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Cui Z, Chen X, Zhai S, Luo F, Wang Y, Hu C, Yuan B. A cross-sectional study investigating the L-shaped relationship between urinary albumin creatinine ratio and overweight/obesity in children and adolescents. Sci Rep 2025; 15:14588. [PMID: 40287475 PMCID: PMC12033328 DOI: 10.1038/s41598-025-99594-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2025] [Accepted: 04/21/2025] [Indexed: 04/29/2025] Open
Abstract
Childhood and adolescent obesity has become one of the most serious public health problems worldwide, and obesity may have potential effects on kidney health. The urinary albumin creatinine ratio (UACR) is a sensitive indicator for assessing renal impairment. Relevant studies on pediatric and adolescent populations are more limited and controversial. This study aimed to clarify the relationship between UACR and overweight/obesity in children and adolescents in the United States, thereby providing new insights and recommendations for the clinical management and prevention of kidney disease. This study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2016. Variables were derived from demographic, examination, and laboratory data. Overweight/obesity status was assessed using BMI criteria, and random urine samples were used to measure UACR. The association between UACR and overweight/obesity was assessed using descriptive statistics, multivariate logistic regression analysis, subgroup analysis, and curve-fitting analysis. In this study of 4116 participants aged 8-19, multivariate logistic regression analysis revealed a significant negative association between UACR and overweight/obesity (OR = 0.32; 95% CI 0.26-0.38; P < 0.001). The interaction P-values were all greater than 0.05 in the interaction of subgroups, indicating that the findings were very stable and consistent between subgroups. In addition, smoothed curve fitting and threshold effect analyses revealed a nonlinear relationship between UACR and overweight/obesity, with an inflection point for log(UACR) determined to be 1.435 mg/g. The findings suggest a significant nonlinear negative correlation between UACR and overweight/obesity in the pediatric and adolescent populations. Until a precise mechanism of association is found, maintaining a standard range of BMI in all age groups may reduce the incidence of albuminuria in this population.
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Affiliation(s)
- Zhengjiu Cui
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaorui Chen
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Siming Zhai
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Fei Luo
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuanyuan Wang
- Department of Pediatrics, Suqian Affiliated Hospital of Nanjing University of Chinese Medicine, Suqian, China
| | - Chanchan Hu
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
| | - Bin Yuan
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
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Jeong SI, Kim SH. Obesity and hypertension in children and adolescents. Clin Hypertens 2024; 30:23. [PMID: 39217385 PMCID: PMC11366140 DOI: 10.1186/s40885-024-00278-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/28/2024] [Indexed: 09/04/2024] Open
Abstract
As childhood obesity rates increase worldwide, the prevalence of obesity-related hypertension is also on the rise. Obesity has been identified as a significant risk factor for hypertension in this age group. National Health Surveys and meta-analyses show increasing trends in obesity and pediatric hypertension in obese children. The diagnosis of hypertension in children involves percentiles relative to age, sex, and height, unlike in adults, where absolute values are considered. Elevated blood pressure (BP) in childhood is consistently associated with cardiovascular disease in adulthood, emphasizing the need for early detection and intervention. The pathogenesis of hypertension in obesity involves multiple factors, including increased sympathetic nervous system activity, activation of the renin-angiotensin-aldosterone system (RAAS), and renal compression due to fat accumulation. Obesity disrupts normal RAAS suppression and contributes to impaired pressure natriuresis and sodium retention, which are critical factors in the development of hypertension. Risk factors for hypertension in obesity include degree, duration, and distribution of obesity, patient age, hormonal changes during puberty, high-sodium diet, sedentary lifestyle, and socioeconomic status. Treatment involves lifestyle changes, with weight loss being crucial to lowering BP. Medications such as angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers may be considered first, and surgical approaches may be an option for severe obesity, requiring tailored antihypertensive medications that consider individual pathophysiology to avoid exacerbating insulin resistance and dyslipidemia.
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Affiliation(s)
- Soo In Jeong
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sung Hye Kim
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggido, Republic of Korea.
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Wang J, Fan Q, Hu Y, Zhu L, Xu J. Body mass index modifies the effect of urinary protein-to-creatinine ratio on chronic kidney disease progression. Int Urol Nephrol 2024; 56:2371-2378. [PMID: 38407753 DOI: 10.1007/s11255-024-03984-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/12/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND This study aimed to determine the association between the urinary protein-to-creatinine ratio (UPCR) and chronic kidney disease (CKD) progression in a cohort study, and to determine whether body mass index (BMI) modifies this association. METHODS The study population consisted of 856 hypertensive patients with CKD stages 2-5, enrolled between 2010 and 2011 in Japan. Generalized linear models with a logit link were used to evaluate the independent and combined effects of the UPCR and BMI on CKD progression RESULTS: During a median follow-up of 25 months, 242 patients developed CKD progression during follow-up. A notably higher risk of CKD progression was found in participants in tertiles 2 [odds ratio (OR): 5.46, 95% confidence interval (95% CI): 2.49-11.99] and 3 (OR 27.74, 95% CI 12.34-62.38) comparing with tertiles 1 for UPCR levels. Moreover, an interaction was found between UPCR and BMI on CKD progression (P for interaction = 0.006). Participants in both the highest tertile of UPCR and overweight (UPCR ≥ 248.9 mg/mmol and BMI ≥ 25 kg/m2) had a 45.59-times higher risk of CKD progression compared with those in the lowest tertile of UPCR and nonoverweight (UPCR < 36.2 mg/mmol and BMI < 25 kg/m2) CONCLUSIONS: The present study demonstrates that the combination of elevated UPCR and BMI may contribute to an increased risk of CKD progression.
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Affiliation(s)
- Jiancheng Wang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, People's Republic of China.
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, 330006, Jiangxi, People's Republic of China.
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, 330006, Jiangxi, People's Republic of China.
| | - Qiwei Fan
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, People's Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, 330006, Jiangxi, People's Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Ying Hu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, People's Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, 330006, Jiangxi, People's Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Lingyan Zhu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, People's Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, 330006, Jiangxi, People's Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Jixiong Xu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, People's Republic of China.
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, 330006, Jiangxi, People's Republic of China.
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, 330006, Jiangxi, People's Republic of China.
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Qin X, Wei J, Chen J, Lei F, Qin Y. Non-linear relationship between body roundness index and albuminuria among children and adolescents aged 8-19 years: A cross-sectional study. PLoS One 2024; 19:e0299509. [PMID: 38451930 PMCID: PMC10919584 DOI: 10.1371/journal.pone.0299509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/09/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Obesity has been found to be correlated with numerous health issues, including an elevated risk of albuminuria in adults. However, this correlation is still controversial among children and adolescents, as several recent large-scale cross-sectional studies have observed a negative correlation between obesity and albuminuria. Our study aimed to investigate the link between the body roundness index (BRI) and albuminuria among children and adolescents, in order to further understand the correlation between obesity and albuminuria in this demographic. METHODS We employed information from the National Health and Nutrition Examination Survey (NHANES) 1999-2010 for cross-sectional analysis. Weighted logistic regression was employed to explore the linear relationship between BRI and albuminuria, with subgroup analyses performed for more detailed insights. Weighted linear regression analysis was employed to explore the relationship between BRI and the urine albumin-creatinine ratio (UACR). Additionally, we applied smooth curve fitting to investigate their non-linear relationship and conducted threshold effect analysis to identify any turning point. RESULTS In this study of 15,487 participants aged 8-19 years, multivariate logistic regression analysis revealed a significant negative correlation between BRI and albuminuria (OR = 0.616, 95%CI: 0.526-0.722). The relationship between BRI and UACR, as shown by multivariate linear regression analysis, was significantly inversely correlated (β: -5.424, 95%CI: -7.416 to -3.433). Furthermore, smooth curve fitting and threshold effect analysis showed a non-linear relationship between BRI and albuminuria, with a BRI inflection point identified at 2.906. CONCLUSIONS These findings of our study suggest a significant nonlinear negative association between BRI and the presence of albuminuria among children and teenagers, and maintaining an appropriate BRI may decrease the occurrence of albuminuria in this population.
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Affiliation(s)
- Xuankai Qin
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jiahui Wei
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jie Chen
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Fengying Lei
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yuanhan Qin
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Carullo N, Zicarelli M, Michael A, Faga T, Battaglia Y, Pisani A, Perticone M, Costa D, Ielapi N, Coppolino G, Bolignano D, Serra R, Andreucci M. Childhood Obesity: Insight into Kidney Involvement. Int J Mol Sci 2023; 24:17400. [PMID: 38139229 PMCID: PMC10743690 DOI: 10.3390/ijms242417400] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
This review examines the impact of childhood obesity on the kidney from an epidemiological, pathogenetic, clinical, and pathological perspective, with the aim of providing pediatricians and nephrologists with the most current data on this topic. The prevalence of childhood obesity and chronic kidney disease (CKD) is steadily increasing worldwide, reaching epidemic proportions. While the impact of obesity in children with CKD is less pronounced than in adults, recent studies suggest a similar trend in the child population. This is likely due to the significant association between obesity and the two leading causes of end-stage renal disease (ESRD): diabetes mellitus (DM) and hypertension. Obesity is a complex, systemic disease that reflects interactions between environmental and genetic factors. A key mechanism of kidney damage is related to metabolic syndrome and insulin resistance. Therefore, we can speculate about an adipose tissue-kidney axis in which neurohormonal and immunological mechanisms exacerbate complications resulting from obesity. Adipose tissue, now recognized as an endocrine organ, secretes cytokines called adipokines that may induce adaptive or maladaptive responses in renal cells, leading to kidney fibrosis. The impact of obesity on kidney transplant-related outcomes for both donors and recipients is also significant, making stringent preventive measures critical in the pre- and post-transplant phases. The challenge lies in identifying renal involvement as early as possible, as it is often completely asymptomatic and not detectable through common markers of kidney function. Ongoing research into innovative technologies, such as proteomics and metabolomics, aims to identify new biomarkers and is constantly evolving. Many aspects of pediatric disease progression in the population of children with obesity still require clarification. However, the latest scientific evidence in the field of nephrology offers glimpses into various new perspectives, such as genetic factors, comorbidities, and novel biomarkers. Investigating these aspects early could potentially improve the prognosis of these young patients through new diagnostic and therapeutic strategies. Hence, the aim of this review is to provide a comprehensive exploration of the pathogenetic mechanisms and prevalent pathological patterns of kidney damage observed in children with obesity.
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Affiliation(s)
- Nazareno Carullo
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (N.C.); (M.Z.); (A.M.); (T.F.); (G.C.)
| | - Mariateresa Zicarelli
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (N.C.); (M.Z.); (A.M.); (T.F.); (G.C.)
| | - Ashour Michael
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (N.C.); (M.Z.); (A.M.); (T.F.); (G.C.)
| | - Teresa Faga
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (N.C.); (M.Z.); (A.M.); (T.F.); (G.C.)
| | - Yuri Battaglia
- Department of Medicine, University of Verona, 37129 Verona, Italy;
| | - Antonio Pisani
- Department of Public Health, University Federico II of Naples, 80131 Naples, Italy;
| | - Maria Perticone
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (M.P.); (D.C.); (D.B.)
| | - Davide Costa
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (M.P.); (D.C.); (D.B.)
- Interuniversity Center of Phlebolymphology (CIFL), “Magna Graecia” University, 88100 Catanzaro, Italy;
| | - Nicola Ielapi
- Interuniversity Center of Phlebolymphology (CIFL), “Magna Graecia” University, 88100 Catanzaro, Italy;
- Department of Public Health and Infectious Disease, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Giuseppe Coppolino
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (N.C.); (M.Z.); (A.M.); (T.F.); (G.C.)
| | - Davide Bolignano
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (M.P.); (D.C.); (D.B.)
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (M.P.); (D.C.); (D.B.)
- Interuniversity Center of Phlebolymphology (CIFL), “Magna Graecia” University, 88100 Catanzaro, Italy;
| | - Michele Andreucci
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (N.C.); (M.Z.); (A.M.); (T.F.); (G.C.)
