Generic placeholder image

Current Diabetes Reviews


ISSN (Print): 1573-3998
ISSN (Online): 1875-6417

Research Article

Association of High Levels of Spot Urine Protein with High Blood Pressure, Mean Arterial Pressure and Pulse Pressure with the Development of Diabetic Chronic Kidney Dysfunction or Failure among Diabetic Patients. Statistical Regression Modeling to Predict Diabetic Proteinuria

Author(s): Kamran M. Ahmed Aziz*

Volume 15, Issue 6, 2019

Page: [486 - 496] Pages: 11

DOI: 10.2174/1573399814666180924114041


Introduction: In research elevated Blood Pressure (BP) has been demonstrated to be a risk for the development of nephropathy and chronic renal disease (CKD) Or Diabetic Kidney Disease (DKD) among diabetics. However, no study has find correlation for the spot urine protein (UPr) excretion with elevated BP, Pulse Pressure (PP) and mean arterial pressure MAP). This technique was invented in the current study.

Methods: 10,270 were recruited for more than 12 years. Demographically, 43%, 38%, and 16% showed hypertension, nephropathy and chronic renal disease, respectively. UPr demonstrated significant correlations with systolic BP (SBP) and diastolic BP (DPB), MAP and PP (p < 0.0001 for all). SBP, DBP, PP and MAP, UPr were observed to be higher among the groups with nephroaphty and CKD/DKD with highly significant p-values (all p < 0.05). With logistic regression, odds ratio of hypertension (HTN) with nephropathy was observed to be 2.99 (95% CI 2.44 to 3.7; p < 0.0001); and odds ratio of HTN with CKD/DK was 7.1 (95% CI 4.3 to 11.84; p<0.0001), indicating that HTN significantly contributes to the development of nephropathy and CKD/DKD in diabetics.

Results: Invented regression models for the excretion of UPr from the kidney with elevated SBP, DBP, MAP and PP were highly significant (p < 0.0001 for all); UPr = -138.6 + [1.347 × SBP] ; UPr = -93.4 + [1.62 × DBP] ; UPr = -149.5 + [1.922 × MAP] ; UPr = -41.23 +[1.541 × PP].

Conclusion: Current study is the first one to introduce this technique. These invented new equations can be used by physicians to estimate protein excretion in urine at bedside and outpatients departments for monitoring proteinuria and CKD/DKD.

Keywords: Blood pressure, diabetic kidney disease, mean arterial pressure, proteinuria, pulse pressure, spot urine protein.

