control in patients with type 2 diabetes and diabetic nephropathy: a randomized controlled study

A six-month periodic fasting reduces microalbuminuria and improves metabolic control in patients with type 2 diabetes and diabetic nephropathy: a randomized controlled study

A study of microalbuminuria in patients with type 2 diabetes mellitus, visiting tertiary care center Sangli

High Glycated Hemoglobin Instead of High Body Mass Index Might Increase the Urine N-Acetyl-β-D-glucosaminidase Con-Centration in Children and Adolescents with Diabetes Mellitus

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