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Gracchi V, van den Belt SM, Corpeleijn E, Heerspink HJL, Verkade HJ. Albuminuria and markers for cardiovascular risk in 12-year-olds from the general Dutch population: a cross-sectional study. Eur J Pediatr 2023; 182:4921-4929. [PMID: 37606701 PMCID: PMC10640422 DOI: 10.1007/s00431-023-05152-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/01/2023] [Accepted: 08/06/2023] [Indexed: 08/23/2023]
Abstract
In adults, albuminuria represents a risk factor for cardiovascular disease and is associated with hypertension and obesity. Pediatric data from the general population are inconsistent and largely based on randomly collected urine. A possible association between antenatal programming and albuminuria at school age has still to be investigated. The purpose of this study is to assess albuminuria in first morning void urine samples in a population-based pediatric cohort and to investigate cross-sectionally the association with factors related to cardiovascular risk. Moreover, we investigate the possible association of antenatal factors with albuminuria. A first morning void urine sample was collected in the population-based GECKO (Groningen Expert Center for Kids with Obesity) Drenthe cohort at the age of 12 years. We investigated cross-sectionally associations between albuminuria and body mass index (BMI), waist circumference (WC), blood pressure (BP) and antenatal factors. The prevalence of UACR (urinary albumin-creatinine ratio) ≥ 3 mg/mmol was 3.3% (95%CI 2.3-4.2). In a multivariate linear regression model, UAC was negatively associated with z-BMI (β-0.08, p = 0.013) and positively with z-systolic BP (β 0.09, p = 0.006), model significance p = 0.002. UACR was negatively associated with z-BMI (β - 0.13, p < 0.001) and positively with z-diastolic BP (β 0.09, p = 0.003), model significance p = 0.001. Albuminuria was not significantly associated with antenatal factors such as gestational age and standardized birth weight. CONCLUSIONS Albuminuria in first morning void urine in 12-year-olds has a lower prevalence than previously reported by randomly collected samples. A negative association between albuminuria and BMI is confirmed. A positive association with blood pressure, but no association with antenatal factors was found. WHAT IS KNOWN • While, in adults, albuminuria is a recognized risk factor for cardiovascular disease and is associated with hypertension and obesity, pediatric data are inconsistent and largely based on randomly collected urine. • A possible association between antenatal programming and albuminuria at school age has still to be investigated. WHAT IS NEW • In this population study on first morning void urine samples from 12-year-olds of the general population, albuminuria is negatively associated with body mass index, and positively associated with blood pressure, while there is no association with antenatal factors. • The prevalence of albuminuria at 12 years is lower than previously reported in studies based on randomly collected urine samples, probably due to elimination of orthostatic proteinuria.
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Affiliation(s)
- Valentina Gracchi
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001 - CA13, 9700RB, Groningen, The Netherlands.
| | - Sophie M van den Belt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700RB, Groningen, The Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700RB, Groningen, The Netherlands
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700RB, Groningen, The Netherlands
| | - Henkjan J Verkade
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001 - CA13, 9700RB, Groningen, The Netherlands
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Evaluation of Arterial Stiffness and Carotid Intima-Media Thickness in Children with Primary and Renal Hypertension. Pediatr Cardiol 2023; 44:54-66. [PMID: 36169696 DOI: 10.1007/s00246-022-03012-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/15/2022] [Indexed: 01/24/2023]
Abstract
Hypertension is an increasing disease in children and the risk of endothelial damage and target organ damage increases in the presence of additional risk factors such as obesity. In our study, the effect of hypertension on early atherosclerotic changes and target organ damage in children was investigated. Twenty four-hour ambulatory pulse wave analysis was performed by oscillometric method in 71 children aged 8-18 years, 17 of whom were diagnosed with primary hypertension without obesity, 18 had both primary hypertension and obesity, and 16 had renal hypertension. Twenty healthy normotensive children were included as the control group. Carotid intima-media thickness (CIMT) and Left Ventricular Mass Index were measured. Central systolic blood pressure (cSBP), central diastolic blood pressure (cDBP), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher in the primary hypertension group compared to controls (p = 0.001, p = 0.005, p = 0.001, p = 0.009, respectively), cSBP was higher in the renal hypertension group than the control group (p = 0.018). There was no difference between the groups in terms of pulse wave analysis parameters, CIMT, or left ventricular mass index (p > 0.05). Pulse wave velocity was positively correlated with SBP, DBP, cSBP, cDBP (p < 0.001). Augmentation index was positively correlated with DBP and cDBP (p = 0.01, p = 0.002, respectively). Our findings show that high blood pressure is associated with arterial stiffness and target organ damage beginning in childhood. The detection of early atherosclerotic vascular changes using pulse wave analysis allows to take necessary precautions such as lifestyle changes to prevent target organ damage in hypertensive children.
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Ruilope LM, Ortiz A, Lucia A, Miranda B, Alvarez-Llamas G, Barderas MG, Volpe M, Ruiz-Hurtado G, Pitt B. Prevention of cardiorenal damage: importance of albuminuria. Eur Heart J 2022; 44:1112-1123. [PMID: 36477861 DOI: 10.1093/eurheartj/ehac683] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/20/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
Chronic kidney disease (CKD) is projected to become a leading global cause of death by 2040, and its early detection is critical for effective and timely management. The current definition of CKD identifies only advanced stages, when kidney injury has already destroyed >50% of functioning kidney mass as reflected by an estimated glomerular filtration rate <60 mL/min/1.73 m2 or a urinary albumin/creatinine ratio >six-fold higher than physiological levels (i.e. > 30 mg/g). An elevated urinary albumin-excretion rate is a known early predictor of future cardiovascular events. There is thus a ‘blind spot’ in the detection of CKD, when kidney injury is present but is undetectable by current diagnostic criteria, and no intervention is made before renal and cardiovascular damage occurs. The present review discusses the CKD ‘blind spot’ concept and how it may facilitate a holistic approach to CKD and cardiovascular disease prevention and implement the call for albuminuria screening implicit in current guidelines. Cardiorenal risk associated with albuminuria in the high-normal range, novel genetic and biochemical markers of elevated cardiorenal risk, and the role of heart and kidney protective drugs evaluated in recent clinical trials are also discussed. As albuminuria is a major risk factor for cardiovascular and renal disease, starting from levels not yet considered in the definition of CKD, the implementation of opportunistic or systematic albuminuria screening and therapy, possibly complemented with novel early biomarkers, has the potential to improve cardiorenal outcomes and mitigate the dismal 2040 projections for CKD and related cardiovascular burden.
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Affiliation(s)
- Luis M Ruilope
- Cardiorenal Translational Laboratory, Institute of Research Imas12, Hospital Universitario , 12 de Octubre, Avenida de Córdoba s/n , Spain
- CIBER-CV, Hospital Universitario , Av. de Córdoba s/n, 28041, Madrid , Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid , Tajo, s/n, 28670 Villaviciosa de Odón, Madrid , Spain
| | - Alberto Ortiz
- IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid , Av. de los Reyes Católicos, 2, 28040 Madrid , Spain
- RICORS2040, Hospital Universitario Fundación Jiménez Díaz , Madrid , Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid , Tajo, s/n, 28670 Villaviciosa de Odón, Madrid , Spain
| | - Blanca Miranda
- Fundación Renal Íñigo Álvarez de Toledo , José Abascal, 42, 28003 Madrid , Spain
| | - Gloria Alvarez-Llamas
- IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid , Av. de los Reyes Católicos, 2, 28040 Madrid , Spain
- RICORS2040, Hospital Universitario Fundación Jiménez Díaz , Madrid , Spain
| | - Maria G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos (HNP), SESCAM , FINCA DE, Carr. de la Peraleda, S/N, 45004 Toledo , Spain
| | - Massimo Volpe
- Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome and IRCCS San Raffaele Rome , Sant'Andrea Hospital, Rome , Italy
| | - Gema Ruiz-Hurtado
- Cardiorenal Translational Laboratory, Institute of Research Imas12, Hospital Universitario , 12 de Octubre, Avenida de Córdoba s/n , Spain
- CIBER-CV, Hospital Universitario , Av. de Córdoba s/n, 28041, Madrid , Spain
| | - Bertram Pitt
- Division of Cardiology, University of Michigan School of Medicine , Ann Arbor, MI , USA
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Colasante AM, Bartiromo M, Nardolillo M, Guarino S, Marzuillo P, Mangoni di S Stefano GSRC, Miraglia del Giudice E, Di Sessa A. Tangled relationship between insulin resistance and microalbuminuria in children with obesity. World J Clin Pediatr 2022; 11:455-462. [PMID: 36439903 PMCID: PMC9685682 DOI: 10.5409/wjcp.v11.i6.455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/19/2022] [Accepted: 10/27/2022] [Indexed: 11/07/2022] Open
Abstract
Childhood obesity represents a complex disease with a well-known cardiometabolic burden including fatty liver, type 2 diabetes, metabolic syndrome, and cardiovascular disease. From a pathogenic point of view, insulin resistance (IR) represents the key factor underlying the spectrum of these obesity consequences. As observed in adults, recent data supported the occurrence of microalbuminuria (MA) as marker of early kidney dysfunction and its potential link with cardiometabolic factors also in children with obesity. In fact, a well-documented pathophysiological hypothesis both in adults and children supported an intimate correlation with the major feature of obesity such as IR through the influence of insulin on renal hemodynamics. Based on the clinical and prognostic relevance of this relationship in daily practice (including an increased risk of chronic kidney disease development overtime), more scientific attention needs to be paid to the evaluation of early kidney damage in children with obesity. In this paper, we attempt to address three debated questions regarding the intriguing liaison between IR and MA in children with obesity: (1) What is the prevalence of pediatric MA? (2) What is the state of art of MA in children with obesity? and (3) Is there a link between IR and MA in children with obesity?
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Affiliation(s)
- Alberto Maria Colasante
- Department of Woman, Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Mario Bartiromo
- Department of Woman, Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Michele Nardolillo
- Department of Woman, Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Stefano Guarino
- Department of Woman, Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | | | - Emanuele Miraglia del Giudice
- Department of Woman, Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Anna Di Sessa
- Department of Woman, Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples 80138, Italy
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10
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Adavadkar PA, Pappalardo AA, Glassgow AE, Zhang C, Schwartz A, Brooks LJ, Martin MA. Rates of diagnoses of sleep disorders in children with chronic medical conditions. J Clin Sleep Med 2022; 18:2001-2007. [PMID: 35621126 PMCID: PMC9340607 DOI: 10.5664/jcsm.10064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This investigation examines sleep disorder (SD) diagnoses in a large population of children and adolescents with chronic medical conditions (CMCs). Little is known about SD diagnoses in this population. The large population used in this study allowed examination of SD rates by CMC type and demographics. METHODS Data were from the Coordinated Health Care for Complex Kids (CHECK) project designed for Medicaid-funded children and adolescents with at least one CMC from a large metropolitan area. The study population (N=16,609) was limited to children and adolescents, 0 to 18 years of age. SD and CMC diagnoses were obtained from Medicaid claims data. RESULTS Fourteen percent of the population (mean age of 9.1 years [SD= 5.2]; 35.8% African American (AA); 56.4% male; 77 with more than one CMC) received a sleep disorder diagnosis. The most frequent diagnosis was SDB (11.2%), followed by nocturnal enuresis (1.2%), and insomnia (1%). SDs were diagnosed more frequently in those with multiple CMCs than in those with one CMC (19.7% vs. 5.8%; p <0.001). Insomnia rates in Hispanic/Latinx (1.2%) and AA (0.8%) children and adolescents were significantly lower (both p<0.001) than in Caucasians (3.5%). Odds of receiving a sleep diagnosis varied among CMCs. CONCLUSIONS Our analysis of Medicaid claims data of a large urban cohort offers detailed information about the rates of sleep diagnoses and suggests under-diagnosis of SDs in this vulnerable, high-risk, primarily ethnic minority population. Under-recognition of sleep disorders have short- and long-term health and economic consequences. Study results may help clinicians implement appropriate SD screening and management for children and adolescents with CMCs.