King H, Aubert RA, Herman WH. Global burden of diabetes, 1995-2025: Prevalence, numerical estimates, and projections. Diabetes Care 1998; 21: 1414-31.
Lachin JM, Genuth S, Cleary P, et al. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. N Engl J Med 2000; 342: 381-9.
Nathan DM, Genuth S, Lachin J, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complication in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977-86.
American Diabetes Association. Cardiovascular disease and risk management. Diabetes Care 2016; 40: S75-87.
Aziz KMA. (2014) Association of microalbuminuria with ischemic heart disease, dyslipidemia and obesity among diabetic patients: experience from 5 year follow up study of 1415 patients. Bioenergetics 2014; 3: 118.
Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006; 3e442
Report of Inter-Society Commission for Heart Disease Resources Primary prevention of the atherosclerotic diseases. Circulation 1970; 42: A55-95.
Rothwell PM. Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension. Lancet 2010; 375: 938-48.
Okada H, Fukui M, Tanaka M, et al. Visit-to-visit variability in systolic blood pressure is correlated with diabetic nephropathy and atherosclerosis in patients with type 2 diabetes. Atherosclerosis 2012; 220: 155-9.
Poortvliet RK, Ford I, Lloyd SM, et al. Blood pressure variability and cardiovascular risk in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). PLoS One 2012; 7e52438
Brand RJ. An examination of the association between a-b behavior and coronary heart disease incidence Proceedings of the forum on coronary prone behavior. St. Petersburg, Florida. 1977.
Criqui MH, Barrett-Connor E, Holdbrook MJ, Austin M, Turner JD. Clustering of cardiovascular disease risk factors. Prev Med 1980; 9: 525-33.
Grimm RH, Svendsen KH, Kasiske B, Keane WF, Wahi MM. Proteinuria is a risk factor for mortality over 10 years of follow-up. MRFIT Research Group. Multiple Risk Factor Intervention Trial. Kidney Int Suppl 1997; 63: S10-4.
Jensen JS, Feldt-Rasmussen B, Strandgaard S, Schroll M, Borch-Johnsen K. Arterial hypertension, microalbuminuria, and risk of ischemic heart disease. Hypertension 2000; 35: 898-903.
Dineen SF, Gerstein HC. The association of microalbuminuria and mortality in non-insulin-dependent diabetes mellitus. A systematic overview of the literature. Arch Intern Med 1997; 157: 1413-8.
Damsgaard EM, Froland A, Jorgensen OD, Mogensen CE. Microalbuminuria as predictor of increased mortality in elderly people. BMJ 1990; 300: 297-300.
Ravid M, Brosh D, Ravid-Safran D, Levy Z, Rachmani R. Main risk factors for nephropathy in type 2 diabetes mellitus are plasma cholesterol levels, mean blood pressure, and hyperglycemia. Arch Intern Med 1998; 158: 998-1004.
Kamran M, A. Aziz. Association of microalbuminuria with ischemic heart disease, dyslipidemia and obesity among diabetic patients: Experience from 5 year follow up study of 1415 patients. Bioenergetics 2014; 3: 118.
Ritz E, Rychlik I, Locatelli F, Halimi S. End stage renal failure in type 2 diabetes: A medical catastrophe of worldwide dimensions. Am J Kidney Dis 1999; 34: 795-808.
Gross JL, de Azevedo MJ, Silveiro SP, et al. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care 2005; 28: 164-76.
Mogensen CE, Chachati A, Christensen CK, et al. Microalbuminuria: An early marker of renal involvement in diabetes. Uremia Invest 1985; 9: 85-95.
Mogensen CE. Definition of diabetic renal disease in insulin dependent diabetes mellitus based on renal function tests: The kidney and hypertension in diabetes mellitus. Kluwer Academic Publishers Boston, USA 2000; pp. 1-14.
KDOQI. Clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis 2007; 49: S12-S154.
Vaur L, Gueret P, Lievre M, et al. Development of congestive heart failure in type 2 diabetic patients with microalbuminuria or proteinuria: Observations from the DIABHYCAR (Type 2 Diabetes, Hypertension, Cardiovascular Events and Ramipril) study. Diabetes Care 2003; 26: 855-60.
Adler AI, Stevens RJ, Manley SE, et al. Development and progression of nephropathy in type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int 2003; 63: 225-32.
