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Prospective and epidemiologic studies have found that microalbuminuria is predictive, independently of traditional risk factors, of all-cause and cardiovascular mortality and CVD events within groups of patients with diabetes or hypertension, and in the general population.
Currently, microalbuminuria is generally thought to be an early marker of DKD in clinical practice. However, a previous study revealed changes in the structure and decreased densities of podocytes in DKD patients with normoalbuminuria by using morphometric analysis based on kidney biopsy. Although biopsy is the gold standard for diagnosing DKD, it is not needed in most cases due to its invasive nature.
Frequency of microalbuminuria was detected among these patients.
Microalbuminuria is predictive of all-cause and cardiovascular disease (CVD) mortality in men and women independently of other established CVD risk factors, with microalbuminuric individuals having approximately a 50% increased risk of all-cause mortality [16-18].
Univariate and multivariate analyses were used to compare study subjects grouped by vitamin D status, glycemic control, and degree of microalbuminuria. We performed receiver operating characteristic (ROC) analysis on the usefulness of VDBP clearance ratio for the diagnosis of VDD, microalbuminuria, and glycemic control.
Kruskal-Wallis test was used to analyse differences in flexion among control group, diabetic patients with normoalbuminuria, and diabetic patients with microalbuminuria. Post hoc analysis between two groups was performed with the Wilcoxon test.
Bivariate analysis revealed only microalbuminuria and duration of disease to be significantly associated with the incidence of DR (p < 0.001 and p = 0.05, resp.), while [HbA.sub.1c], systolic BP, diastolic BP, smoking, BMI, family history of diabetes, CAD, CVD, PVD, neuropathy, cholesterol, HDL, LDL, triglyceride levels, serum creatinine, and age at onset were not associated with the incidence of DR.
Serum Uric acid and microalbuminuria by albumin to creatinine ratio (ACR) in random urine sample was measured at the time of inclusion of patients.
A 2011 meta-analysis of 5 RCTs (total 2975 patients) that compared ACE inhibitor therapy with placebo in diabetic patients without hypertension and albuminuria found that ACE inhibitors reduced the risk of new-onset microalbuminuria or macroalbuminuria by 18% (relative risk [RR]=0.82; 95% confidence interval [CI], 0.73-0.92).
Microalbuminuria was defined as UACR from 30 to 300 mg/g in two consecutive portions taken a least 1 week apart .
For each outcome, we further excluded participants with prevalent disease at the sixth examination (164 with prevalent CKD for the incident CKD analyses and 698 with prevalent microalbuminuria or missing covariates that were additionally adjusted for in the microalbuminuria analyses).
Infelizmente, tanto no DM1 (estudo RASS com enalapril ou losartan (18) e estudo DIRECT com candesartan (19)), quanto no DM2 (estudo ROADMAP com Olmesartan (20) e DIRECT (19)), o tratamento com drogas bloqueadoras do SRAA nao preveniu o aparecimento de microalbuminuria. Aparentemente os efeitos positivos do bloqueio do SRAA ocorrem principalmente em pacientes hipertensos, sendo menos evidentes nos normotensos normoalbuminuricos, que estao na fase inicial da doenca.
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