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Affiliation(s)
- Pranshu A Adavadkar
- Department of Pediatrics, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois.,Department of Medicine, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois
| | - Andrea A Pappalardo
- Department of Pediatrics, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois.,Department of Medicine, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois
| | - Anne Elizabeth Glassgow
- Department of Pediatrics, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois
| | - Christina Zhang
- Department of Pediatrics, University of Southern California, Los Angeles, California
| | - Alan Schwartz
- Department of Pediatrics, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois.,Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois
| | - Lee J Brooks
- Department of Pediatrics, Rowan SOM, Stratford, NJ
| | - Molly A Martin
- Department of Pediatrics, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois
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11
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Diaz DMM, Aguirre MDCC, Escalera ALR, Gutiérrez MTT, Robles IO, Guzmán MJM, Díaz ALG, Peña MCG, Alvarado-Nájera AN, Domínguez IG, Villavicencio-Bautista JC, Rodríguez AAH, Marín-García R, González FJA, Wong AC, Guerra EG, Castañeda RD, Aguilar CAP, Zúñiga-Macías LP, Guerra JMA. Histologic characterization and risk factors for persistent albuminuria in adolescents in a region of highly prevalent end-stage renal failure of unknown origin. Clin Kidney J 2022; 15:1300-1311. [PMID: 35756733 PMCID: PMC9217647 DOI: 10.1093/ckj/sfac018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
End-stage renal failure of unknown origin (ESRD-UO) is a public health problem in Mexico and many regions of the world. The prevalence of ESRD-UO in Aguascalientes Mexico is one of the highest worldwide, particularly in adults between 20 and 40 years of age.
Aim
To screen adolescents for chronic kidney disease (CKD), identify risk factors, and histologically characterize adolescents with persistent albuminuria (pACR).
Methodology
This is a cross-sectional, observational, and comparative study of adolescents in whom serum creatinine and the albumin creatinine ratio (ACR) were determined when screening for CKD. A clinical evaluation and risk factor survey were conducted. Patients with an abnormal ACR (≥ 30 mg/gr) or a low glomerular filtration rate (GFR) (≤75 ml/min/1.73 m2) were reevaluated and a renal ultrasound was obtained (rUS). A kidney biopsy was performed in patients with pACR.
Results
Five-hundred and thirteen (513) students were included, 19 had pACR and 494 were controls. The prevalence of pACR was 3.7% (95%CI 2.1 – 5.3). Only one patient had a decreased GRF. None of the patients with pACR had anatomical abnormalities of the urinary tract by rUS. Patients with pACR had a decreased total renal volume in comparison with the control group (150 vs 195 ml/m2, p <0.01). Eighteen (18) kidney biopsies were performed, 72% had glomerulomegaly, and only one patient had mild fibrosis. Podocyte abnormalities were evident on electron microscopy: partial fusion (100%), microvillous degeneration (80%), and increased organelles (60%). Risk factors for pACR were: homestead proximity to maize crops, the use of pesticides at the father´s workplace, a family history of CKD, and blood pressure abnormalities. The body mass index and breastfeeding were protective factors.
Conclusions
The prevalence of pACR in adolescents in Aguascalientes is high, and histologic compromise is characterized by podocyte injury in the absence of fibrosis. The renal volume of pACR patients was decreased, suggesting oligonephronia. Exposure to environmental toxins such as pesticides, even prenatally, may be responsible for this pathological entity. Screening programs in adolescents by determining ACR are necessary in our milieu.
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Affiliation(s)
| | - Myriam del Carmen Corrales Aguirre
- Department of Nephrology, Hospital Centenario Miguel Hidalgo, Mexico
- Department of Pediatrics, Hospital Centenario Miguel Hidalgo, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | - Alfredo Chew Wong
- Department of Nephrology, Hospital Centenario Miguel Hidalgo, Mexico
| | | | - Rodolfo Delgadillo Castañeda
- Department of Nephrology, Hospital Centenario Miguel Hidalgo, Mexico
- Department of Pediatrics, Hospital Centenario Miguel Hidalgo, Mexico
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12
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Mahfouz N, Salah E, Armaneous A, Youssef MM, Abu Shady MM, Sallam S, Anwar M, Morsy S, Hussein J. Association between Bisphenol A Urine Level with Low-Grade Albuminuria in Egyptian Children and Adolescents. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The glomerulus is the accessible window to visualize the endothelial status of the whole body. Minimal level of albuminuria even below the cutoff point of microalbuminuria might be a marker of endothelial dysfunction. Exposure to Bisphenol A may be a risk factor of developing low-grade albuminuria in pediatrics. Aim: This study investigated the association of exposure to Bisphenol A and the presence of low-grade albuminuria. Methods: A cross-sectional study enrolling 158 children; 91 boys and 67 girls. Children with hepatic disease, kidney disease and endocrinopathies were excluded from the study. Urinary albumin and creatinine were measured in a first morning urine specimen. Urinary albumin/creatinine ratio was calculated in mg/gm and was stratified into: macroalbuminuria of ˃300mg/gm, microalbuminuria of 30-300mg/gm and low grade albuminuria of ˂30mg/gm. Urinary Bisphenol A was measured by high performance liquid chromatography using florescent detector. Results: Low grade albuminuria was detected in 141 participants (89.24%), while microalbuminuria and macroalbuminuria were detected in 15 (9.5%) and 2 (1.26%) participants, respectively. The total urinary Bisphenol A in candidates with low grade albuminuria was categorized into four quartiles (<0.285, 0.285–0.599, 0.600–1.215, >1.215) ng/mL and similarly their low grade albuminuria into (<2.0404, 2.0404–4.0385, 4.0386–7.3870, >7.3870) mg/gm. Children with the highest compared to the lowest quartile of urinary Bisphenol A had comparable mean of low grade albuminuria with insignificant P value. Conclusion: low grade albuminuria was found in 141 out of 158 children. A direct cause effect of exposure to Bisphenol A could not be proved. Further studies are needed to investigate the pathophysiology of low grade albuminuria and its significance
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13
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Matjuda EN, Sewani-Rusike CR, Anye SNC, Engwa GA, Nkeh-Chungag BN. Relationship between High Blood Pressure and Microalbuminuria in Children Aged 6-9 Years in a South African Population. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E131. [PMID: 32906740 PMCID: PMC7552714 DOI: 10.3390/children7090131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022]
Abstract
Though the association between high blood pressure and microalbuminuria is well established in adults, there is a paucity of information on microalbuminuria in children. This study investigated the relationship between high blood pressure and microalbuminuria in 6-9-year-old children. A cross-sectional study, which included 306 primary school children of age 6-9 years old from urban areas (n = 154) and rural areas (n = 152) of the Eastern Cape Province of South Africa, was conducted. Participants' anthropometric data were determined and systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were measured and converted to BP percentiles for age, sex and height. Creatinine and albumin concentrations were assayed in early morning midstream urine and the albumin to creatinine ratio (ACR) was calculated. There was a 42.8% prevalence of elevated blood pressure/high blood pressure (E-BP/H-BP) and a 10.1% prevalence of microalbuminuria. Among the 131 children with E-BP/H-BP, 17 had elevated ACR with a prevalence of 13.95%. SBP and HR increased with increasing range of ACR and, furthermore, SBP was significantly (p < 0.05) higher in children with moderately and severely increased ACR. SBP was associated with ACR and increased SBP predicted microalbuminuria (R2 = 0.42, adj R2 = 0.039, B: 0.120, p = < 0.05). In conclusion, microalbuminuria was present in 6-9-year-old South African children of African Ancestry and a weak association was observed with SBP in children.
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Affiliation(s)
- Edna Ngoakoana Matjuda
- Department of Human Biology, Faculty of Health Sciences, Walter Sisulu University PBX1, 5117 Mthatha, South Africa; (E.N.M.); (C.R.S.-R.)
| | - Constance R. Sewani-Rusike
- Department of Human Biology, Faculty of Health Sciences, Walter Sisulu University PBX1, 5117 Mthatha, South Africa; (E.N.M.); (C.R.S.-R.)
| | - Samuel Nkeh Chungag Anye
- MBCHB Programme, Faculty of Health Sciences, Walter Sisulu University PBX1, 5117 Mthatha, South Africa;
| | - Godwill Azeh Engwa
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University PBX1, 5117 Mthatha, South Africa;
| | - Benedicta Ngwechi Nkeh-Chungag
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University PBX1, 5117 Mthatha, South Africa;
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Çakıcı EK, Yazılıtaş F, Kurt-Sukur ED, Güngör T, Çelikkaya E, Karakaya D, Bülbül M. Clinical assessment of primary and secondary hypertension in children and adolescents. Arch Pediatr 2020; 27:286-291. [PMID: 32682663 DOI: 10.1016/j.arcped.2020.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/01/2020] [Accepted: 06/23/2020] [Indexed: 01/19/2023]
Abstract
The aim of this study was to compare the clinical features of patients with elevated blood pressure and to detect variables associated with the diagnosis of primary hypertension. We identified 383 (69%) hypertensive children (197 [51.5%] with primary hypertension, and 186 [48.5%] with secondary hypertension) out of 553 children referred to our clinic with a history of elevated blood pressure. The primary hypertension group was significantly older and had higher BMI, positive family history of hypertension, and lower prevalence of preterm birth compared with those with secondary hypertension. No difference was found between the two groups in terms of the frequency of target organ damage. Multiple regression analysis showed that a family history of hypertension, obesity, age over 10 years, elevated uric acid, and presence of higher systolic blood pressure values at admission were independent predictors of primary hypertension; therefore, these parameters can be considered important clues for diagnosing primary hypertension.
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Affiliation(s)
- E K Çakıcı
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey.
| | - F Yazılıtaş
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - E D Kurt-Sukur
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - T Güngör
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - E Çelikkaya
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - D Karakaya
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - M Bülbül
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
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Battaglia Y, Esposito P, Corrao S, Russo L, Balducci A, Storari A, Russo D. Evaluation of Hypertension, Proteinuria, and Abnormalities of Body Weight in Italian Adolescents Participating in the World Kidney Days. Kidney Blood Press Res 2020; 45:286-296. [PMID: 32036372 DOI: 10.1159/000502547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/06/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION World Kidney Day (WKD) was promoted by the Italian Kidney Foundation and the Italian Society of Nephrology for raising awareness, detection, prevention, and treatment of kidney diseases. The Italian WKD focused on the "School Project" by screening students attending the fifth year of high school. The main goal of the "School Project" was to assess in healthy adolescents the presence of hypertension (HTN) and proteinuria; as well as to evaluate potential interrelations between overweight, obesity (both measured with different anthropometric methods), blood pressure (BP) levels, and proteinuria. The ancillary goal was to have an estimate of awareness on some nephrology topics. METHODS The study population consisted of 17- to 19-year-old students. HTN was defined as systolic BP (SBP) ≥140 mm Hg and/or diastolic BP (DBP) ≥90 mm Hg. Isolated systolic hypertension (ISH) was defined as SBP ≥140 mm Hg and DBP <90 mm Hg; isolated diastolic hypertension as SBP <140 mm Hg and DBP ≥90 mm Hg; systolic and diastolic hypertension as SBP ≥140 mm Hg and DBP ≥90 mm Hg; pre-hypertension as SBP >120 mm Hg but <140 mm Hg or DBP >80 mm Hg but <90 mm Hg; and optimal BP as SBP ≤120 mm Hg and DBP ≤80 mm Hg. Urine tests were performed with a dipstick; the subjects were regarded as proteinuric when the urine dipstick was positive (proteinuria ≥30 mg/dL). Body weight, height, and waist circumference (WC) were measured; body mass index (BMI), waist-to-height ratio (WHtR), and conicity index (Ci) were calculated. According to the BMI, the following classifications were adopted: underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), class-I obesity (30-34.9 kg/m2), class-II obesity (35-39.9 kg/m2), class-III obesity (≥40 kg/m2). RESULTS Data from 12,125 students (45.6% males) were evaluated. HTN was found in 1,349 participants (11.1%; 61.1% male), and ISH was present in 7.4%. Overweight (24.1%) and class-I (6%), -II (3.6%), and -III (1%) obesity were present in hypertensive participants. Compared to participants with normal BP, hypertensive participants had a higher BMI (p < 0.001), WC (p < 0.001), and WHtR (p < 0.001); whereas the Ci was not different (p = 0.527). Multivariate linear regression analysis showed that both WC and BMI were predictors of abnormal SBP and DBP (p < 0.001) both in males and females. Proteinuria was present in 14.8, 13.8, 14.7, and 14.7% of all normal weight, overweight, obese, and all subjects, respectively. In addition, no association was found between body weight, proteinuria, and BP. CONCLUSION This study shows that overweight and obesity were significantly associated to HTN in Italian adolescents. BMI and WC were predictors of SBP and DBP. The occurrence of proteinuria was quite similar to that of HTN, but it was not associated with anthropometric indicators or HTN.