Miettinen H, Haffner SM, Lehto S, et al. Proteinuria predicts stroke and other atherosclerotic vascular disease events in nondiabetic and non-insulin-dependent diabetic subjects. Stroke 1996; 27: 2033-9.
Aziz MAK. Correlation of urine biomarkers: Microalbuminuria and spot urine protein among diabetic patients. application of spot urine protein in diabetic kidney disease, nephropathy, proteinuria estimation, diagnosing and monitoring. Recent Pat Endocr Metab Immune Drug Discov july 2015; 9: 1.
Rodby R, Rohde R, Sharon Z, Pohl M, Bain R, Lewis E. The urine protein to creatinine ratio as a predictor of 24-hour urine protein excretion in type 1 diabetic patients with nephropathy. The Collaborative Study Group. Am J Kidney Dis 1995; 26: 904-9.
Eddy A, McCulloch L, Liu E, Adams J. A relationship between proteinuria and acute tubulo-interstitial disease in rats with experimental nephrotic syndrome. Am J Pathol 1991; 138: 1111-23.
Côté A, Brown M, Lam E, et al. Diagnostic accuracy of urinary spot protein: Creatinine ratio for proteinuria in hypertensive pregnant women: Systematic review. BMJ 2008; 336: 1003-6.
Lemann J, Doumas B. Proteinuria in health and disease assessed by measuring the urinary protein/creatinine ratio. Clin Chem 1987; 33: 297-9.
Ginsberg J, Chang B, Matarese R, Garella S. Use of single voided urine samples to estimate quantitative proteinuria. N Engl J Med 1983; 309: 1543-6.
Ruggenenti P, Gaspari F, Perna A, Remuzzi G. Cross sectional longitudinal study of spot morning urine protein: Creatinine ratio, 24 hour urine protein excretion rate, glomerular filtration rate, and end stage renal failure in chronic renal disease in patients without diabetes. BMJ 1998; 316: 504-9.
Abitbol C, Zilleruelo G, Freundlich M, Strauss J. Quantitation of proteinuria with urinary protein/creatinine ratios and random testing with dipsticks in nephrotic children. J Pediatr 1990; 116: 243-7.
Morgenstern B, Butani L, Wollan P, Wilson D, Larson T. Validity of protein-osmolality versus protein-creatinine ratios in the estimation of quantitative proteinuria from random samples of urine in children. Am J Kidney Dis 2003; 41: 760-6.
Kim H, Cheon H, Choe J, Yoo K, Hong Y, Lee J, et al. Quantification of proteinuria in children using the urinary protein-osmolality ratio. Pediatr Nephrol 2001; 16: 73-6.
Houser M. Assessment of proteinuria using random urine samples. J Pediatr 1984; 104: 845-8.
Hara M, Saito A, Tomino Y, Asanuma K, et al. Method for test on diabetic nephropathy. US20120164667 (2012).
Hirowatari Y, Hara K, Takahashi H. Method for assessing diabetic nephropathy. EP20060004475 (2006).
Verheijen JH, Hanemaaijer JR, Diamant M. Method for determining if a subject having type II diabetes has a kidney disorder. US8012709 (2011).
Niewezas MA, Krolewski AS. Methods of diagnosing and predicting renal disease. US20010281758 (2001).
Klahr S, Levey AS, Beck GJ, et al. The modification of diet in renal disease study group. The effects of dietary protein restriction and blood pressure control on the progression of chronic renal disease. N Engl J Med 1994; 330: 877-84.
Locatelli F, Marcelli D, Comelli D, et al. Proteinuria and blood pressure as causal components to progression to end-stage renal failure. Northern Italian cooperative study group. Nephrol Dial Transplant 1996; 11: 461-7.
Ravid M, Savin H, Jutrin I, Bental T, Katz B, Lishner M. Long term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetics. Ann Intern Med 1993; 118: 577-81.
The GISEN Group. Randomised placebo controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet 1997; 349: 1857-63.
Ruggenenti P, Perna A, Gherhardi G, et al. Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria. Lancet 1999; 345: 359-64.
O’Rourke MF. Arterial Function in Health and Disease. Edinburgh, UK: Churchill Livingstone 1982.
Nichols WW, O’Rourke MF. McDonald’s Blood Flow in Arteries. Philadelphia, Pa: Lea & Febiger 1998.
Nichols WW, Nicolini FA, Pepine CJ. Determinants of isolated systolic hypertension in the elderly. J Hypertens 1992; 10(Suppl. 6): S73-7.
