OBJECTIVE: To develop a rapid detection method for microalbuminuria with size-exclusion high performance liquid chromatography. METHODS: With a new mobile phase, samples were injected onto an Agilent Zorbax GF-250 size exclusion chromatographic column. The method was evaluated and urine albumin of 56 diabetic patients was analyzed. RESULTS: The mobile phase containing 0.1% formic acid and acetonitrile, with 20 μL sample size, 1 mL/min flow rate, 205 nm detection wavelength. The retention time of albumin both in human serum and urine was 1.7 min. The linear range was 5-2000 mg/L. The lower limit of measurement was 2 mg/L. The intra-assay coefficient of variation and the inter-assay coefficient of variation were 3.98% and 4.05% (20 mg/L), 3.55% and 3.60% (200 mg/L), 4.65% and 4.74% (2000 mg/L), respectively. Recovery rates were 95.3%, 98.1%, and 97.2%. Microalbuminuria was detected in 30 samples by high performance liquid chromatography and 15 samples by immunoturbidimetry from 56 patients with diabetic mellitus. CONCLUSION A fast and high sensitivity method, namely size-exclusion high performance liquid chromatography, with mobile phase containing 0.1% formic acid and acetonitrile has been established to analyze microalbuminuria, which can detect more microalbuminuria than other methods and is suitable for clinical routine measurement.
Albuminuria ; diagnosis ; Chromatography, High Pressure Liquid ; Diabetes Mellitus ; urine ; Humans

To assess the validity of urine albumin concentration (UAC) and the urine albumin:creatine ratio (UACR) in a random urine specimen (RUS) for screening diabetic nephropathy in Korea, a total of 105 ambulatory diabetes mellitus patients (male:female, 52:53), ages 40-75 years (median 59 years) collected 105 RUSs after completing a timed 24 hour urine collection. Albumin was measured by immunonephelometry. According to the timed urinary albumin excretion rate (UAER) measured in the 24 hour collection (criterion standard), samples were classified normoalbuminuric (UAER < 20 micrograms/min; n = 50), microalbuminuric (UAER 20-200 micrograms/min; n = 30), and macroalbuminuric (UAER > 200 micrograms/min; n = 25). The receiver operating characteristics (ROC) curve of UAC and UACR in a RUS for screening of microalbuminuria (normo- and microalbuminuric samples; n = 80) and macroalbuminuria (micro- and macroalbuminuric samples; n = 55) were plotted. Pearson's coefficients of correlation of 24 hour UAER vs. UAC and UACR were 0.81 and 0.75, respectively (P < 0.001). The point of intersection with a 100%-to-100% diagonal for microalbuminuria were as follows: 31.0 mg/l for UAC and 32.5 mg/g for UACR; for macroalbuminuria 181 mg/l for UAC and 287.3 mg/g for UACR. The sensitivity and specificity of the cut-off points for microalbuminuria were 77% and 82% for UAC and 77% and 92% for UACR. The sensitivity and specificity of the cut-off points for macroalbuminuria were 84% and 90% for UAC and 88% and 90% for UACR. In present study, no difference was observed when comparing the performance of UAC and UACR based on a statistical comparison by McNemar test. The repeated measurements of UAC and UACR in the same individual were statistically similar and were correlated with each other. Based on these results, albumin measurements (UAC and UACR) in a RUS were considered as a valid test for screening diabetic nephropathy.
Adult ; Aged ; Aged, 80 and over ; Albuminuria/diagnosis* ; Diabetic Nephropathies/diagnosis* ; Female ; Human ; Male ; Middle Age

Chronic kidney disease (CKD) is an important problem worldwide. CKD is defined as either a glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m2 body surface area (BSA) or the presence of kidney damage, most commonly assessed by the presence of albuminuria for at least three consecutive months. In Korea, the reported overall prevalence of CKD is 13.7%, and the prevalence of CKD according to stage is 2.0, 6.7, 4.8, 0.2, and 0.0% for stages 1 to 5, respectively. This review emphasizes the importance of awareness, making an early diagnosis, and an appropriate management strategy for CKD.
Albuminuria ; Body Surface Area ; Early Diagnosis ; Glomerular Filtration Rate ; Kidney ; Korea ; Prevalence ; Renal Insufficiency, Chronic

OBJECTIVETo investigate the correlation of microalbuminuria (MA) and fibrinogen (Fib) to the severity of coronary artery lesions in patients with metabolic syndrome (MS).

METHODSEighty-five patients with MS undergoing coronary artery angiography were divided, according to the number of vessels involved, into multivessel disease group and non-multivessel disease group, and also according to the modified Gensini score, into severe lesion (Gensini score>20) and non-severe lesion group. The correlations of MA and Fib to the number of involved vessels and the severity of the lesions were analyzed.