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Affiliation(s)
- Yuri Battaglia
- Division of Nephrology and Dialysis, University-Hospital St. Anna, Ferrara, Italy,
| | - Pasquale Esposito
- Nephrology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Salvatore Corrao
- Internal Medicine Unit, National Relevance and High Specialization Hospital Trust, Palermo, Italy
| | - Luigi Russo
- Nephrology Unit, Ospedale del Mare, Naples, Italy
| | | | - Alda Storari
- Division of Nephrology and Dialysis, University-Hospital St. Anna, Ferrara, Italy
| | - Domenico Russo
- Department of Public Health, Nephrology Unit, University Federico II, Naples, Italy
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Jadresic L, Silverwood RJ, Kinra S, Nitsch D. Can childhood obesity influence later chronic kidney disease? Pediatr Nephrol 2019; 34:2457-2477. [PMID: 30415420 DOI: 10.1007/s00467-018-4108-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 08/22/2018] [Accepted: 09/28/2018] [Indexed: 11/24/2022]
Abstract
Childhood overweight and obesity affects more and more children. Whilst associations of childhood overweight with later outcomes such as hypertension, diabetes and cardiovascular disease have been well documented, less is known about the association of childhood overweight and obesity with kidney disease. We review the existing evidence for the association of childhood obesity with markers of childhood and adult kidney disease. Whilst there is some evidence for an association, studies have not been able to distinguish between childhood being a sensitive time to develop later kidney problems, or whether observed associations of childhood obesity with poor outcomes are driven by greater lifelong exposure to obesity.
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Affiliation(s)
- Lyda Jadresic
- Department of Paediatrics, Gloucestershire Royal Hospital, Gloucester, GL1 3NN, UK
| | - Richard J Silverwood
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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17
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Obesity and insulin sensitivity effects on cardiovascular risk factors: Comparisons of obese dysglycemic youth and adults. Pediatr Diabetes 2019; 20:849-860. [PMID: 31301210 PMCID: PMC6786916 DOI: 10.1111/pedi.12883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/01/2019] [Accepted: 06/03/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Obesity and pubertal insulin resistance worsen cardiovascular (CV) risk factors in youth. It is unclear how the relationships of obesity and insulin resistance with CV risk compare to adults. SUBJECTS AND METHODS We evaluated 66 pubertal youth (mean ± SD: age 14.2 ± 2.0 years, body mass index [BMI] 36.6 ± 6.0 kg/m2 , hemoglobin A1c [HbA1c] 38.5 ± 6.1 mmol/mol) and 355 adults with comparable BMI (age 52.7 ± 9.4 years, BMI 35.1 ± 5.1 kg/m2 , HbA1c 39.8 ± 4.2 mmol/mol) participating in a multicenter study. Insulin sensitivity was quantified using hyperglycemic clamps. Assessment of CV risk factors was standardized across sites. Regression analyses compared the impact of insulin sensitivity and CV risk factors between youth and adults. RESULTS Obese pubertal youth were more insulin resistant than comparably obese adults (P < .001), but with similar slopes for the inverse relationship between insulin sensitivity and obesity. The impact of obesity on CV risk factors was explained by insulin sensitivity (P = NS after adjustment for sensitivity). The two age groups did not differ in relationships between insulin sensitivity and diastolic blood pressure, total cholesterol, and low-density lipoprotein (LDL) cholesterol, after adjusting for obesity. However, while systolic blood pressure (SBP) and high-density lipoprotein (HDL) cholesterol exhibited the expected direct and inverse relationships, respectively with insulin sensitivity in adults, these slopes were flat in youth across the range of insulin sensitivity (P ≤ .05 for group differences). CONCLUSIONS Effects of obesity on CV risk factors were attributable to insulin sensitivity in both groups. The relationships between insulin sensitivity and CV risk factors were similar in obese youth and adult groups except for SBP and HDL cholesterol. CLINICAL TRIAL REGISTRATION The RISE consortium studies are registered through Clinicaltrials.gov as NCT01779362 (Adult Medication Study); NCT01763346 (Adult Surgery Study); and NCT01779375 (Pediatric Medication Study). Clinical trial registration numbers: NCT01779362, NCT01779375 and NCT01763346 at clinicaltrials.gov.
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Affiliation(s)
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- RISE Coordinating Center, Rockville, Maryland
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18
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Subclinical Organ Damage in Children and Adolescents with Hypertension: Current Guidelines and Beyond. High Blood Press Cardiovasc Prev 2019; 26:361-373. [PMID: 31650516 DOI: 10.1007/s40292-019-00345-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/10/2019] [Indexed: 01/20/2023] Open
Abstract
High blood pressure (BP) is becoming a growing health issue even in children and adolescents. Moreover, BP elevation in youth frequently translates into children and adult hypertension contributing to the development of cardiovascular disease. The detection of early markers of vascular damage, potentially leading to overt cardiovascular disease, is important for clinical decisions about if and how to treat hypertension and can be useful in monitoring the effectiveness of the treatment. The purpose of this review is to summarize the actual knowledge about subclinical organ damage (SOD) in hypertensive children and adolescents and its association with cardiovascular disease in children and young adults. Our focus is especially put on left ventricular mass, pulse wave velocity, carotid intima-media thickness and microalbuminuria. We also want to address the scientific evidence about possible regression of SOD and cardiovascular risk with the use of behavioural and specific anti-hypertensive therapy. Indications from current guidelines are critically discussed.
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Larkins NG, Kim S, Carlin JB, Grobler AC, Burgner DP, Lange K, Craig JC, Wake M. Albuminuria: population epidemiology and concordance in Australian children aged 11-12 years and their parents. BMJ Open 2019; 9:75-84. [PMID: 31273018 PMCID: PMC6624040 DOI: 10.1136/bmjopen-2017-020262] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To describe the distribution of albuminuria among Australian children aged 11-12 years and their parents, and assess its intergenerational concordance within parent-child dyads. DESIGN Population-based cross-sectional study (the Child Health CheckPoint), nested within the Longitudinal Study of Australian Children. SETTING Assessment centres (seven Australian cities and eight regional towns) and home visits across Australia, February 2015 to March 2016. PARTICIPANTS Of all participating CheckPoint families (n=1874), 1557 children (46.2% girls) and 1454 parents (85.5% mothers) provided random urine samples at the visit; samples from menstruating females were excluded. OUTCOME MEASURES Urine albumin-to-creatinine ratio (ACR) and its components (urine albumin and creatinine concentration); albuminuria was defined as an ACR ≥3.4 mg/mmol. Pearson's correlation coefficients and multivariable linear regression models assessed parent-child concordance, using log-transformed data due to skewing. Survey weights and methods were applied to account for the complex sample design. RESULTS The median ACR for children was 1.03 mg/mmol (IQR 0.65-1.97) and 1.01 mg/mmol (IQR 0.60-2.09) for adults. The median ACR was higher in girls (1.20, IQR 0.71-2.65) than boys (0.90, IQR 0.61-1.65) and in mothers (1.13, IQR 0.63-2.33) than fathers (0.66, IQR 0.41-1.05). Albuminuria was detected in 15.1% of children (girls 20.8%, boys 10.1%) and 13.5% of adults (15.1% mothers, 4.0% fathers) had albuminuria. There was a small correlation between parent and child ACR (Pearson correlation coefficient 0.06, 95% CI 0.01 to 0.12). CONCLUSIONS Albuminuria is common among Australian children and adults, which is of concern because it predicts risk for kidney and cardiovascular disease, and mortality. The weak concordance among intergenerational pairs for urine ACR suggests either that genetic heritability is low or that it becomes evident only at later offspring life stages.
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Affiliation(s)
- Nicholas G Larkins
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Nephrology, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Siah Kim
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
| | - John B Carlin
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Anneke C Grobler
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - David P Burgner
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Katherine Lange
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Jonathan C Craig
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Melissa Wake
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics and The Liggins Institute, The University of Auckland, Auckland, New Zealand
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Larkins NG, Teixeira-Pinto A, Craig JC. A narrative review of proteinuria and albuminuria as clinical biomarkers in children. J Paediatr Child Health 2019; 55:136-142. [PMID: 30414234 DOI: 10.1111/jpc.14293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/01/2018] [Accepted: 10/09/2018] [Indexed: 11/28/2022]
Abstract
Proteinuria is an important biomarker commonly used to detect and manage kidney disease in children. There are now a variety of methods available to measure urinary protein loss, and physicians are faced with several contrasting strategies: 24-h or timed collection versus spot samples (first-morning or random), measurement of total urinary protein versus selective measurement of urinary albumin, unadjusted urine protein concentration versus protein-to-creatinine ratio and the use of dipstick versus laboratory-based methods. In this review, we will discuss the advantages and disadvantages of these different approaches. We will then summarise the evidence base for proteinuria as a clinical biomarker in different settings, including discussion of the current and potential role of measuring low-level albuminuria. Finally, we will highlight gaps in the literature and opportunities for further research into proteinuria among children.
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Affiliation(s)
- Nicholas G Larkins
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, Kids Research Institute, Sydney, New South Wales, Australia.,Department of Nephrology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Armando Teixeira-Pinto
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, Kids Research Institute, Sydney, New South Wales, Australia
| | - Jonathan C Craig
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, Kids Research Institute, Sydney, New South Wales, Australia
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21
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Abstract
Obesity is a leading cause of chronic kidney disease. Children with severe obesity have an increased prevalence of early kidney abnormalities and are at high risk to develop kidney failure in adulthood. The pathophysiology of obesity-related kidney disease is incompletely understood, although the postulated mechanisms of kidney injury include hyperfiltration, adipokine dysregulation, and lipotoxic injury. An improved understanding of the long-term effects of obesity on kidney health is essential treat the growing epidemic of obesity-related kidney disease. The purpose of this article is to review the epidemiology, pathophysiology, clinical features, and management of obesity-related kidney disease in children and adolescents.
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Affiliation(s)
- Edward Nehus
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7022, Cincinnati, OH 45229, USA.
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7022, Cincinnati, OH 45229, USA
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22
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Rashidbeygi E, Safabakhsh M, Delshad Aghdam S, Mohammed SH, Alizadeh S. Metabolic syndrome and its components are related to a higher risk for albuminuria and proteinuria: Evidence from a meta-analysis on 10,603,067 subjects from 57 studies. Diabetes Metab Syndr 2019; 13:830-843. [PMID: 30641817 DOI: 10.1016/j.dsx.2018.12.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/07/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIM Previous studies have explored the relation of metabolic syndrome (MetS), its components and the risk of albuminuria/proteinuria but their results are inconsistent. Then, we aimed to conduct a meta-analysis in order to resolve these controversies. METHOD PubMed and Scopus were systematically searched from their inception to 1 march 2018. Risk estimates and their 95% confidence intervals were extracted and pooled using the random-effects approach. RESULT A total of 57 studies, 44 studies on albuminuria and 13 studies on proteinuria, with a total sample size of 10,603,067 participants, were included in this meta-analysis. Overall, MetS was contributed to higher risks of proteinuria (OR = 2.08, 95%CI = 1.85-2.34) and albuminuria (OR = 1.92, 95%CI = 1.71-2.15), independent of diabetes status; although, this relationship was more noticeable in studies that used the WHO definition of MetS and in non-East Asian populations. Also, the relationship between MetS and proteinuria was sex independent, while, for albuminuria was significant only in men. MetS components such as obesity, impaired fasting glucose, elevated blood pressure and hypertriglyceridemia were associated with significant increases in proteinuria and albuminuria risk, while lower HDL-Cholesterol was only linked to greater risk of proteinuria. Moreover, the total impact of MetS on proteinuria was more remarkable than each component of the syndrome and an escalating dose-response association was found between the number of MetS components and albuminuria risk. CONCLUSION MetS and its components are potential risk factors for albuminuria and proteinuria.