Safar ME. Pulse pressure in essential hypertension: clinical and therapeutical implications. J Hypertens 1989; 7: 769-76.
Darne B, Girerd X, Safar M, Cambien F, Guize L. Pulsatile versus steady component of blood pressure: A cross-sectional analysis and a prospective analysis on cardiovascular mortality. Hypertension 1989; 13: 392-400.
Franklin SS, Gustin W IV, Wong ND, et al. Hemodynamic patterns of age-related changes in blood pressure: The Framingham Heart Study. Circulation 1997; 96: 308-15.
Benetos A, Laurent S, Asmar RG, Lacolley P. Large artery stiffness in hypertension. J Hypertens Suppl 1997; 15: S89-97.
Madhavan S, Ooi WL, Cohen J, Alderman MH. Relation of pulse pressure and blood pressure reduction to the incidence of myocardial infarction. Hypertension 1994; 23: 395-401.
Fang J, Madhavan S, Cohen H, Alderman MH. Measures of blood pressure and myocardial infarction in treated hypertensive patients. J Hypertens 1995; 13: 413-9.
Benetos A, Safar M, Rudnichi A, et al. Pulse pressure: A predictor of long-term cardiovascular mortality in a French male population. Hypertension 1997; 30: 1410-5.
Mitchell GF, Moye LA, Braunwald E, et al. Sphygmomanometrically determined pulse pressure is a powerful independent predictor of recurrent events after myocardial infarction in patients with impaired left ventricular function. Circulation 1997; 96: 4254-60.
Sesso HD, Stampfer MJ, Rosner B, et al. GlynnSystolic and diastolic blood pressure, pulse pressure, and mean arterial pressure as predictors of cardiovascular disease risk in men. Hypertension 2000; 36: 801-7.
Mogensen CE. Microalbuminuria, blood pressure, and diabetic renal disease: Origin and development of ideas. Diabetologia 1999; 42: 263-85.
Keane WF. Proteinuria: its clinical importance and role in progressive renal disease. Am J Kidney Dis 2000; 35: S97-S105.
Weinstock Brown W, Keane WF. Proteinuria and cardiovascular disease. Am J Kidney Dis 2001; 38: S8-S13.
Rosa TT, Palatini P. Clinical value of microalbuminuria in hypertension. J Hypertens 2000; 18: 645-54.
Bianchi S, Bigazzi R, Campese VM. Microalbuminuria in essential hypertension: significance, pathophysiology, and therapeutic implications. Am J Kidney Dis 1999; 34: 973-95.
Ruilope LM. Microalbuminuria as risk in essential hypertension. Nephrol Dial Transplant 1997; 12: 2-5.
Gansevoort RT, Navis GJ, Wapstra FH, de Jong PE, de Zeeuw D. Proteinuria and progression of renal disease: Therapeutic implications. Curr Opin Nephrol Hypertens 1997; 6: 133-40.
Rajani Chelliah, Giuseppe A. Sagnella, Nirmala D. Markandu, Graham A. MacGregor. Urinary protein and essential hypertension in black and in white people. Hypertension 2002; 39: 1064-70.
Christensen KL. Reducing pulse pressure in hypertension may normalize small artery structure. Hypertension 1991; 18: 722-7.
Verdecchia P, Schillaci G, Borgione C, Ciucce A, Pede S, Porcellati C. Ambulatory pulse pressure: A potent predictor of total cardiovascular risk in hypertension. Hypertension 1998; 32: 983-8.
Brown MC, Boston MA, Reyes C, Davie FL. Mean arterial pressure estimation. US2016O166211A1 (2016).
Pinsky MR. Use of aortic pulse pressure and flow in bedside hemodynamic management. US006776764B2 (2004).
Mitchell RJ. Improved method for specific determination of creatinine in serum and urine. Clin Chem 1973; 19: 408-10.
Slot C. Plasma creatinine determination. A new and specific Jaffe reaction method. Scand J Clin Lab Invest 1965; 17: 381-7.
Bishop Michael L. Clinical Chemistry: Principles and Correlations 2nd ed.Philadelphia:. Lippincott JB, Company 1992; p. 441.
Fujita Y, Mori I, Kitano S. Color reaction between pyrogallol red molybdenum (VI) complex and protein. Bunseki Kagaku 1983; 32: 379-86.
] NATCOM Hospital Information System (NATCOM HIS), National Computer System Co, Ltd.. and (Accessed on: April 17, 2018.).
Whelton PK, Carey RM, Aronow WS, et al. Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. a report of the american college of cardiology/american heart association task force on clinical practice guidelines. J Am Coll Cardiol 2017; 23976
American Diabetes Association. (2011) Standards of medical care in diabetes--2011. Diabetes Care 34: S11-61.