RESULTSThe urinary albumin to creatinine ratio (ACR) and Fib were significantly different between the multivessel and non-multivessel disease groups (P<0.05), and were found to be positively correlated to the number of coronary artery lesion (r=0.378, P=0.000; r=0.327, P=0.002). ACR, Fib, sex, smoking history and HDL-C differed significantly between severe lesion and non-severe lesion groups (P<0.05), and ACR and Fib showed positive correlations to the Gensini score (r=0.337, P=0.002; r=0.286, P=0.008). Logistic regression analysis identified ACR as an independent predictor of multivessel disease (B=2.655, P=0.000) and Gensini score (B=1.803, P=0.009), independent of sex, age, body mass index, smoking history, diabetes mellitus, LDL-C and HDL-C.

CONCLUSIONMA and Fib are positively correlated to the severity of coronary artery lesion, and MA is an independent predictor of multivessel disease and Gensini score in patients with MS.

Aged ; Albuminuria ; Coronary Artery Disease ; diagnosis ; pathology ; Female ; Fibrinogen ; metabolism ; Humans ; Male ; Metabolic Syndrome ; blood ; urine ; Middle Aged

An analytical observation was carried out on clinical features manifested by 435 patients admitted to Sacred Heart Hospital under a diagnosis of hypertension for a period of June 1968 to August 1972. The following results were obtained: 1. The occurence rate of hypertension was like to be higher in males than in females, showing a ratio of 3:2. The group of the 6th decade of age showed the densest distribution followed the groups in the 5th and the 7th decades, in either sex. 2. The average measurement of blood pressure in patients with hypertension for less than 2 years of duration was 174.8+/-25.14/114.0+/-18.72 mmHg. One who had suffered for over 10 years showed 189.7+/-32.02/126.6+/-23.95mmHg. The value had a tendency to increase as the ailment duration prolonged. 3. In eye fundus findings,hypertensive retinopathy of K-W stage II was the most frequent, observed in 39.0% of all. The appearing rate of hypertensive retinopathy increased and the change in the eye ground was accentuated as the ailment lingered longer. There was no noticeable correlative evidence between serum cholesterol and retinopathy by K-W classification, while the appearing rate of arteriosclerosis in the eye ground by Scheie's classification somewhat increased as serum cholesterol elevated. 4. Albuminuria was observed in 62.9% of all cases, a tendency of a higher appearing rate in parallel with the protraction of illness and a higher measurement of blood pressure. 5. The appearing rate of albuminuria increased as the change of eye fundus deepened. 6. The mean value of serum cholesterol was 192.0mg%, and there was no difference in cholesterol determination by age. 7. The ECG revealed an abnormal tracing in 78.0% of all cases, of which LVH was the most common abnormality appearing in 62.3%. The abnormalities in ECG were found more frequently as the illness protracted longer and blood pressure measured higher. 8. The chest X-ray showed abnormal findings in 55.6% of all cases, of which cardiomegaly was the most common change evidenced in 43.9%. 9. The cerebrovascular accident(22.9%), cardiac failure(8.6%) and renal insufficiency(7.9%) were the major complications of hypertension. The cerebrovascular accident was also found in higher occurence in the cases of longer duration of ailment with hypertension.
Albuminuria ; Arteriosclerosis ; Blood Pressure ; Cardiomegaly ; Cholesterol ; Classification ; Diagnosis ; Electrocardiography ; Female ; Heart ; Humans ; Hypertension* ; Hypertensive Retinopathy ; Korea* ; Male ; Stroke ; Thorax

This study was aimed to evaluate renal dysfunction during three weeks after the burn injuries in 12 patients admitted to the Hallym University Hankang Medical Center with flame burn injuries (total body surface area, 20-40%). Parameters assessed included 24-hr urine volume, blood urea nitrogen, serum creatinine, creatinine clearance, total urinary protein, urinary microalbumin, 24-hr urinary N-acetyl--D-glucosaminidase (NAG) activity, and urinary malondialdehyde (MDA). Statistical analysis was performed using repeated measures ANOVA test. The 24-hr urine volume, creatinine clearance, and urinary protein significantly increased on day 3 post-burn and fell thereafter. The urine microalbumin excretion showed two peak levels on day 0 post-burn and day 3. The 24-hr urinary NAG activity significantly increased to its maximal level on day 7 post-burn and gradually fell thereafter. The urinary MDA progressively increased during 3 weeks after the burn injury. Despite recovery of general renal function through an intensive care of burn injury, renal tubular damage and lipid peroxidation of the renal tissue suggested to persist during three weeks after the burn. Therefore, a close monitoring and intensive management of renal dysfunction is necessary to prevent burn-induced acute renal failure as well as to lower mortality in patients with major burns.
Acetylglucosaminidase/*urine ; Adult ; Aged ; Albuminuria/etiology ; Biological Markers ; Burns/*complications ; Female ; Human ; Kidney Diseases/*diagnosis/urine ; Kidney Failure, Acute/diagnosis ; Lipid Peroxidation ; Male ; Malondialdehyde/*urine ; Middle Age