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Affiliation(s)
- Elaheh Rashidbeygi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Maryam Safabakhsh
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Saeideh Delshad Aghdam
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Shimels Hussien Mohammed
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences-International Campus (TUMS-IC), Tehran, Iran
| | - Shahab Alizadeh
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Sawamura LS, Souza GGD, Santos JDGD, Suano-Souza FI, Gessullo ADV, Sarni ROS. Albuminuria and glomerular filtration rate in obese children and adolescents. ACTA ACUST UNITED AC 2018; 41:193-199. [PMID: 30328467 PMCID: PMC6699442 DOI: 10.1590/2175-8239-jbn-2018-0006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 08/14/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the frequency of albuminuria in overweight and obese children and adolescents and to relate it to the severity of obesity, pubertal staging, associated morbidities and the glomerular filtration rate. METHOD Cross-sectional study including 64 overweight and obese children and adolescents between 5 and 19 years of age. DATA COLLECTED weight, height, waist circumference and systemic arterial pressure. LABORATORY TESTS lipid profile; glycemia and insulin, used to calculate the Homeostasis Model Assessment (HOMA-IR); C-reactive protein; glutamic-pyruvic transaminase and albuminuria in an isolated urine sample (cutoff <30 mg/g). Creatinine was used to calculate the estimated glomerular filtration rate (eGFR, mL/min/1.73 m2). RESULTS The mean age was 11.6 ± 3.4 years, 32 (50%) and 29 (45.3%) were male and prepubertal. Forty-six (71.9%) had severe obesity. The frequency and median (min/max) of the observed values for albuminuria (> 30 mg/g) were 14 (21.9%) and 9.4 mg/g (0.70, -300.7 mg/g). The mean eGFR was 122.9 ± 24.7 mL/min/1.73 m2. There was no significant correlation between body mass index, pubertal staging, insulin and HOMA-IR with albuminuria values and neither with eGFR. Children with albuminuria tended to have higher values of diastolic blood pressure (75.0 ± 12.2 vs. 68.1 ± 12.4, p = 0.071). CONCLUSION Albuminuria, although frequent in children and adolescents with obesity, was not associated with other morbidities and the glomerular filtration rate in these patients.
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Affiliation(s)
| | | | | | - Fabíola Isabel Suano-Souza
- Faculdade de Medicina do ABC, Departamento de Pediatria, Santo André, SP, Brasil.,Universidade Federal de São Paulo, Departamento de Pediatria, São Paulo, SP, Brasil
| | - Anelise Del Vecchio Gessullo
- Faculdade de Medicina do ABC, Departamento de Pediatria, Santo André, SP, Brasil.,Universidade Federal de São Paulo, Departamento de Pediatria, São Paulo, SP, Brasil
| | - Roseli Oselka Saccardo Sarni
- Faculdade de Medicina do ABC, Departamento de Pediatria, Santo André, SP, Brasil.,Universidade Federal de São Paulo, Departamento de Pediatria, São Paulo, SP, Brasil
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24
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Chen MC, Wang JH, Chu CH, Cheng CF. Differential prevalence of hematuria and proteinuria with socio-demographic factors among school children in Hualien, Taiwan. Pediatr Neonatol 2018; 59:360-367. [PMID: 29221788 DOI: 10.1016/j.pedneo.2017.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 07/11/2017] [Accepted: 11/15/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pediatric hematuria/proteinuria is a risk factor for chronic kidney disease in later life, and school urinary screening can detect asymptomatic glomerulonephritis in the early stage. This study aimed to evaluate the prevalence of hematuria/proteinuria and its association with different socio-demographic factors among school children in 2013 in Hualien, Taiwan. METHODS A cross-sectional study was conducted among first, fourth, and seventh graders. Health examination results and urinalysis data were analyzed. Logistic regression models were used to the simultaneously analyze the association between the prevalence of hematuria/proteinuria and socio-demographic factors. RESULTS A total of 9544 students were included. The overall prevalence of hematuria and proteinuria was 4.1% and 5.7%, respectively. Students who were females, of a high grade level, of aboriginal ethnicity, and living in rural areas had higher hematuria risk (all P < 0.001) than other students. Underweight students had low odds ratio (0.53) of hematuria (P < 0.001). Seventh-grade students had higher odds ratio (3.63) of proteinuria than first grade students (P < 0.001). Students with both parents of aboriginal descent had lower odds ratio (0.81) of proteinuria than those with non-aboriginal parents (P = 0.044). Only higher grade level students had significantly higher risk of combined hematuria and light proteinuria (odds ratio: 10.67) and heavy proteinuria with/without hematuria (odds ratio: 3.22) than first graders. CONCLUSION Increased hematuria/proteinuria prevalence was noted in our county as compared to prior studies. Hematuria/proteinuria was significantly associated with gender, grade level, body mass index, ethnicity, and residence urbanization. Our data can be used for future longitudinal dataset collection to prevent pediatric renal disorders in Taiwan.
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Affiliation(s)
- Ming-Chun Chen
- Department of Pediatrics, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Tzu Chi General Hospital, Hualien, Taiwan
| | - Chia-Hsiang Chu
- Department of Pediatrics, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ching-Feng Cheng
- Department of Pediatrics, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Department of Medical Research, Tzu Chi General Hospital, Hualien, Taiwan; Department of Pediatrics, College of Medicine, Tzu-Chi University, Hualien, Taiwan.
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25
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Saydah SH, Xie H, Imperatore G, Burrows NR, Pavkov ME. Trends in Albuminuria and GFR Among Adolescents in the United States, 1988-2014. Am J Kidney Dis 2018; 72:644-652. [PMID: 30017204 DOI: 10.1053/j.ajkd.2018.04.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/19/2018] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Albuminuria and low estimated glomerular filtration rate (eGFR) define chronic kidney disease in adults and youth. Different from adults, the burden of abnormal kidney markers among youth in the general United States population is largely unknown. STUDY DESIGN Serial cross-sectional national surveys. SETTING & PARTICIPANTS Adolescents aged 12 to 18 years participating in the National Health and Nutrition Examination Surveys 1988 to 2014. Surveys were grouped into three 6-year periods. PREDICTORS Demographic and clinical determinants of kidney markers. OUTCOME Prevalence and trends in persistent albuminuria, low (< 60mL/min/1.73m2) and reduced (< 90mL/min/1.73m2) eGFRs. ANALYTICAL APPROACH Outcomes defined as persistent albumin-creatinine ratio ≥ 30mg/g (persistent albuminuria), eGFR < 90mL/min/1.73m2 (reduced kidney function), and eGFR < 60mL/min/1.73m2 (low kidney function). Multiple imputation analysis was used to estimate missing follow-up values of albuminuria. RESULTS Prevalences of persistent albuminuria were 3.64% (95% CI, 1.82%-5.46%) in 1988-1994 and 3.29% (95% CI, 1.94%-4.63%) in 2009-2014 (adjusted prevalence ratio, 0.93; 95% CI, 0.53-1.62; P=0.8 for trend). Prevalences of reduced eGFR were 31.46% (95% CI, 28.42%-34.67%) and 34.58% (95% CI, 32.07%-37.18%), respectively (adjusted prevalence ratio, 1.21; 95% CI, 1.00-1.46; P < 0.001 for trend). Prevalences of low eGFR were 0.32% (95% CI, 0.12%-0.84%) in 1988-1994 and 0.91% (95% CI, 0.58%-1.42%) in 2009-2014 (adjusted prevalence ratio, 3.10; 95% CI, 1.10-9.01; P = 0.09 for trend). Prevalences of albuminuria and/or low eGFR remained at 4.0% in 1988-1994 and 2009-2014 (adjusted prevalence ratio, 1.06; 95% CI, 0.64-1.77; P = 0.8 for trend). LIMITATIONS Persistent albuminuria data were based on imputed values (for second assessment of albuminuria) in 91% of participants; lack of second eGFR assessment to confirm sustained reduction in kidney function. CONCLUSIONS Albuminuria prevalence has not changed significantly in the US adolescent population between 1988 and 2014. Prevalences of both reduced and low eGFRs were higher in the most recent study period; however, < 1% of adolescents had low eGFRs.
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Affiliation(s)
- Sharon H Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Hui Xie
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Nilka Ríos Burrows
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Meda E Pavkov
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.
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26
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Ricotti R, Genoni G, Giglione E, Monzani A, Nugnes M, Zanetta S, Castagno M, Marolda A, Bellomo G, Bona G, Bellone S, Prodam F. High-normal estimated glomerular filtration rate and hyperuricemia positively correlate with metabolic impairment in pediatric obese patients. PLoS One 2018; 13:e0193755. [PMID: 29505614 PMCID: PMC5837119 DOI: 10.1371/journal.pone.0193755] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 02/17/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Childhood obesity represents a major health concern worldwide due to its well established detrimental effect on cardiovascular and its potential negative effect on kidney functions. However, biomarkers that can help diagnose early stages of kidney damage in obese children represent an unmet clinical need. OBJECTIVES In this study, we asked whether the prevalence of microalbuminuria, estimated glomerular filtration rate (eGFR) or hyperuricemia recorded in a wide cohort of obese children and adolescents would positively correlate with cardiometabolic dysfunction in these subjects. METHODS We carried out a cross-sectional study on 360 obese children and adolescents between the ages of 3-18 years, enrolled in a tertiary care center. Clinical and biochemical evaluations including oral glucose tolerance tests (OGTTs) were performed on all patients. Microalbuminuria was defined as urinary albumin-to-creatinine ratio (u-ACR) of 30-300 mg/g. All data are expressed as mean ± standard deviation (SD), absolute values or percentages. Sex age-specific and eGFR SDs were used for statistical analyses. Serum uric acid ≥ 5.5 mg/dL was considered abnormal. RESULTS The prevalence of microalbuminuria was 6.4%. Except for a lower insulinogenic-index, no correlations between microalbuminuria and cardiometabolic risk factors were detected. eGFR was < -1 SD and > 1 SD in 1.4% and 60.8% of subjects, respectively. Subjects with an eGFR > 1 SD had higher systolic blood pressure, liver enzymes, insulin resistance, glucose and insulin during OGTT, lower insulin sensitivity and a more prevalent microalbuminuria. Hyperuricemia (27.5%) increased the odds of hypertension, HDL ≤ 10th percentile and glucose ≥ 155.0 mg/dL after 60 minutes of OGTT. CONCLUSIONS A worse cardiometabolic profile was observed in subjects with an eGFR > 1 SD compared to other subgroups. Therefore, pediatric obese patients with eGFR > 1 SD or hyperuricemia should be closely monitored for microalbuminuria and post-challenge glucose and insulin secretion, all potential indicators of renal dysfunction in these young patients.
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Affiliation(s)
- Roberta Ricotti
- SCDU of Pediatrics, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Giulia Genoni
- SCDU of Pediatrics, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Enza Giglione
- SCDU of Pediatrics, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Alice Monzani
- SCDU of Pediatrics, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Martina Nugnes
- SCDU of Pediatrics, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Sara Zanetta
- SCDU of Pediatrics, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Matteo Castagno
- SCDU of Pediatrics, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Agostina Marolda
- SCDU of Pediatrics, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Giorgio Bellomo
- Clinical Chemistry, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Gianni Bona
- SCDU of Pediatrics, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Simonetta Bellone
- SCDU of Pediatrics, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
- Interdisciplinary Research Center of Autoimmune Diseases (IRCAD) University of Eastern Piedmont, Novara, Italy
| | - Flavia Prodam
- SCDU of Pediatrics, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
- Interdisciplinary Research Center of Autoimmune Diseases (IRCAD) University of Eastern Piedmont, Novara, Italy
- Endocrinology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
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27
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Lozano-Kasten F, Sierra-Diaz E, de Jesus Celis-de la Rosa A, Margarita Soto Gutiérrez M, Aarón Peregrina Lucano A. Prevalence of Albuminuria in Children Living in a Rural Agricultural and Fishing Subsistence Community in Lake Chapala, Mexico. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1577. [PMID: 29240709 PMCID: PMC5750995 DOI: 10.3390/ijerph14121577] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/09/2017] [Accepted: 12/10/2017] [Indexed: 12/25/2022]
Abstract
The occurrence of Chronic Kidney Disease (CKD) of unknown etiology in autochthonous child populations residing along the Lake Chapala lakeshore is endemic (Jalisco, México). The objective of this study was to determine the prevalence of albuminuria in the pediatric population and to measure the glomerular filtration rate in children with two positive albuminuria tests. Urinary albumin was measured in 394 children. Subjects with two or more positive albuminuria test donated blood samples for the determination of serum biomarkers. From a rural community with 565 children under the age of 17 years, 394 (69.7%) participated with first morning urine samples. A total of 180 children were positive (with two or more positive albuminuria tests). The prevalence of albuminuria among the children participating in the study was 45.7%. Of the 180 children with persistent albuminuria, 160 (88.9%) were tested for serum creatinine, urea, and cystatin C. The 68.1% of the children studied, were found in stages 3a and 3b of the Kidney Disease Improving Global Outcomes (KDIGO) classification (mean glomerular filtration rate (GFR) 51.9 and 38.4 mL/min/1.73 m² respectively). The lowest frequencies were for classifications 1 and 4. None of the subjects was classified as grade 5. The prevalence of albuminuria in children from this rural community is 3-5 times higher than reported in international literature. Regarding GFR, more than 50% of children studied are under 60 mL/min/1.73 m². It is a priority to find the causes of albuminuria and CKD in this Mexican region.