UKPDS. (1998) Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ 317: 703-13.
Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 2003; 289: 2560-72.
Estacio RO, Jeffers BW, Gifford N, Schrier RW. Effect of blood pressure control on diabetic microvascular complications in patients with hypertension and type 2 diabetes. Diabetes Care 2000; 23: B54-64.
Schrier RW, Estacio RO, Esler A, Mehler P. Effects of aggressive blood pressure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokes. Kidney Int 2002; 61: 1086-97.
Mancia G. Effects of intensive blood pressure control in the management of patients with type 2 diabetes mellitus in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Circulation 2010; 122: 847-9.
Ninomiya T, Zoungas S, Neal B, et al. Efficacy and safety of routine blood pressure lowering in older patients with diabetes: Results from the ADVANCE trial. J Hypertens 2010; 28: 1141-9.
Cushman WC, Evans GW, Byington RP, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010; 362: 1575-85.
Varughese GI, Lip GY. Antihypertensive therapy in diabetes mellitus: Insights from ALLHAT and the blood pressure-lowering treatment trialists’ collaboration meta-analysis. J Hum Hypertens 2005; 19: 851-3.
ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The antihypertensive and Lipid- Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981-97.
Berl T, Hunsicker LG, Lewis JB, et al. Impact of achieved blood pressure on cardiovascular outcomes in the Irbesartan Diabetic Nephropathy Trial. J Am Soc Nephrol 2005; 16: 2170-9.
Dahlöf B, Sever PS, Poulter NR, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): A multicentre randomised controlled trial. Lancet 2005; 366: 895-906.
Agardh CD, Garcia-Puig J, Charbonnel B, Angelkort B, Barnett AH. Greater reduction of urinary albumin excretion in hypertensive type II diabetic patients with incipient nephropathy by lisinopril than by nifedipine. J Hum Hypertens 1996; 10: 185-92.
Franklin SS, Khan SA, Wong ND, Larson MG, Levy D. Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham Heart Study. Circulation 1999; 100: 354-60.
Leone M, Asfar P, Radermacher P, Vincent JL, Martin C. Optimizing mean arterial pressure in septic shock: A critical reappraisal of the literature. Crit Care 2015; 19: 101.
Sesso HD, Stampfer MJ, Rosner B, et al. Systolic and diastolic blood pressure, pulse pressure and mean arterial pressure as predictors of cardiovascular disease risk in men. Hypertension 2000; 36: 801-7.
Abdelfatah AB, Motte G, Ducloux D, Chalopin JM. Determinants of mean arterial pressure and pulse pressure in chronic haemodialysis patients. J Hum Hypertens 2001; 15: 775-9.
Malone AF, Reddan DN. Pulse pressure. Why it is important? Perit Dial Int 2010; 30: 265-8.
Wilking SV, Belanger A, Kannel WB, D’Agostino RB, Steel K. Determinants of isolated systolic hypertension. JAMA 1988; 260: 3451-5.
Sagie A, Larson MG, Levy D. The natural history of borderline isolated systolic hypertension. N Engl J Med 1993; 329: 1912-7.
Lee ML, Rosner BA, Vokonas PS, Weiss ST. Longitudinal analysis of adult male blood pressure: The Normative Aging Study, 1963-1992. J Epidemiol Biostat 1996; 1: 79-87.
Tate RB, Manfreda J, Krahn AD, Cuddy TE. Tracking of blood pressure over a 40-year period in the University of Manitoba Follow-up Study, 1948-1988. Am J Epidemiol 1995; 142: 946-54.
Dyer AR, Stamler J, Shekelle RB, et al. Pulse pressure, III: prognostic significance in four Chicago epidemiologic studies. J Chron Dis 1982; 35: 283-94.
Domanski MJ, Davis BR, Pfeffer MA, Kastantin M, Mitchell GF. Isolated systolic hypertension: prognostic information provided by pulse pressure. Hypertension 1999; 34: 375-80.
Franklin SS, Sutton-Tyrrell K, Belle SH, Weber MA, Kuller LH. The importance of pulsatile components of hypertension in predicting carotid stenosis in older adults. J Hypertens 1997; 15: 1143-50.
O’Donnell CJ, Ridker PM, Glynn RJ, et al. Hypertension and borderline isolated systolic hypertension increase risks of cardiovascular disease and mortality in male physicians. Circulation 1997; 95: 1132-7.
