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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2012  |  Volume : 23  |  Issue : 1  |  Page : 129-132
Prevalence of microalbuminuria in a population of healthy blood donors: A single-center experience


Department of Internal Medicine, Renal Unit, Faculty of Medicine, Zagazig University, Zagazig, Egypt

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Date of Web Publication3-Jan-2012
 

How to cite this article:
Ghonemy TA. Prevalence of microalbuminuria in a population of healthy blood donors: A single-center experience. Saudi J Kidney Dis Transpl 2012;23:129-32

How to cite this URL:
Ghonemy TA. Prevalence of microalbuminuria in a population of healthy blood donors: A single-center experience. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2019 Jul 19];23:129-32. Available from: http://www.sjkdt.org/text.asp?2012/23/1/129/91318
To the Editor,

The American Diabetes Association has defined microalbuminuria (MA) as excretion of 30-299 mg of albumin in a 24-hour urine collection, with values >300 mg being defined as macroalbuminuria. [1] The cutoff value used to define MA is urinary albumin excretion (UAE) > 20 μg/min or >30 mg/24 hours. [2] Microalbuminuria occurs frequently in the general population, even in subjects without diabetes or hypertension. Moreover, there is evidence that as in diabetes, even modestly increased levels of albumin excretion are associated with increased glomerular filtration rate (GFR) in patients with essential hypertension as well as in non-diabetic, non-hypertensive subjects. [3]

Albumin excretion and MA may be a reflection of generalized endothelial dysfunction in capillaries (e.g. glomeruli) and arteries. [4] Screening for MA may be an excellent tool, either alone or in combination with screening for hypertension and hypercholesterolemia, to identify subjects at risk for progressive renal failure. [5] In this work, we studied the prevalence of MA and its impact on renal function in the general population.

This study was carried out in the blood bank and Department of Clinical Pathology, Faculty of Medicine, Zagazig University. Five hundred healthy blood donors (age range: 16-58 years) were recruited for the study. They had no family history of diabetes mellitus, hypertension, kidney disease and/or cardiovascular diseases. They had no history of any chronic illness, did not receive any medication for one month prior to the study and did not give history of any disease associated with increased risk for MA. None of the study subjects had any specific symptoms and they all were normal on clinical examination. [Table 1] shows the clinical and demographic data of the studied group.
Table 1: Clinical and laboratory data of the study subjects.

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All participants were subjected to thorough history taking and physical examination with special emphasis on risk factors for MA. Detailed laboratory investigations were performed as indicated in [Table 2].
Table 2: Correlation between microalbuminuria and other parameters.

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Data are presented as means ± SD. Comparisons between groups were performed by analysis of variance (ANOVA). When comparing two groups, independent t-test was performed, while χ2 tests were used for categorical variables. All data were coded, checked, entered and analyzed using Epi-Info version I for the year 2000, software computer package. [6]

Based on the results, the patients were divided into the following groups:

  1. Normoalbuminuric group: This included 383 persons (76.6%); 333 were males and 50 were females. Their age ranged from 16 to 58 years and body mass index (BMI) ranged from 19.3 to 36.9 kg/m 2 . There are 89 smokers with duration of smoking ranging from 3 to 30 years.
  2. Microalbuminuric group: This included 67 persons (13.4%); six were females and 61 were males. Their age ranged from 19 to 56 years and BMI ranged from 20.3 to 37.6 kg/m 2 . There were 35 smokers with duration of smoking ranging from 5 to 30 years.
  3. Proteinuric group: This included 50 persons (10%); four were females and 46 were males. Their age ranged from 18 to 56 years and BMI ranged from 21.2 to 37.6 kg/m 2 . There were 23 smokers and the duration of smoking ranged from 3 to 30 years.


Our study did not show any significant association between gender and presence of MA (P = 0.9). There was a significant difference in the prevalence of MA among people of different ages, with the maximum prevalence seen in the age group 20-40 years (P < 0.001); also, significant difference was seen between people with high BMI and those with normal BMI (P < 0.01). A significantly higher prevalence of MA was seen among smokers (P < 0.01).

We found significant positive correlation between presence of MA and age, BMI, systolic and diastolic blood pressure, uric acid levels and smoking (P < 0.01); there was no significant correlation with other blood parameters (P > 0.05) [Table 2].

Albumin excretion and MA are currently believed to be risk factors for kidney failure, [7] stroke, [8] and cardiovascular diseases as well as all-cause mortality, not only for persons with diabetes and/or hypertension, [9] but also in the general population. [10]

In this study, it was found that MA was present in 13.4% and proteinuria in 10% of healthy blood donors. However, the reported prevalence of MA in the general population in several large cohort studies is in the range of 5-7%. In the PREVEND (Prevention of Renal and Vascular End-stage Disease) study, although the prevalence of MA was higher in diabetic (16%) and hypertensive (11%) subjects, 6.6% of subjects without known risk factors had MA. Also, the incidence of an individual moving from normoalbuminuric to microalbuminuric stage occurred at a rate of approximately 8% in four years, which is very close to that of treated diabetes. Our study showed that age correlated positively with UAE; this is in agreement with Ritz et al, [11] who found that in both normo and hypertensives, age correlated positively with UAE, perhaps due to nephro-sclerosis that accompanies age (which is greater in hypertensives). However, Metcalf et al 14 found a negative correlation between UAE and age in New Zealand.