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Affiliation(s)
- Felipe Lozano-Kasten
- Public Health Department, University of Guadalajara, C.P. 44340 Guadalajara, Jalisco, Mexico.
| | - Erick Sierra-Diaz
- Public Health Department, University of Guadalajara, C.P. 44340 Guadalajara, Jalisco, Mexico.
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The population-based prevalence of albuminuria in children. Pediatr Nephrol 2017; 32:2303-2309. [PMID: 28752385 DOI: 10.1007/s00467-017-3764-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 07/03/2017] [Accepted: 07/05/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To determine the population-based prevalence of albuminuria in Australian children and validate any negative correlation with body mass index (BMI). METHODS Data from the Australian Health Survey 2011-2013 were used. This is a large-scale survey of the health of the Australian population, conducted by the Australian Bureau of Statistics, and uses a stratified, multistage area design with replicate weights attached to observations to allow for the derivation of accurate population estimates. We considered children aged 5-18 years, and defined albuminuria as an albumin-to-creatinine ratio (ACR) >30 mg/g (3.4 mg/mmol). RESULTS A total of 975 children provided urine samples for determination of ACR. The prevalence of albuminuria was 10.2% for males (95% confidence interval [CI] 6.1-14.2) and 15.5% for females (95% CI 10.7-20.3). After adjusting for age and gender, the odds ratio for albuminuria associated with being overweight or obese was 0.34 (95% CI 0.15-0.75). This relationship also held for waist-to-height ratio, where the adjusted odds ratio for each 0.1 increase was 0.46 (95% CI 0.26-0.82). CONCLUSIONS Albuminuria, using a measurement suitable for population-based and clinical screening, occurs in 12.8% of school-aged Australian children, and is less common in overweight and obese children.
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Cho MH, Kim KS, Chung S. Microalbuminuria Is Associated with Lower Weight and Taller Height in Adolescence. TOHOKU J EXP MED 2017; 243:151-157. [PMID: 29129845 DOI: 10.1620/tjem.243.151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Microalbuminuria (MA) is a well-known predictor of cardiovascular disease and mortality in adults. However, these relationships remain unclear in adolescents. A few studies on association between MA and obesity have been conducted in adolescents. However, the association between MA and growth parameters such as height has not been studied, despite the fact that adolescence is a period of rapid physiological change. We, therefore, aimed to evaluate the association between MA and growth parameters, and the association between MA and obesity related cardiovascular risk factors after adjusting for growth. The study included 1,459 adolescents (847 boys and 612 girls) aged 12-18 years who participated in the Korean National Health and Nutrition Examination Survey (2011-2013). A urine albumin/creatinine ratio (UACR) of 30-299 mg/g in a morning urine sample was considered to reflect MA. MA was detected in 53 (3.6%) including 24 girls. Height z-score of adolescents with MA was greater than that of normoalbuminuric adolescents (0.87 vs. 0.38; P < 0.01). Upon multiple regression analysis, UACR was associated with lower weight z-score (β = -0.100, P < 0.01) and higher height z-score (β = 0.069, P < 0.01). In term of cardiovascular risk factors, the UACR was not associated with fasting glucose, high-density-lipoprotein cholesterol, or triglyceride levels. Adolescents with MA tend to be thin and tall. MA is not a useful screening method for obesity-related cardiovascular risk in adolescents, but instead MA is associated with taller height and lower weight, growth-related parameters in adolescence.
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Affiliation(s)
- Myung Hyun Cho
- Department of Pediatrics, Konkuk University Medical Center
| | - Kyo Sun Kim
- Department of Pediatrics, Konkuk University Medical Center.,Department of Pediatrics, Konkuk University School of Medicine
| | - Sochung Chung
- Department of Pediatrics, Konkuk University Medical Center.,Department of Pediatrics, Konkuk University School of Medicine
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30
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Sierra-Diaz E, Celis-de la Rosa ADJ, Lozano-Kasten F, Bravo-Cuellar A, Garcia-Gutierrez M, Georgina HF. Non-Traditional Risk Factors of Albuminuria in the Pediatric Population: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1231. [PMID: 29035316 PMCID: PMC5664732 DOI: 10.3390/ijerph14101231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 10/11/2017] [Accepted: 10/11/2017] [Indexed: 12/27/2022]
Abstract
The presence of albumin in urine has been used for more than four decades as a marker of renal and cardiovascular damage. Most of the information on this marker is related to adults. The prevalence of albuminuria in the pediatric population has been reported as being 2.2-12.8% in some countries. Most research in this field is related to albuminuria and diseases, such as diabetes and hypertension. Using the methodology described by Arksey and O'Malley in 2005, a scoping review was carried out to show that the presence of albumin in urine in the pediatric population might be associated with environmental, demographic, congenital, infectious, and non-infectious factors. The information collected is supported by 74 references present in PubMed. The results reveal the multiple causes associated with albuminuria in the pediatric population. This information can be very useful for clinical practice by adding knowledge about albuminuria behavior in children.
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Affiliation(s)
- Erick Sierra-Diaz
- Public Health Department, University of Guadalajara, Sierra Mojada 950, Colonia Independencia, Guadalajara, Jalisco 44340, Mexico.
| | | | - Felipe Lozano-Kasten
- Environmental Health Department, University of Guadalajara, Sierra Mojada 950, Colonia Independencia, Guadalajara, Jalisco 44340, Mexico.
| | - Alejandro Bravo-Cuellar
- Immunology Department, Western Research Biomedical Center (IMSS), Sierra Mojada 800, Colonia Independencia, Guadalajara, Jalisco 44340, Mexico.
| | - Mariana Garcia-Gutierrez
- Pediatrics Department, Hospital Angeles del Carmen, Health Services, Tarascos 3473 Interior 240A, Fraccionamiento Monraz, Guadalajara, Jalisco 44670, Mexico.
| | - Hernandez-Flores Georgina
- Immunology Department, Western Research Biomedical Center (IMSS), Sierra Mojada 800, Colonia Independencia, Guadalajara, Jalisco 44340, Mexico.
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31
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2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens 2017; 34:1887-920. [PMID: 27467768 DOI: 10.1097/hjh.0000000000001039] [Citation(s) in RCA: 785] [Impact Index Per Article: 98.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Increasing prevalence of hypertension (HTN) in children and adolescents has become a significant public health issue driving a considerable amount of research. Aspects discussed in this document include advances in the definition of HTN in 16 year or older, clinical significance of isolated systolic HTN in youth, the importance of out of office and central blood pressure measurement, new risk factors for HTN, methods to assess vascular phenotypes, clustering of cardiovascular risk factors and treatment strategies among others. The recommendations of the present document synthesize a considerable amount of scientific data and clinical experience and represent the best clinical wisdom upon which physicians, nurses and families should base their decisions. In addition, as they call attention to the burden of HTN in children and adolescents, and its contribution to the current epidemic of cardiovascular disease, these guidelines should encourage public policy makers to develop a global effort to improve identification and treatment of high blood pressure among children and adolescents.
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Obesity in pediatric kidney transplant recipients and the risks of acute rejection, graft loss and death. Pediatr Nephrol 2017; 32:1443-1450. [PMID: 28361229 DOI: 10.1007/s00467-017-3636-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 02/12/2017] [Accepted: 02/13/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Obesity is prevalent in children with chronic kidney disease (CKD), but the health consequences of this combination of comorbidities are uncertain. The aim of this study was to evaluate the impact of obesity on the outcomes of children following kidney transplantation. METHODS Using data from the ANZDATA Registry (1994-2013), we assessed the association between age-appropriate body mass index (BMI) at the time of transplantation and the subsequent development of acute rejection (within the first 6 months), graft loss and death using adjusted Cox proportional hazards models. RESULTS Included in our analysis were 750 children ranging in age from 2 to 18 (median age 12) years with a total of 6597 person-years of follow-up (median follow-up 8.4 years). Overall, at transplantation 129 (17.2%) children were classified as being overweight and 61 (8.1%) as being obese. Of the 750 children, 102 (16.2%) experienced acute rejection within the first 6 months of transplantation, 235 (31.3%) lost their allograft and 53 (7.1%) died. Compared to children with normal BMI, the adjusted hazard ratios (HR) for graft loss in children who were underweight, overweight or diagnosed as obese were 1.05 [95% confidence interval (CI) 0.70-1.60], 1.03 (95% CI 0.71-1.49) and 1.61 (95% CI 1.05-2.47), respectively. There was no statistically significant association between BMI and acute rejection [underweight: HR 1.07, 95% CI 0.54-2.09; overweight: HR 1.42, 95% CI 0.86-2.34; obese: HR 1.83, 95% CI 0.95-3.51) or patient survival (underweight: HR 1.18, 95% CI 0.54-2.58, overweight: HR 0.85, 95% CI 0.38-1.92; obese: HR 0.80, 95% CI 0.25-2.61). CONCLUSIONS Over 10 years of follow-up, pediatric transplant recipients diagnosed with obesity have a substantially increased risk of allograft failure but not acute rejection of the graft or death.
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Cho H, Kim JH. Prevalence of microalbuminuria and its associated cardiometabolic risk factors in Korean youth: Data from the Korea National Health and Nutrition Examination Survey. PLoS One 2017; 12:e0178716. [PMID: 28575100 PMCID: PMC5456094 DOI: 10.1371/journal.pone.0178716] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/17/2017] [Indexed: 12/18/2022] Open
Abstract
Background Microalbuminuria is a known early predictive factor for renal and cardiovascular diseases, not only for patients with diabetes mellitus or hypertension but also in the general population. However, the prevalence and risk factors associated with microalbuminuria in Korean youth are unknown. Objectives The aims of this study are to evaluate the prevalence of microalbuminuria and the association between microalbuminuria and obesity or cardiometabolic risk factors in Korean children and adolescents without diabetes. Methods This study examines data obtained from the Korea National Health and Nutrition Examination Survey (between 2011 and 2014). It includes a total of 1,976 participants aged between 10 and 19 years (boys 1,128 and girls 848). Microalbuminuria was defined as a urine albumin-to-creatinine ratio (UACR) of ≥ 30 mg/g and < 300 mg/g. Association between microalbuminuria and the risk factors for cardiometabolic diseases including insulin resistance was evaluated. Results The prevalence of microalbuminuria was found to be 3.0% in Korean children and adolescents over this time period. The mean UACR for non-obese youth was significantly greater than that found in obese youth (3.2 ± 0.1 mg/g in the non-obese group vs. 2.1 ± 0.2 mg/g in the obese group; P < 0.001). In multiple logistic regression analysis, microalbuminuria was associated with hyperglycemia (OR 2.62, 95% CI 1.09–6.30) and hemoglobin A1c (OR 3.34, 95% CI 1.09–10.17) in the non-obese group and hypertension (OR 14.10, 95% CI 1.12–177.98) and HbA1c (OR 6.68, 95% CI 1.87–23.95) in the obese group. Conclusions The prevalence of microalbuminuria is not prominent in obese children and adolescents. Our findings demonstrated that the presence of hypertension and hyperglycemia was associated with microalbuminuria. Especially Hemoglobin A1c was associated with microalbuminuria in youths regardless of weight status. Microalbuminuria in pediatric population can be a helpful marker for the risk of cardiovascular disease.