Chronic kidney disease (CKD) is an important problem in the elderly as well as in general population. The CKD is defined either by a glomerular filtration rate (GFR) of less than 60 ml/min/1.73m(2) BSA or by the presence of kidney damage, assessed most commonly by the finding of albuminuria for three or more consecutive months. The severity of CKD can be classified as follows : stage 1, kidney damage with a normal or increased GFR (more than 90ml/min/1.73m(2) BSA); stage 2, kidney damage with a mild decrease in GFR (89 to 60ml/min/1.73m(2) BSA) ; stage 3, a moderate decrease in GFR (59 to 30ml/min/1.73m(2) BSA); stage 4, a severe decrease in GFR (15 to 29ml/min/1.73m(2) BSA); stage 5, kidney failure (i.e., a GFR of less than 15 ml/min/1.73m(2) or conditions requiring dialysis). The CKD in elderly population is closely related with a high risk of cardiovascular disease, cognitive impairment, functional limitation, and death. We now have to assess the risk among the elderly patients with CKD for the prevention of morbidity and mortality. Clinicians should measure albuminuria and estimate GFR from serum creatinine to detect CKD. Patients with CKD should be evaluated appropriately and treated according to the underlying cause of CKD. Moreover, the medical society should make an effort to inform individuals with increased risk to develop CKD and the necessity of simple diagnostic tests for CKD.
Aged* ; Albuminuria ; Cardiovascular Diseases ; Creatinine ; Diagnostic Tests, Routine ; Early Diagnosis ; Glomerular Filtration Rate ; Humans ; Kidney ; Mortality ; Renal Insufficiency ; Renal Insufficiency, Chronic* ; Societies, Medical

A 37-year-old male patient was admitted with generalized edema as the main symptom. A blood test confirmed hypoalbuminemia and hyperlipidemia, and a urine test confirmed severe albuminuria. A renal biopsy was conducted, which revealed a diagnosis of minimal change disease. Although the patient experienced complete remission of minimal change nephrotic syndrome after oral prednisolone and cyclophosphamide treatment, he is readmitted due to bilateral leg edema 5 years later since minimal change nephrotic syndrome was completely cured. The patient is diagnosed with IgA nephropathy. Although the exact mechanisms of IgA nephropathy in this patient remain unclear, this case represents an extremely rare development, and is separate from the remission of minimal change nephrotic syndrome.
Adult ; Albuminuria ; Biopsy ; Cyclophosphamide ; Diagnosis ; Edema ; Glomerulonephritis, IGA* ; Hematologic Tests ; Humans ; Hyperlipidemias ; Hypoalbuminemia ; Immunoglobulin A* ; Leg ; Male ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Prednisolone

Diabetic nephropathy is the leading cause of end-stage renal disease, and is associated with increased risk of cardiovascular disease. Optimal control of blood glucose and blood pressure based on the blockade of renin-angiotensin system is the standard of care for the prevention and treatment of diabetic nephropathy. Regardless of these therapies, the prevalence of diabetic nephropathy continues to increase, highlighting the need for additional therapies. Diabetes affects the progression of kidney disease through a variety of mechanisms; several new therapeutic agents targeting these pathways have been developed, with currently being evaluated in clinical trials.
Albuminuria ; Blood Glucose ; Blood Pressure ; Cardiovascular Diseases ; Diabetic Nephropathies* ; Diagnosis ; Kidney Diseases ; Kidney Failure, Chronic ; Prevalence ; Renal Insufficiency, Chronic ; Renin-Angiotensin System ; Standard of Care

Chronic kidney disease (CKD) is a worldwide problem. This study was designed to survey the prevalence and risk factors for CKD in Korea. The 2,356 subjects were selected in proportion to age, gender, and city. Subjects 35 yr of age or older were selected from 7 cities. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) Study equation, with albuminuria defined as a urine albumin to creatinine ratio of 30 mg/g or more. The overall prevalence of CKD was 13.7%. The prevalences of CKD according to stage were 2.0% stage 1, 6.7% stage 2, 4.8% stage 3, 0.2% stage 4, and 0.0% stage 5. The prevalences of microalbuminuria and macroalbuminuria were 8.6% and 1.6%, respectively. The prevalence of eGFR less than 60 mL/min/1.73 m2 was 5.0%. Age, body mass index (BMI), hypertension, diabetes mellitus, systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood glucose were independent factors related to the presence of CKD. In conclusions, Korea, in which the prevalence of CKD is increasing, should prepare a policy for early detection and appropriate treatment of CKD. The present data will be helpful in taking those actions.
Adult ; Aged ; Albuminuria/diagnosis ; Diet ; Disease Susceptibility ; Female ; Glomerular Filtration Rate ; Humans ; Kidney Failure, Chronic/*epidemiology ; Korea ; Male ; Middle Aged ; Nephrology/methods ; Prevalence ; Risk Factors