Glycocalyx Loss— Podocyte and Kidney Injury Induces Albuminuria Nat Rev Nephrol 2015;11:667-676
Atherosclerotic Lesions Develop After Glycocalyx Loss Nat Rev Nephrol 2015;11:667-676
Mechanism of Glycocalyx Degradation Nat Rev Nephrol 2015;11:667-676
Glycocalyx Thickness is Lower in Children with Type 1 Diabetes J Pediatr 2014;164:584-589
So what is albuminuria? An elevated urinary albumin excretion is a marker of endothelial dysfunction; it symbolizes the kidney’s way of translating the existence of vascular damage.
Prevalence of Albuminuria in the General Population Macroalbuminuria Microalbuminuria >300 mg/24h 30-300 mg/24h 0.7% 7.2% High-Normal Albuminuria 11-29 mg/24h 16.6% Low-Normal Albuminuria N = 40,856 0-10mg/24h 75% J Int Med 2001;249:519-526
The Significance of Albuminuria • Results from injury to systemic and glomerular circulation (loss of glycocalyx) • When increased, associated with progressive decline in renal function • Predicts new onset diabetes risk • When increased, associated with greater risk of cardiovascular, cerebrovascular, and peripheral vascular disease N Engl J Med 2000;342:145-153; Am J Kidney Dis 2000;36:646-661; Am J Kidney Dis 2000;35(4suppl1):S97-S105
Albuminuria Predicts Chronic Kidney Disease in the Non-Diabetes General Population 70 Incidence of Stage 3 CKD (%) 58 60 50 40 22 30 13 20 9 10 0 0 - 14 30 - 300 15 – 29 >300 Albuminuria (mg/day) Stage 3 CKD = creatinine clearance < 60 mL/min Kidney Int 2004;66(suppl 92):1-4
Albuminuria Predicts New Onset Diabetes Risk in General Population 14 New Onset Diabetes (%) 11.8 12 10 7.9 8 6 4.3 4 2.2 2 0 0 - 14 15 – 29 30 - 300 >300 Albuminuria (mg/24h) Diabetes Care 2005;28:2525-2530
Albuminuria Predicts Cardiovascular Death in General Population 35 CV death (% per 1000 patients) 29.1 30 25 20 15 11.2 10 4.5 3.5 5 0 0 - 14 30 - 300 15 – 29 >300 Albuminuria (mg/24h) Circulation 2002;106:1777-1782
Increased All-Cause Morality when the Albumin Creatinine Ratio is > 5 ↓ Kidney Int 2011;79:1341-1352
eGFR and UACR: CVD, Stroke, and CHF Risks ↓ Hyperfiltration ↓ HR: 1.0 HR: 1.0 UACR eGFR 5 mg/g 95 mL/min creatinine ↓ ↓ Lancet Diabetes Endocrinol 2015;3:514-525
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