RESUMO
PURPOSE: New-onset diabetes after transplantation (NODAT) is a frequent metabolic complication associated with podocyte damage and renal allograft dysfunction. Thus, Wilm's tumor-1 (WT-1) protein, as a podocyte marker, holds promise as an option to evaluate renal allograft dysfunction in NODAT. Therefore, the study aimed to investigate urinary WT-1 levels in NODAT patients during the first year after kidney transplantation (KTx). MATERIALS AND METHODS: KTx patients were categorized into non-NODAT and NODAT groups. Fasting blood glucose, glycated hemoglobin (HbA1c), urinary albumin/creatinine ratio (ACR), serum creatinine, estimated glomerular filtration rate (eGFR), and urinary WT-1 were measured at 3, 6, 9, and 12-months post-KTx. RESULTS: The NODAT group manifested elevated levels of blood glucose and HbA1c during the first year post-KTx. Also, exhibited elevations in ACR and serum creatinine levels at 6, 9, and 12-months post-KTx when compared to non-NODAT group. Conversely, eGFR values in the NODAT group demonstrated significant declines at 3, 6, and 9-months post-KTx relative to non-NODAT. Furthermore, NODAT group exhibited a median annual eGFR of 47 âmL/min/1.73 âm2. Urinary WT-1 levels at 3, 6, 9, and 12-months post-KTx were significantly higher in the NODAT group compared to non-NODAT. Additionally, noteworthy positive correlations were identified between urinary WT-1 and HbA1c levels, along with significant negative correlations between urinary WT-1 and eGFR at the 3, 6, 9, and 12-months post-KTx. CONCLUSION: The increased urinary WT-1 levels from 3-months post-KTx in NODAT patients may indicate the first sign of podocyte injury, predicting a renal allograft dysfunction in these patients.
Assuntos
Diabetes Mellitus , Taxa de Filtração Glomerular , Transplante de Rim , Proteínas WT1 , Humanos , Transplante de Rim/efeitos adversos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Proteínas WT1/urina , Diabetes Mellitus/urina , Biomarcadores/urina , Biomarcadores/sangue , Aloenxertos , Prognóstico , Seguimentos , Hemoglobinas Glicadas/metabolismoRESUMO
Bisphenol A (BPA) is an endocrine-disrupting chemical widely used in the production of polycarbonate plastics and epoxy resins, which has been previously linked to diabetes among non-Hispanic populations. As part of a case control study for breast cancer, only controls with BPA information were included in this report. The final sample size comprises 70 self-reported diabetics and 334 non-diabetics. Urinary free bisphenol A (BPA-F) (µg/L) was determined by solid-phase extraction and HPLC/FLD analysis. Logistic regression models were used to evaluate the association between BPA-F and self-reported diabetes. After adjusting by age, urinary BPA-F (4.06-224.53 µg/g creatinine) was associated with diabetes exposure (OR = 1.85; 95% CI 1.04, 3.28) compared with women in the reference category (0.67-4.05 µg/g creatinine). BPA may be an environmental cofactor of diabetes. More studies are needed to confirm this result, especially in Hispanic populations.