Cruickshank JM. Coronary flow reserve and the J curve relation between diastolic blood pressure and myocardial infarction. BMJ 1988; 297: 1227-30.
Psaty BM, Furberg CD, Kuller LH, et al. Isolated systolic hypertension and subclinical cardiovascular disease in the elderly: initial findings from the Cardiovascular Health Study. JAMA 1992; 268: 1287-91.
Girerd X, Laurent S, Pannier B, Asmar R, Safar M. Arterial distensibility and left ventricular hypertrophy in patients with sustained essential hypertension. Am Heart J 1991; 122: 1210-4.
Lee ML, Rosner BA, Weiss ST. Relationship of blood pressure to cardiovascular death: the effects of pulse pressure in the elderly. Ann Epidemiol 1999; 9: 101-7.
Chae CU, Pfeffer MA, Glynn RJ, Mitchell GF, Taylor JO, Hennekens CH. Increased pulse pressure and risk of heart failure in the elderly. JAMA 1999; 281: 634-9.
Rostand SG, Kirk KA, Rutsky EA, Pate BA. Racial differences in the incidence of treatment for end-stage renal disease. N Engl J Med 1982; 306: 1276-9.
Freedman BI, Spray BJ, Tuttle AB, Buckalew VM Jr. The familial risk of end-stage renal disease in African Americans. Am J Kidney Dis 1993; 21: 387-93.
Jiang X, Srinivasan SR, Radhakrishnamurthy B, Dalferes ER Jr, Bao W, Berenson GS. Microalbuminuria in young adults related to blood pressure in a biracial (black-white) population. The Bogalusa Heart Study. Am J Hypertens 1994; 7: 794-800.
Summerson JH, Bell RA, Konen JC. Racial differences in the prevalence of microalbuminuria in hypertension. Am J Kidney Dis 1995; 26: 577-9.
Kassirer JP, Harrington JT. Laboratory evaluation of renal function. In: Schrier RW, Gooschalk CW, Eds.. Diseases of the Kidney,. 4th ed.. Boston/Toronto: Little Brown and Company 1988; pp. 393-441.
Waller KV, Ward KM, Mahan JD, Wismatt DK. Current concepts in proteinuria. Clin Chem 1989; 35: 755-65.
Walls J. Relationship between proteinuria and progressive renal disease. Am J Kidney Dis 2001; 37: S13-6.
Krolewski AS, Warren J. Method of evaluating a subject for risk or predisposition of reduced renal function over time. US7560244 (2009)..
Krolewski AS, Warren J. Predictors of renal disease. US20060240437 (2006)..
Gerstein HC, Mann JF, Yi Q, et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001; 286: 421-6.
Konen J, Shihabi Z, Newman J. The association of non–insulin-dependent diabetes mellitus and hypertension with urinary excretion of albumin and transferrin. Am J Kidney Dis 1993; 22: 791-7.
Retnakaran R, Cull CA, Thorne KI, Adler AI, Holman RR. UKPDS Study Group. Risk factors for renal dysfunction in type 2 diabetes: U.K. Prospective Diabetes Study 74. Diabetes 2006; 55: 1832-9.
Fioretto P, Dodson PM, Ziegler D, Rosenson RS. Residual microvascular risk in diabetes: unmet needs and future directions. Nat Rev Endocrinol 2010; 6: 19-25.
Molitch ME, DeFronzo RA, Franz MJ, Keane WF, Mogensen CE, Parving HH. American Diabetes Association. Diabetic nephropathy. Diabetes Care 2003; 26(Suppl. 1): S94-8.
Goldschmid MG, Domin WS, Ziemer DC, Gallina DL, Phillips LS. Diabetes in urban African-Americans. II. High prevalence of microalbuminuria and nephropathy in African-Americans with diabetes. Diabetes Care 1995; 18: 955-61.
Kohler KA, McClellan WM, Ziemer DC, Kleinbaum DG, Boring JR. Risk factors for microalbuminuria in black Americans with newly diagnosed type 2 diabetes. Am J Kidney Dis 2000; 36: 903-13.
Konen JC, Summerson JH, Bell RA. Abnormal urinary protein excretion in African Americans with type 2 diabetes mellitus. Ethn Dis 1999; 9: 3-9.
Hebert LA, Kusek JW, Greene T, et al. Effects of blood pressure control on progressive renal disease in blacks and whites. Modification of diet in renal disease study group. Hypertension 1997; 30: 428-35.
Obialo CI, Hewan-Lowe K. Rapid progression to end-stage renal disease in young hypertensive African Americans with proteinuria. J Natl Med Assoc 1998; 90: 649-55.
Joint National Committee on Prevention. Detection, Evaluation, and Treatment of High Blood Pressure. The 5th report of the Joint national committee on detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1993; 153: 154-83.