The BMI was found to correlate positively with UAE and this is in agreement with the findings of Metcalf et al. [12] A similar association has been reported from Singapore as well. [13]

Smoking was found to be positively correlated with UAE; this is in agreement with the findings of the cohort study [14] and is contrary to the findings of other studies. [15] However, Pinto Sietsma et al [16] found that smoking is related to albuminuria and decreased GFR in a dose-dependent manner both in the general population and in subjects with essential hypertension.

Both systolic and diastolic blood pressure levels were found to correlate significantly with MA. [17] Also, a correlation was found between UAE and 24-hour blood pressure measurements with a regression coefficient for this association ranging from 0.32 to 0.62. [18]

We conclude that screening of MA may be an excellent tool, either alone or in combination with screening for hypertension and hypercholesterolemia, to identify subjects at risk for progressive renal failure.

 
   References Top

1.American Diabetes Association. Clinical practice recommendations: Diabetic nephropathy. Diabetes Care 2001;24:S69-72.  Back to cited text no. 1
    
2.Molitch ME, DeFronzo RA, Franz MJ, et al. Nephropathy in diabetes (Position Statement). Diabetes Care 2004;27:S79-83  Back to cited text no. 2
    
3.Scheid DC, McCarthy LH, Lawler FH, et al. Screening for microalbuminuria to prevent nephropathy in patients with diabetes. J Fam Pract 2001;50:661-8.  Back to cited text no. 3
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4.Stehouwer CD, Yudkin JS, Fioretto P, Nosadini R. How heterogeneous is microalbuminuria in diabetes mellitus? The case for 'benign' and 'malignant' microalbuminuria. Nephrol Dial Transplant 1998;13:2751-4.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.De Jong PE, Hillege HL, Pinto-Sietsma SJ, De Zeeuw D. Screening for microalbuminuria in the general population: a tool to detect subjects at risk for progressive renal failure in an early phase? Nephrol Dial Transplant 2003;18:10-3.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Dean MN, Stein FN, Viboud ST. EPI-INFO (version 6.1) software computer package. 2000.  Back to cited text no. 6
    
7.Locatelli F, Marcelli D, Comelli M, et al. Proteinuria and blood pressure as causal components of progression to end-stage renal failure. Northern Italian Cooperative Study Group. Nephrol Dial Transplant 1996;11:461- 7.  Back to cited text no. 7
[PUBMED]  [FULLTEXT]  
8.Gerstein HC, Mann JF, Pogue J, et al. Prevalence and determinants of microalbuminuria in high-risk diabetic and nondiabetic patients in the Heart Outcomes Prevention Evaluation Study. The HOPE Study Investigators. Diabetes Care 2000;23(Suppl.2):B35-9.  Back to cited text no. 8
    
9.Stehouwer CD, Gall MA, Twisk JW, et al. Increased urinary albumin excretion, endothelial dysfunction, and chronic low-grade inflammation in type II diabetes: progressive, interrelated, and independently associated with risk of death. Diabetes 2002;51:1157-62.  Back to cited text no. 9
[PUBMED]  [FULLTEXT]  
10.Hillege HL, Fidler V, Diercks GF, et al. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation 2002;106:1777.  Back to cited text no. 10
[PUBMED]  [FULLTEXT]  
11.Ritz E, Nowicki M, Fliser D, Hörner D, Klimm HP. Proteinuria and hypertension. Kidney International 1994;47(Suppl.47):s76-80.  Back to cited text no. 11
    
12.Metcalf P, Baker J, Scragg R, Dryson E, Scott A, Wild C. Microalbuminuria in a middle-aged work force. Diabetes Care 1993;16:148593.  Back to cited text no. 12
    
13.Ramirez SP, Mcclellan W, Port FK, Hsu SI. Risks factors for proteinuria in a large, multiracial Southeast Asian population. J Am Soc Nephrol 2002;13:1907-17.  Back to cited text no. 13
[PUBMED]  [FULLTEXT]  
14.Cohort study. Microalbuminuria Collaborative Study Group, United Kingdom. Risk factors for development of microalbuminuria in insulin dependent diabetic patients. Br Med J 1993; 306:1235-9.  Back to cited text no. 14
    
15.Biesenbach G, Zazgornik J. High prevalence of hypertensive retinopathy and coronary heart disease in hypertensive patients with persistent microalbuminuria under short intensive therapy. Clin Nephrol 1994;41(4):211-8.  Back to cited text no. 15
    
16.Pinto-Sietsma SJ, Mulder J, Janssen WM, Hillege HL, de Zeeuw D, de Jong PE. Smoking is related to albuminuria and abnormal renal function in nondiabetic persons. Ann Intern Med 2000b;133:585-91.  Back to cited text no. 16
[PUBMED]  [FULLTEXT]  
17.Schmieder R, Grube E, Ruddel H, Schlebush H, Schulte W. Microproteinuria as a marker for target organ damage in essential hypertension. Klin Wochenschr 1990;68:256-62.  Back to cited text no. 17
    
18.Bianchi S, Bigazzi R, Valtriani C, et al. Elevated serum insulin levels in patients with essential hypertension and microalbuminuria. Hypertension 1994;23:681-7.  Back to cited text no. 18
[PUBMED]  [FULLTEXT]  

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Correspondence Address:
Tarek A Ghonemy
Department of Internal Medicine, Renal Unit, Faculty of Medicine, Zagazig University, Zagazig
Egypt
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PMID: 22237235

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