Assuntos
Compostos Benzidrílicos/toxicidade , Diabetes Mellitus/induzido quimicamente , Exposição Ambiental/efeitos adversos , Fenóis/toxicidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Compostos Benzidrílicos/urina , Estudos de Casos e Controles , Creatinina/urina , Diabetes Mellitus/urina , Disruptores Endócrinos/toxicidade , Disruptores Endócrinos/urina , Feminino , Humanos , México , Pessoa de Meia-Idade , Fenóis/urina , Fatores de RiscoRESUMO
Higher blood pressure level and poor glycemic control in diabetic patients are considered progression factors that cause faster decline in kidney functions leading to kidney damage. The present study aimed to develop a quantification model of biomarkers creatinine, urea, and glucose by means of selected peaks of these compounds, measured by Raman spectroscopy, and to estimate the concentration of these analytes in the urine of normal subjects (G_N), diabetic patients with hypertension (G_WOL) patients with chronic renal failure doing dialysis (G_D). Raman peak intensities at 680 cm-1 (creatinine), 1004 cm-1 (urea), and 1128 cm-1 (glucose) from normal, diabetic, and hypertensive and doing dialysis patients, obtained with a dispersive 830 nm Raman spectrometer, were estimated through Origin software. Spectra of creatinine, urea, and glucose diluted in water were also obtained, and the same peaks were evaluated. A discrimination model based on Mahalanobis distance was developed. It was possible to determine the concentration of creatinine, urea, and glucose by means of the Raman peaks of the selected biomarkers in the urine of the groups G_N, G_WOL, and G_D (r = 0.9). It was shown that the groups G_WOL and G_D had lower creatinine and urea concentrations than the group G_N (p < 0.05). The classification model based on Mahalanobis distance applied to the concentrations of creatinine, urea, and glucose presented a correct classification of 89% for G_N, 86% for G_WOL, and 79% for G_D. It was possible to obtain quantitative information regarding important biomarkers in urine for the assessment of renal impairment in patients with diabetes and hypertension, and this information can be correlated with clinical criteria for the diagnosis of chronic kidney disease.
Assuntos
Diabetes Mellitus/urina , Hipertensão/urina , Modelos Biológicos , Insuficiência Renal Crônica/diagnóstico , Análise Espectral Raman/métodos , Urinálise , Idoso , Biomarcadores/urina , Creatinina/sangue , Creatinina/urina , Feminino , Glucose/análise , Humanos , Masculino , Pessoa de Meia-Idade , Ureia/urinaRESUMO
The discovery of protein biomarkers that reflect the biological state of the body is of vital importance to disease management. Urine is an ideal source of biomarkers that provides a non-invasive approach to diagnosis, prognosis and prediction of diseases. Consequently, the study of the human urinary proteome has increased dramatically over the last 10 years, with many studies being published. This review focuses on urinary protein biomarkers that have shown potential, in initial studies, for diseases affecting the urogenital tract, specifically chronic kidney disease and prostate cancer, as well as other non-urogenital pathologies such as breast cancer, diabetes, atherosclerosis and osteoarthritis. PubMed was searched for peer-reviewed literature on the subject, published in the last 10 years. The keywords used were "urine, biomarker, protein, and/or prostate cancer/breast cancer/chronic kidney disease/diabetes/atherosclerosis/osteoarthritis". Original studies on the subject, as well as a small number of reviews, were analysed including the strengths and weaknesses, and we summarized the performance of biomarkers that demonstrated potential. One of the biggest challenges found is that biomarkers are often shared by several pathologies so are not specific to one disease. Therefore, the trend is shifting towards implementing a panel of biomarkers, which may increase specificity. Although there have been many advances in urinary proteomics, these have not resulted in similar advancements in clinical practice due to high costs and the lack of large data sets. In order to translate these potential biomarkers to clinical practice, vigorous validation is needed, with input from industry or large collaborative studies.