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Affiliation(s)
- Heeyeon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- * E-mail:
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Affiliation(s)
- Elena Dingle
- 1 New York University School of Medicine, New York, NY, USA
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Kim S, Macaskill P, Hodson EM, Daylight J, Williams R, Kearns R, Vukasin N, Lyle DM, Craig JC. Beginning the trajectory to ESKD in adult life: albuminuria in Australian aboriginal children and adolescents. Pediatr Nephrol 2017; 32:119-129. [PMID: 27338727 DOI: 10.1007/s00467-016-3429-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 05/11/2016] [Accepted: 05/13/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Globally, disadvantaged populations suffer a high burden of chronic kidney disease (CKD). The trajectory to CKD during childhood and adolescence remains unclear due to a paucity of longitudinal studies. METHODS This was a prospective, population-based cohort study in which since 2002 we have followed 3418 children (1469 non-Aboriginal and 1949 Aboriginal) attending participating schools across New South Wales (NSW), Australia. The albumin:creatinine ratio was measured by dipstick every 2 years together with the body mass index (BMI) and blood pressure. We used multivariable logistic generalised estimating equation models to examine whether Aboriginal children had a higher prevalence of albuminuria compared with non-Aboriginal children with increasing age and to identify potential risk factors. RESULTS The mean age at enrolment was 10.6 years, at which time 14.2 % of the children were obese and 16.0 % overweight, with 11.5 % found to have albuminuria. Over 8 years (11,387 participant-years) of follow-up the prevalence of albuminuria increased to 18.5 %, overweight to 16.1 % and obesity to 17.2 %. The BMI standard deviation score (SDS) was found to have a differential effect on the risk of albuminuria in Aboriginal and non-Aboriginal children (P interaction < 0.01). The prevalence of albuminuria decreased as the BMI SDS increased in both groups of children, but it increased more in non-Aboriginal children, leading to a 2.5 % higher prevalence of albuminuria in overweight Aboriginal children (95 % confidence interval 1.0-4.2 %). CONCLUSION Compared with non-Aboriginal children, Aboriginal children are of higher risk of albuminuria when overweight or obese. We hypothesise that overweight and obesity are key contributors to the development of adult onset CKD among Aboriginal Australians, which needs further exploration in future studies.
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Affiliation(s)
- Siah Kim
- Centre for Kidney Research, The Children's Hospital at Westmead, PO Box 4001, Westmead, NSW, 2145, Australia.
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia.
| | - Petra Macaskill
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia
| | - Elisabeth M Hodson
- Centre for Kidney Research, The Children's Hospital at Westmead, PO Box 4001, Westmead, NSW, 2145, Australia
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia
| | - Jennifer Daylight
- Centre for Kidney Research, The Children's Hospital at Westmead, PO Box 4001, Westmead, NSW, 2145, Australia
| | - Rita Williams
- Centre for Kidney Research, The Children's Hospital at Westmead, PO Box 4001, Westmead, NSW, 2145, Australia
| | - Rachael Kearns
- Centre for Kidney Research, The Children's Hospital at Westmead, PO Box 4001, Westmead, NSW, 2145, Australia
| | - Nicola Vukasin
- Centre for Kidney Research, The Children's Hospital at Westmead, PO Box 4001, Westmead, NSW, 2145, Australia
| | - David M Lyle
- Department of Rural Health, University of Sydney, Camperdown, NSW, Australia
| | - Jonathan C Craig
- Centre for Kidney Research, The Children's Hospital at Westmead, PO Box 4001, Westmead, NSW, 2145, Australia
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia
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Yin C, Chu H, Li H, Xiao Y. Plasma Sfrp5 and adiponectin levels in relation to blood pressure among obese children. J Hum Hypertens 2016; 31:284-291. [DOI: 10.1038/jhh.2016.76] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 08/25/2016] [Accepted: 09/07/2016] [Indexed: 02/03/2023]
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Prevalence of chronic kidney disease risk factors among low birth weight adolescents. Pediatr Nephrol 2016; 31:1509-16. [PMID: 27117307 DOI: 10.1007/s00467-016-3384-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND By adulthood, low birth weight infants have an increased risk for chronic kidney disease (CKD). The extent to which objective CKD risk factors are present at earlier ages is unclear. METHODS We analyzed 5352 participants aged 12-15 years in the National Health and Nutrition Examination Survey, 1999-2012. Participants were classified as low birth weight (LBW; < 2500 g), very low birth weight (VLBW; < 1500 g), or normal (2500-4000 g) by parental/proxy recall. Albuminuria (albumin/creatinine 30 - <300 mg/g), decreased estimated glomerular filtration rate (eGFR; < 90 ml/min/1.73 m(2); Counahan-Barratt), and elevated systolic blood pressure (BP; ≥ 95th percentile for age, height, and sex) were considered CKD risk factors. RESULTS While albuminuria did not vary by birth weight, elevated blood pressure (BP) and decreased eGFR occurred more frequently in LBW/VLBW adolescents (elevated BP: LBW 6.0 %, VLBW 11.2 %, normal 2.4 %; decreased eGFR: LBW 23.2 %, VLBW 32.5 %, normal 16.1 %). After multivariable adjustment, LBW/VLBW adolescents had greater odds for both elevated BP (LBW: OR 2.90, 95 % CI 1.48-5.71; VLBW: 5.23; 1.11-24.74) and decreased eGFR (LBW: 1.49, 95 % CI 1.06-2.10; VLBW 2.49, 95 % CI 1.20-5.18). CONCLUSIONS In the U.S. population, both decreased eGFR and elevated systolic BP occur frequently among adolescents with history of LBW/VLBW.
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Flynn JT. Microalbuminuria in Children With Primary Hypertension. J Clin Hypertens (Greenwich) 2016; 18:962-965. [PMID: 27259969 DOI: 10.1111/jch.12858] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Joseph T Flynn
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA.
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Kelly RK, Magnussen CG, Sabin MA, Cheung M, Juonala M. Development of hypertension in overweight adolescents: a review. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2015; 6:171-87. [PMID: 26543386 PMCID: PMC4622556 DOI: 10.2147/ahmt.s55837] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The upward trend in adolescent hypertension is widely attributed to the adolescent obesity epidemic. Secular trends in adolescent prehypertension and hypertension have risen in congruence with increasing trends in the prevalence of overweight and obesity. The correlation between body mass index and blood pressure in adolescence is moderate to strong in most studies and strongest in those classified as overweight or obese. The mechanisms relating to the development of hypertension in overweight adolescents are unclear; however, a number of nonmodifiable and modifiable factors have been implicated. Importantly, certain clinical and biochemical markers in overweight adolescents are indicative of high risk for hypertension, including family history of hypertension and hyperinsulinemia. These characteristics may prove useful in stratifying overweight adolescents as high or low risk of comorbid hypertension. The treatment of overweight and obesity related hypertension in this population focuses on two key modalities: lifestyle change and pharmacotherapy. These approaches focus almost exclusively on weight reduction; however, a number of emerging strategies target hypertension more specifically. Among adolescents with overt hypertension there are also several factors that indicate higher risk of concurrent subclinical disease, persistent adult hypertension, and adult cardiovascular disease. This group may benefit substantially from more aggressive pharmacological treatments. Limitations in the literature relate to the paucity of studies reporting specific effects for the adolescent age group of overweight and obese individuals. Nonetheless, intervention for adiposity-related hypertension in adolescence may partially mitigate some of the cardiovascular risk in adulthood.
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Affiliation(s)
- Rebecca K Kelly
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia ; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Matthew A Sabin
- Murdoch Childrens Research Institute, Royal Children's Hospital and University of Melbourne, Parkville, Australia
| | - Michael Cheung
- Murdoch Childrens Research Institute, Royal Children's Hospital and University of Melbourne, Parkville, Australia
| | - Markus Juonala
- Murdoch Childrens Research Institute, Royal Children's Hospital and University of Melbourne, Parkville, Australia ; Department of Medicine, University of Turku, Turku, Finland ; Division of Medicine, Turku University Hospital, Turku, Finland
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Övünç Hacıhamdioğlu D, Zeybek C, Gök F, Pekel A, Muşabak U. Elevated Urinary T Helper 1 Chemokine Levels in Newly Diagnosed Hypertensive Obese Children. J Clin Res Pediatr Endocrinol 2015; 7:175-82. [PMID: 26831550 PMCID: PMC4677551 DOI: 10.4274/jcrpe.1917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Increasing evidence suggests that T helper (Th) cells play a significant role in the pathogenesis of hypertension. The aim of this study was to evaluate the effect of obesity and anti-hypertensive treatment on urinary Th1 chemokines. METHODS The study groups consisted of three types of patients: hypertensive obese, healthy, and non-hypertensive obese. Pre-treatment and post-treatment samples of the hypertensive obese group and one sample from the other two groups were evaluated for urinary chemokine: regulated on activation, normal T cell expressed and secreted (RANTES), interferon-gamma-inducible protein 10 (IP10), and monokine induced by interferon-gamma (MIG). In the hypertensive obese group, urine microalbumin: creatinine ratio was examined before and after treatment. We recommended lifestyle changes to all patients. Captopril was started in those who could not be controlled with lifestyle changes and those who had stage 2 hypertension. RESULTS Twenty-four hypertensive obese (mean age 13.1), 27 healthy (mean age 11.2) and 22 non-hypertensive obese (mean age 11.5) children were investigated. The pre-treatment urine albumin: creatinine ratio was positively correlated with pre-treatment MIG levels (r=0.41, p<0.05). RANTES was significantly higher in the pre-treatment hypertensive and non-hypertensive obese group than in the controls. The urinary IP10 and MIG levels were higher in the pre-treatment hypertensive obese group than in the non-hypertensive obese. Comparison of the pre- and post-treatment values indicated significant decreases in RANTES, IP10, and MIG levels in the hypertensive obese group (p<0.05). CONCLUSION Th1 cells could be activated in obese hypertensive children before the onset of clinical indicators of target organ damage. Urinary RANTES seemed to be affected by both hypertension and obesity, and urinary IP10 and MIG seemed to be affected predominantly by hypertension.
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Affiliation(s)
- Duygu Övünç Hacıhamdioğlu
- Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Clinic of Child Health and Diseases, İstanbul, Turkey Phone: +90 216 542 20 20 E-mail:
| | - Cengiz Zeybek
- Gülhane Military Medical Academy Hospital, Department of Child Health and Diseases, Ankara, Turkey
| | - Faysal Gök
- Gülhane Military Medical Academy Hospital, Department of Child Health and Diseases, Ankara, Turkey
| | - Aysel Pekel
- Gülhane Military Medical Academy Hospital, Department of Immunology, Ankara, Turkey
| | - Uğur Muşabak
- Gülhane Military Medical Academy Hospital, Department of Immunology, Ankara, Turkey
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Gurecká R, Koborová I, Šebek J, Šebeková K. Presence of Cardiometabolic Risk Factors Is Not Associated with Microalbuminuria in 14-to-20-Years Old Slovak Adolescents: A Cross-Sectional, Population Study. PLoS One 2015; 10:e0129311. [PMID: 26046923 PMCID: PMC4489371 DOI: 10.1371/journal.pone.0129311] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 05/07/2015] [Indexed: 01/19/2023] Open
Abstract
Introduction In adults, microalbuminuria indicates generalized endothelial dysfunction, and is
an independent risk factor for cardiovascular and all cause mortality. Slovak
adults present one of the highest cardiovascular mortality rates in Europe. Thus
Slovak adolescents are on a high-risk to develop cardiovascular afflictions early,
and screening for microalbuminuria might be useful in early assessment of their
cardiovascular risk. We aimed to study the prevalence of microalbuminuria in
Slovak adolescents, and the association of urinary albumin-to-creatinine ratio
(ACR) to cardiovascular risk factors. Subjects and methods Anthropometric data, blood pressure, blood count, glucose homeostasis, lipid
profile, renal function, inflammatory status, concentrations of homocysteine and
uric acid were determined and associated with ACR in 2 666 adolescents (49.4%
boys, 51.6% girls) aged 14-to-20 years. Microalbuminuria was classified as ACR
2.5–25.0 mg/mmol in boys and 3.5–35.0 mg/mmol in girls. Results Prevalence of microalbuminuria in both genders reached 3.3%, and did not differ
significantly between lean and centrally obese subjects. Girls presented higher
ACR than boys (normoalbuminuric: 0.6±0.5 mg/mmol vs. 0.5±0.4
mg/mmol, p>0.001; microalbuminuric: 9.3±7.3 mg/mmol vs.
5.0±3.8 mg/mmol; p>0.001). Microalbuminuric adolescents and those
presenting normoalbuminuria within the upper ACR quartile were slimmer than their
normoalbuminuric counterparts or adolescents with normoalbuminuria within the
lower quartile, respectively. No association between microalbuminuria and
cardiovascular risk markers was revealed. Conclusion Results obtained in this study do not support our assumption that ACR associates
with cardiometabolic risk factors in apparently healthy adolescents. Follow-up
studies until adulthood are needed to estimate the potential cardiometabolic risk
of apparently healthy microalbuminuric adolescents.