Guidelines Subcommittee of the WHO/ISH Mild Hypertension Liaison Committee. 1993 guidelines for the management of mild hypertension (memorandum from a World Health Organization/International Society of Hypertension meeting). Hypertension 1993; 22: 392-403.
Joint National Committee on Prevention. Detection, Evaluation, and Treatment of High Blood Pressure. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1997; 157: 2413-46.
Intersalt Cooperative Research Group. Intersalt: an international study of electrolyte excretion and blood pressure. Results for 124-hour urinary sodium and potassium excretion. BMJ 1988; 297: 319-28.
Yu HCM, Burrell LM, Black MJ, et al. Salt induces myocardial and renal fibrosis in normotensive and hypertensive rats. Circulation 1998; 98262128
Cianciaruso B, Bellizzi V, Minutolo R, et al. Salt intake and renal outcome in patients with progressive renal disease. Miner Electrolyte Metab 1998; 24: 296-301.
He FJ, Markandu ND, Sagnella GA, MacGregor GA. Importance of the renin system in determining blood pressure fall with salt restriction in black and white hypertensives. Hypertension 1998; 32: 820-4.
Campese VM, Parise M, Karubian F, Bigazzi R. Abnormal renal hemodynamics in black salt-sensitive patients with hypertension. Hypertension 1999; 18: 805-12.
DeFelice SL. Composition and method for preventing and/or treating microalbuminuria. US005962020 (1999)..
Ryan JW, Chung A. Antihypertensive agents. US4833152 (1989)..
Winn M, Zydowsky TM, Kerkman DJ, et al. Angiotensin II receptor antagonists. EP0475206 (1992)..
Montgomery HE, Maritn JF, Erusalimsky JD. Use of inhibitors of the rennin angiotensin system. US7071183 (2006)..
Kondoh G. Drug containing angiotensin convertase. US007407933 (2008)..
Bjerguard UP, Larsen BA, Thorsteinsson B, Pramming S. Renin angiotensin system in diabetes mellitus. US20030158090 (2003)..
Dittrich HG, Otsuki L, Widder KJ. Method of treatment of cardiac and/or renal failure using a calcium channel blocker and an angiotensin converting enzyme inhibitor or an angiotensin II receptor blocker. US20060058355 (2006)..
Scholkens B, Bender N, Reangoonwala B, Dagenais G, Yusuf S. use of inhibitors of the rennin angiotensin system in the prevention of cardiovascular events. US20080287403 (2008)..
Almirante N, Nicotra A, Mandelli V, Biondi S, Stefanini S, Sebhat IK. Angiotensin II receptor blocker derivatives. US20110052674 (2011)..
Schena FP. Epidemiology of end stage renal disease: International comparisons of renal replacement therapy. Kidney Int Suppl 2000; 57: S39-45.
Aziz KMA. Association between hypothyroidism, body mass index, systolic blood pressure and proteinuria in diabetic patients: does treated hypothyroid with thyroxin replacement therapy prevent nephropathy/ chronic renal disease? Curr Diabetes Rev 2016; 12(3): 297-306.
Aziz KMA. Association of Hypothyroidism with High Non-HDL Cholesterol and Ankle Brachial Pressure Index in Patients with Diabetes: 10-Year Results from a 5780 Patient Cohort. A Need for Intervention. Annals Thyroid Res 2016; 2(2): 53-7.
Jenkins AJ, Lyons TJ, Zheng D, et al. Lipoproteins in the DCCT/EDIC cohort: Associations with diabetic nephropathy. Kidney Int 2003; 64: 817-28.
Aziz KMA. Association between Non-HDL and HDL Cholesterol with microalbuminuria in patients with Diabetes. J Diabetol 2013; 1: 4.
Aziz KMA. Targeting LDL Dyslipidemia for Controlling Progression of Nephropathy in Diabetic Population: A Cross Sectional Analytical Study. Journal of the Dow University of Health Sciences, Karachi 2012; 6(1): 7-11.
Adult Treatment Panel III. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. JAMA 2001; 285: 2486-96.
Aziz KMA. Association of Serum Lipids with High Blood Pressure and Hypertension among Diabetic Patients. Mathematical Regression Models to Predict Blood Pressure from Lipids. An Experience from 12-year Follow Up of more than 9000 Patients’ Cohort. Gen Med (Los Angel) 2007; 5: 297.
Olechnowicz-Tietz S, Gluba A, Paradowska A, Banach M, Rysz J. The risk of atherosclerosis in patients with chronic kidney disease. Int Urol Nephrol 2013; 45: 1605-12.