Assuntos
Aterosclerose/urina , Biomarcadores Tumorais/urina , Diabetes Mellitus/urina , Neoplasias/urina , Osteoartrite/urina , Proteinúria/urina , Humanos , PubMedRESUMO
Chronic exposure to inorganic arsenic (iAs) has been linked to an increased risk of diabetes, yet the specific disease phenotype and underlying mechanisms are poorly understood. In the present study we set out to identify iAs exposure-associated metabolites with altered abundance in nondiabetic and diabetic individuals in an effort to understand the relationship between exposure, metabolomic response, and disease status. A nested study design was used to profile metabolomic shifts in urine and plasma collected from 90 diabetic and 86 nondiabetic individuals matched for varying iAs concentrations in drinking water, body mass index, age, and sex. Diabetes diagnosis was based on measures of fasting plasma glucose and 2-h blood glucose. Multivariable models were used to identify metabolites with altered abundance associated with iAs exposure among diabetic and nondiabetic individuals. A total of 132 metabolites were identified to shift in urine or plasma in response to iAs exposure characterized by the sum of iAs metabolites in urine (U-tAs). Although many metabolites were altered in both diabetic and nondiabetic 35 subjects, diabetic individuals displayed a unique response to iAs exposure with 59 altered metabolites including those that play a role in tricarboxylic acid cycle and amino acid metabolism. Taken together, these data highlight the broad impact of iAs exposure on the human metabolome, and demonstrate some specificity of the metabolomic response between diabetic and nondiabetic individuals. These data may provide novel insights into the mechanisms and phenotype of diabetes associated with iAs exposure.
Assuntos
Arsênio/toxicidade , Diabetes Mellitus/epidemiologia , Metabolômica , Adolescente , Adulto , Idoso , Diabetes Mellitus/sangue , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus/urina , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Adulto JovemRESUMO
INTRODUCTION: Diabetes knowledge among TB patients can contribute to improved TB treatment outcomes, but lack of diabetes diagnosis awareness is a limitation in developing countries. Given its low cost, the sensitivity of urine glucose dipsticks for diabetes screening in TB patients was assessed. METHODS: Glycosuria was assessed in 90 newly diagnosed TB patients (38 with diabetes) in south Texas, USA (n = 20) and northeast Mexico (n = 70) during January 2009-December 2010. RESULTS: Glycosuria was detected in 65% of the diabetic patients with chronic hyperglycemia (positive predictive value 91%, negative predictive value 84%). CONCLUSION: We propose that TB clinics with limited budgets where portable glucometers may not be available conduct universal screening for diabetes with urine dipsticks. This could be followed by blood glucose or HbA1c testing in the subset of patients requiring confirmation or higher sensitivity assessment, to improve the comanagement of TB and diabetes.
Assuntos
Diabetes Mellitus/diagnóstico , Glucose/metabolismo , Glicosúria/diagnóstico , Hiperglicemia/diagnóstico , Programas de Rastreamento , Tuberculose/complicações , Urinálise/métodos , Adolescente , Adulto , Glicemia/metabolismo , Diabetes Mellitus/urina , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/urina , Feminino , Glicosúria/urina , Humanos , Hiperglicemia/urina , Masculino , México , TexasRESUMO
OBJECTIVE: The aim of this study was to verify whether preoperative diabetes, hypertension, and renal function had any relationship with postoperative tubule function in patients submitted to anesthesia for arterial surgery. METHODS: Prospective observational study. One hundred and forty-four patients submitted to anesthesia for arterial surgery enrolled consecutively and divided into four groups: G1--diabetes and hypertension; G2--diabetes; G3--hypertension; and G4--without hypertension or diabetes. Urine was obtained for laboratory analysis of urinary creatinine (Ucr), alkaline phosphatase (AP), γ-glutamyltransferase (γGT), and blood for cystatin C and creatinine before the surgery (M1) and 24 h after the surgery (M2). RESULTS: Values of γGT, γGT/Ucr, and AP × Î³GT/Ucr increased at M2 in G4. Patients without renal function compromise (GFR ≥90 mL/min/1.73 m(2)) presented increased γGT/Ucr and AP × Î³GT/Ucr values at M2 and those with slightly compromised renal function (60-89 mL/min/1.73 m(2)) presented increased γGT values at M2. There was no correlation between deltaCystatin C and deltaAP, deltaγGT, deltaγGT/Ucr, deltaAP/Ucr, and deltaAP × Î³GT/Ucr. CONCLUSIONS: Diabetes, hypertension, and preoperative renal function seem to interfere in tubular enzymuria immediately after surgery in arteriopathic patients. However, when these markers do not increase in postoperative period, renal dysfunction cannot be discarded.
Assuntos
Artérias/cirurgia , Túbulos Renais/fisiopatologia , Doenças Vasculares/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/metabolismo , Arteriopatias Oclusivas/cirurgia , Biomarcadores/sangue , Biomarcadores/urina , Diabetes Mellitus/sangue , Diabetes Mellitus/urina , Angiopatias Diabéticas/sangue , Angiopatias Diabéticas/complicações , Angiopatias Diabéticas/urina , Enzimas/sangue , Enzimas/urina , Feminino , Humanos , Hipertensão/sangue , Hipertensão/complicações , Hipertensão/urina , Rim/fisiologia , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Estudos Prospectivos , Doenças Vasculares/complicações , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adulto JovemRESUMO
Elevated concentrations of naturally occurring Cd have been found mainly in the bauxitic soils of central Jamaica at levels up to 100-1,000 times higher than typical worldwide averages. Some food crops cultivated on these soils absorb significant amounts of Cd. Autopsy studies of kidney Cd concentrations confirm elevated human exposure, and some long-term residents in central Jamaica exceed the general population average by a factor of two. Diet studies have ascertained that a population in central Jamaica is at risk of being exposed to Cd levels in excess of the Provisional Tolerable Weekly Intake (PTWI) set by the WHO of 7 µgCd/kg bodyweight/week, and the EU TWI of 2.5 µgCd/kg bodyweight/week. Elevated levels of urine cadmium (U-Cd) and beta-2 microglobulin (ß2-MG) concentrations were confirmed with a strong correlation between soil Cd and the U-Cd. Also, higher ß2-MG concentrations (>200µg/g creatinine) were found in the population with U-Cd concentrations greater than 2.5µg/L. While this identification is often taken to indicate impairment in the reabsorption capacity of the renal tubules leading to renal disease, there is no evidence in the mortality records of enhanced deaths in central Jamaica compared with the general population resulting from renal disease or diabetes related complications. The highest median age of death in the island is found in Manchester, the parish with the highest average Cd concentration. While we have identified a possible Cd linked renal dysfunction, significant indications of morbidity are not present in the general population.
Assuntos
Cádmio/urina , Exposição Ambiental/análise , Contaminação de Alimentos/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/urina , Cádmio/toxicidade , Estudos de Coortes , Diabetes Mellitus/urina , Dieta , Feminino , Geografia , Humanos , Hipertensão/urina , Jamaica , Rim/metabolismo , Masculino , Pessoa de Meia-Idade , Fumar , Solo/química , Organização Mundial da SaúdeRESUMO
Dietary fiber performs important functions in diabetes mellitus control and treatment. In this study, we evaluate the reduction in plasma glucose after the treatment of diabetic rats with high-fiber Solanum lycocarpum flour. We found that serum glucose, water and food intake, urine excretion, and urine sodium concentration were reduced in S. lycocarpum flour-treated diabetic rats (TDRs), compared with diabetic control rats (DCRs). In addition, TDRs did not show signs of kidney hypertrophy, unlike those in the DCR group. These results suggest that the use of S. lycocarpum flour can be an effective support in diabetes mellitus treatment.