Brunzell JD, Davidson M, Furberg CD, et al. American Diabetes Association; American College of Cardiology Foundation. Lipoprotein management in patients with cardiometabolic risk: Consensus statement from the American Diabetes Association and the American College of Cardiology Foundation. Diabetes Care 2008; 31: 811-22.
Wang Z, Jiang T, Li J, et al. Regulation of renal lipid metabolism, lipid accumulation, and glomerulosclerosis in FVBdb/db mice with type 2 diabetes. Diabetes 2005; 54: 2328-35.
Sun L, Halaihel N, Zhang W, Rogers T, Levi M. Role of sterol regulatory element-binding protein 1 in regulation of renal lipid metabolism and glomerulosclerosis in diabetes mellitus. J Biol Chem 2002; 277: 18919-27.
Abrass CK. Lipid metabolism and renal disease. Contrib Nephrol 2006; 151: 106-21.
Fakhrzadeh H, Ghaderpanahi M, Sharifi F, Badamchizade Z, Mirarefin M, Larijani B. Increased risk of chronic kidney disease in elderly with metabolic syndrome and high levels of C-reactive protein: Kahrizak Elderly Study. Kidney Blood Press Res 2009; 32: 457-63.
Gr¨one HJ, Hohbach J, Grone EF. Modulation of glomerular sclerosis and interstitial fibrosis by native and modified lipoproteins. Kidney Int Suppl 1996; 4: S18-22.
Daousi C, Bain SC, Barnett AH, Gill GV. Hypertriglyceridaemia is associated with an increased likelihood of albuminuria in extreme duration (>50 years) type 1 diabetes. Diabet Med 2008; 25: 1234-6.
Takamatsu N, Abe H, Tominaga T, et al. Risk factors for chronic kidney disease in Japan: a community-based study. BMC Nephrol 2009; 10: 34.
Wang F, Ye P, Luo L, Xiao W, Wu H. Association of risk factors for cardiovascular disease and glomerular filtration rate: A community-based study of 4,925 adults in Beijing. Nephrol Dial Transplant 2010; 25: 3924-31.
Yokoyama H, Sone H, Oishi M, Kawai K, Fukumoto Y, Kobayashi M. Japan Diabetes Clinical Data Management Study Group. Prevalence of albuminuria and renal insufficiency and associated clinical factors in type 2 diabetes: The Japan Diabetes Clinical Data Management study (JDDM15). Nephrol Dial Transplant 2009; 2(4): 1212-9.
American Diabetes Association Standards of Medical Care in Diabetes - 2017. Diabetes Care 2017; 40(sup 1): S1-S138..
Aziz KMA. Management of type-1 and type-2 diabetes by insulin injections in diabetology clinics - a scientific research review. Recent Pat Endocr Metab Immune Drug Discov 2012; 6(2): 148-70.
[PMID: 22559241] []
Aziz KMA. Unique glycemic and cardio-renal protective effects of metformin therapy among type-2 diabetic patients: A lesson from a five-year cross-sectional observational study of 1590 patients. Research 2014; 1: 874.
[ 10.13070/rs.en.1.874]
Valmadrid CT, Klein R, Moss SE, Klein BE. The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus. Arch Intern Med 2000; 160: 1093-100.
Aziz KMA. Association of high serum triglycerides and triglycerides/ HDL ratio with raised HbA1c, creatinine, microalbuminuria and development of diabetic kidney disease and diabetic renal failure. Mathematical and statistical regression models of 10,370 diabetic patients. Clin Nephrol Res 2017; 1(1): 12-20.
Gall MA, Hougaard P, Borch-Johnsen K, Parving HH. Risk factors for development of incipient and overt diabetic nephropathy in patients with non-insulin dependent diabetes mellitus: Prospective, observational study. BMJ 1997; 314: 783-8.
Aziz KMA. Association of diabetic retinopathy and maculopathy with elevated HbA1c, blood pressure, Serum creatinine, microalbuminuria, spot urine protein, nephropathy and diabetic kidney disease. An Experience from Data Analysis of 10,580 Diabetic Patients. J Endocrinol Diabetes 2018; 5(1): 1-11.
Ravid M, Lang R, Rachmani R, Lishner M. Long-term renoprotective effect of angiotensin-converting enzyme inhibition in non-insulin-dependent diabetes mellitus. A 7-year follow-up study. Arch Intern Med 1996; 156: 286-9.
University of Michigan Health System. Screening and management of lipids. Ann Arbor, Mich: University of Michigan Health System 2009.
Stone NJ, Robinson JG, Lichtenstein AH, et al. ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129(25)(Suppl. 2): S1-S45.

© 2024 Bentham Science Publishers | Privacy Policy