Assuntos
Glicemia/efeitos dos fármacos , Diabetes Mellitus/dietoterapia , Índice Glicêmico/efeitos dos fármacos , Solanum , Análise de Variância , Animais , Índice de Massa Corporal , Cardiomegalia/patologia , Diabetes Mellitus/sangue , Diabetes Mellitus/urina , Modelos Animais de Doenças , Ingestão de Líquidos/efeitos dos fármacos , Ingestão de Alimentos/efeitos dos fármacos , Hipertrofia/patologia , Rim/efeitos dos fármacos , Rim/patologia , Masculino , Tamanho do Órgão/efeitos dos fármacos , Ratos , Ratos Wistar , Sódio/urinaRESUMO
A nefropatia diabética (ND) é uma complicação crônica grave do diabetes melito (DM); é a principal causa de insuficiência renal terminal. A ND é classificada em 3 estágios conforme a excreção urinária de albumina (EUA): normoalbuminúria (EUA <17 mg/l), microalbuminúria (EUA 17-174 mg/l) e macroalbuminúria (>174 mg/l). Da fase de microalbuminúria pode ocorrer regressão para normoalbuminúria (30% casos) ou progressão para a macroalbuminúria, quando ocorre maior risco de evolução para a doença renal crônica (DRC) terminal. O diagnóstico da ND é realizado através da medida da albumina na urina e pela avaliação da taxa de filtração glomerular (TFG). Recomenda-se a medida da albumina em amostra isolada de urina (primeira da manhã ou amostra casual), podendo-se medir o índice albumina-creatinina ou a concentração de albumina. Valores elevados de albuminúria devem ser confirmados em pelo menos 2 de 3 coletas de urina, em um intervalo de 3 a 6 meses. Na impossibilidade da medida da albuminúria, a medida de proteínas totais (proteinúria @430 mg/l em amostra ou >500 mg/24 h), pode ser utilizada para diagnóstico de fases mais avançadas de ND. Em pacientes com DM tipo 2 o rastreamento deve iniciar ao diagnóstico de DM, e nos pacientes com DM tipo 1 deve ser após os 10 anos de idade; logo após o início da puberdade; ou quando a duração do DM for >5 anos. Se negativo repetir anualmente; e, se positivo, recomenda-se a monitoração mais frequente da albumina urinária. A estimativa da TFG é realizada através de fórmulas que empregam a creatinina sérica, ajustadas para idade, gênero e etnia. São recomendadas as equações do estudo Modification of Diet in Renal Disease (MDRD) e Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Deve ser levado em conta que, em pacientes com DM, essas equações tendem a subestimar a TFG. A ND deve ser identificada o mais precocemente possível e para isto tanto os profissionais de saúde como os pacientes com DM devem ser conscientizados.
Diabetic nephropathy (DN) is an important chronic complication of diabetes mellitus (DM) and is the leading cause of end-staage renal disease. DN is classified into stages according to the urinary albumin excretion (UAE): normoalbuminuria (UAE <17 mg/l), microalbuminuria (UAE 17-174 mg/l), and macroalbuminuria (UAE >174 mg/l. From microalbuminuria there might be regression to normoalbuminuria (30% cases) or progression to macroalbuminuria, in which case there is higher risk of progression to advanced chronic kidney disease (CKD). DN has a high cardiovascular morbidity and mortality rate that is possibly more significant than the progression to terminal CKD. DN diagnosis is established by the measurement of albumin in the urine and assessment of glomerular filtration rate (GFR). The measurement of albumin in an isolated urine sample (first morning urine or random sample) is recommended, with the possibility of measuring albumin-creatinine ratio or albumin concentration. High levels of albuminuria should be confirmed by at least 2 out of 3 urine samples within a time interval of 3 to 6 months. If albuminuria cannot be measured, total protein level (proteinuria @ 430 mg/l in a sample or > 500 mg/24 h) can be used to diagnose advanced stages of DN. In patients with type 2 DM, screening should start upon diagnosis of DM, and in patients with type 1 DM, it should be started after the patient turns 10 years old; soon after the onset of puberty; or when the duration of DM is >5 years. In case of negative results, screening should be repeated annually and, if the result is positive, more frequent monitoring of urinary albumin is recommended. GFR estimation is calculated using formulas that employ serum creatinine adjusted for age, gender, and ethnicity. Modification of Diet in Renal Disease (MDRD) study and CKD-EPI (Chronic Kidney Disease - Epidemiology Collaboration) equations are the recommended. In patients with DM, this equation shows a tendency to underestimate GFR.