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Affiliation(s)
- Radana Gurecká
- Institute of Molecular BioMedicine, Faculty of Medicine, Comenius University,
Bratislava, Slovakia
- * E-mail:
| | - Ivana Koborová
- Institute of Molecular BioMedicine, Faculty of Medicine, Comenius University,
Bratislava, Slovakia
| | - Jozef Šebek
- Institute of Technology, Slovak Academy of Sciences, Bratislava,
Slovakia
| | - Katarína Šebeková
- Institute of Molecular BioMedicine, Faculty of Medicine, Comenius University,
Bratislava, Slovakia
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Jiménez-Corona A, Ávila-Hermosillo A, Nelson RG, Ramírez-López G. A Family History of Diabetes Modifies the Association between Elevated Urine Albumin Concentration and Hyperglycemia in Nondiabetic Mexican Adolescents. J Diabetes Res 2015; 2015:437079. [PMID: 26347891 PMCID: PMC4548133 DOI: 10.1155/2015/437079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/08/2015] [Indexed: 11/17/2022] Open
Abstract
We examined the frequency of elevated urine albumin concentration (UAC) and its association with metabolic syndrome (MetS) and metabolic markers in 515 nondiabetic Mexican adolescents stratified by family history of diabetes (FHD). UAC was measured in a first morning urine sample and considered elevated when excretion was ≥20 mg/mL. MetS was defined using International Diabetes Federation criteria. Fasting insulin, insulin resistance, and lipids were evaluated. Multivariate logistic regression was performed. Elevated UAC was present in 12.4% and MetS was present in 8.9% of the adolescents. No association was found between elevated UAC and MetS. Among adolescents with FHD, 18.4% were overweight and 20.7% were obese, whereas, among those without a FHD, 15.9% were overweight and 7.5% were obese. Hyperglycemia was higher in those with elevated UAC than in those without (44.4% versus 5.1%, p = 0.003). Hyperglycemia (OR = 9.8, 95% CI 1.6-59.4) and number of MetS components (OR = 4.5, 95% CI 1.5-13.3) were independently associated with elevated UAC. Among female participants, abdominal obesity was associated with elevated UAC (OR = 4.5, 95% CI 1.2-16.9). Conclusion. Elevated UAC was associated neither with MetS nor with any metabolic markers in nondiabetic adolescents. However, FHD modified the association of elevated UAC with hyperglycemia and the number of MetS components.
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Affiliation(s)
- Aida Jiménez-Corona
- General Directorate of Epidemiology, Health Secretariat, Francisco P Miranda 177, Colonia Lomas de Plateros, Delegación Álvaro Obregón, 01480 Mexico City, DF, Mexico
- Ocular Epidemiology Department, Institute of Ophthalmology Foundation Conde of Valenciana, IAP, Chimalpopoca 14, Colonia Obrera, Delegación Cuauhtémoc, 06800 Mexico City, DF, Mexico
| | - Antonio Ávila-Hermosillo
- Regional General Hospital No. 89, Mexican Institute of Social Security, Washington 1988, Colonia Moderna, Sector Juárez, 44150 Guadalajara, JAL, Mexico
| | - Robert G. Nelson
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix Epidemiology and Clinical Research Branch, 1550 East Indian School Road, Phoenix, AZ 85014, USA
| | - Guadalupe Ramírez-López
- Adolescent Epidemiological and Health Services Research Unit, Mexican Institute of Social Security, Avenida Tonalá 121, 45400 Guadalajara, JAL, Mexico
- *Guadalupe Ramírez-López:
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Hvidt KN, Olsen MH, Holm JC, Ibsen H. Obese children and adolescents have elevated nighttime blood pressure independent of insulin resistance and arterial stiffness. Am J Hypertens 2014; 27:1408-15. [PMID: 24717420 DOI: 10.1093/ajh/hpu055] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Insulin resistance has been related to elevated blood pressure (BP) in obese children and may adversely affect the vasculature by arterial stiffening. The objective was to investigate whether daytime and nighttime BP were elevated and related to insulin resistance and arterial stiffness in obese children and adolescents. METHODS Ninety-two obese patients aged 10-18 years were compared with 49 healthy control individuals. Insulin resistance was measured as the homeostatic assessment model (HOMA), and arterial stiffness was measured as carotid-femoral pulse wave velocity (cfPWV). RESULTS Mean ± SD daytime systolic BP (SBP) (obese: 125±8.3mm Hg; control: 121±10.1mm Hg; P = 0.03) and nighttime SBP (obese: 108±10.7mm Hg; control: 102±8.2mm Hg; P = 0.0001) were higher in the obese group when compared with the control group. No difference was found in daytime diastolic BP (DBP), whereas nighttime DBP (obese: 60±6.6mm Hg; control: 57±4.8mm Hg; P = 0.001) and night-to-day BP ratios were higher in the obese group. Nighttime SBP was related to BMI z score (β = 6.0; 95% confidence interval (CI) = 2.9-9.1; P = 0.0002) and waist/height ratio (β = 36.7; 95% CI = 5.6-67.9; P = 0.02) in the obese group. HOMA index (obese: median = 3.7, interquartile range (IQR) = 2.3-6.0; control: median = 2.6, IQR = 1.8-3.4; P = 0.002) was higher, whereas cfPWV (obese: 4.8±0.8 m/s; control: 5.1±0.6 m/s; P = 0.03) was lower in the obese group. CfPWV was not related to logHOMA index. In multiple regression analyses, the higher nighttime BP in the obese group was independent of logHOMA and cfPWV. CONCLUSIONS Obese children had a higher nighttime BP when compared with the control group independently of insulin resistance and arterial stiffness. No relationship was found between insulin resistance and arterial stiffness. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov identifier NCT01310088.
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Affiliation(s)
- Kristian N Hvidt
- Division of Cardiology, Department of Medicine, Copenhagen University Hospital Holbæk, Holbæk, Denmark; Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark;
| | - Michael H Olsen
- Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Center for Individualized Medicine in Arterial Diseases, Odense University Hospital and Hypertension in Africa Research Team, School for Physiology, Nutrition and Consumer Sciences, North-West University, South Africa
| | - Jens-Christian Holm
- Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark
| | - Hans Ibsen
- Division of Cardiology, Department of Medicine, Copenhagen University Hospital Holbæk, Holbæk, Denmark
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Xiao N, Jenkins TM, Nehus E, Inge TH, Michalsky MP, Harmon CM, Helmrath MA, Brandt ML, Courcoulas A, Moxey-Mims M, Mitsnefes MM. Kidney function in severely obese adolescents undergoing bariatric surgery. Obesity (Silver Spring) 2014; 22:2319-25. [PMID: 25376399 PMCID: PMC4225641 DOI: 10.1002/oby.20870] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/24/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Determine objective measures of kidney function and analyze factors associated with kidney dysfunction in severely obese adolescents undergoing weight loss surgery were described. METHODS Cross-sectional data from 242 adolescent participants in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study before weight loss surgery were analyzed. Kidney status was assessed by measuring urine albumin creatinine ratio to determine microalbuminuria and by calculating serum cystatin C-based estimated glomerular filtration rate (eGFR) to assess kidney function. RESULTS Mean age and median body mass index (BMI) were 17.1 years and 50.5 kg/m(2) , respectively; 76% were females and 65% were non-Hispanic white race. Fourteen percent of the cohort had microalbuminuria, and 3% had macroalbuminuria; 3% had eGFR < 60 ml/min/1.73 m(2) , and 7.1% had eGFR > 150 ml/min/1.73 m(2) . In adjusted analyses, female gender and increasing ferritin levels were significantly associated with the presence of microalbuminuria/macroalbuminuria. Increasing BMI and homeostasis model assessment of insulin resistance values were significantly associated with lower eGFR. CONCLUSIONS A significant number of severely obese adolescents undergoing weight loss surgery have evidence of early kidney dysfunction. Longitudinal studies following weight loss surgery in these individuals are needed to determine whether these kidney abnormalities are reversible following weight loss therapy.
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Affiliation(s)
- Nianzhou Xiao
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Gunta SS, Mak RH. Hypertension in children with obesity. World J Hypertens 2014; 4:15-24. [DOI: 10.5494/wjh.v4.i2.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 05/04/2014] [Accepted: 05/14/2014] [Indexed: 02/06/2023] Open
Abstract
The prevalence of obesity related hypertension has dramatically increased in children with the parallel increase in pediatric obesity. This pediatric health problem may adversely affect cardiovascular health in adult life. The pathogenesis of hypertension in obese children is not widely understood. We therefore undertake this review to raise public awareness. Early childhood parameters like birth weight and postnatal weight gain may play important roles in risk for obesity and obesity related hypertension later in childhood and adult life. Further information is required to confirm this origin of hypertension so that appropriate measures are taken in the peri-natal period. The role of sympathetic nervous system has now been well established as one of the principle mechanisms involved in obesity related hypertension. The Renin-Angiotensin system, insulin resistance due to obesity and as a part of metabolic syndrome along with imbalance in adipokines such as leptin and adiponectin, cause activation of the sympathetic system, vasoconstriction, endothelial dysfunction and sodium reabsorption among other perturbations. Multi-step interventions targeting these various mechanisms are required to break the cycle of obesity and metabolic syndrome. Vitamin D deficiency, sleep apnea due to airway obstruction and hyperuricemia may also play a significant role and should not be ignored in its early stages. Obesity is a risk factor for other co-morbid conditions like chronic kidney disease and fatty liver which further accentuate the risk of hypertension. Increased awareness is required to prevent, diagnose and treat obesity related hypertension among the pediatric population.
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Should screening of renal markers be recommended in a working population? Int Urol Nephrol 2014; 46:1601-8. [PMID: 24771473 DOI: 10.1007/s11255-014-0718-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 04/09/2014] [Indexed: 01/27/2023]
Abstract
INTRODUCTION It is debated whether the general population should be screened for kidney disease. This study evaluated whether screening of albuminuria and estimated glomerular filtration rate (eGFR) in a working population should be recommended to detect subjects with chronic kidney disease. METHODS The unreferred renal insufficiency study is a cross-sectional study in 1,398 workers aged 17-65. Markers of cardiovascular and renal disease were measured. Cardiovascular risk (CVR) was defined by hypertension (n = 416), diabetes (n = 45), dyslipidemia (n = 159) and/or history of a cardiovascular event (n = 10). RESULTS In our population, 5 % of the workers had microalbuminuria, 0.5 % had macroalbuminuria and <0.1 % had eGFR <60 ml/min/1.73 m(2). All workers with an eGFR <60 ml/min/1.73 m(2) and/or macroalbuminuria (8/8) had at least one CVR factor, whereas this was the case in only half of workers with microalbuminuria (36/73, p = 0.007). In workers without CVR factors, the presence of microalbuminuria was associated with low body mass index (BMI, p < 0.001) or physiochemical exposure risk (p < 0.001). CONCLUSIONS Screening of renal markers in a working population, identified only a few subjects with an eGFR <60 ml/min/1.73 m(2) or macroalbuminuria. Although microalbuminuria was more prevalent, it might not necessarily indicate kidney disease, as it may have a completely different meanings depending of the phenotype of the screened subjects. Besides underlying CVR factors, microalbuminuria was also associated with low BMI in absence of any risk factor, suggesting presence of benign postural proteinuria. In addition, microalbuminuria also seemed to be related to physicochemical exposure. In view of the impossibility to further analyze this finding in the present study, the meaning of this observation needs to be further investigated.
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Abstract
There is growing concern about elevated blood pressure in children and adolescents, because of its association with the obesity epidemic. Moreover, cardiovascular function and blood pressure level are determined in childhood and track into adulthood. Primary hypertension in childhood is defined by persistent blood pressure values ≥ the 95th percentile and without a secondary cause. Preventable risk factors for elevated blood pressure in childhood are overweight, dietary habits, salt intake, sedentary lifestyle, poor sleep quality and passive smoking, whereas non-preventable risk factors include race, gender, genetic background, low birth weight, prematurity, and socioeconomic inequalities. Several different pathways are implicated in the development of primary hypertension, including obesity, insulin resistance, activation of the sympathetic nervous system, alterations in sodium homeostasis, renin-angiotensin system and altered vascular function. Prevention of adult cardiovascular disease should begin in childhood by regularly screening for high blood pressure, counseling for healthy lifestyle and avoiding preventable risk factors.
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Prevalence and factors related to urinary albumin excretion in obese youths. J Hypertens 2013; 31:2230-6; discussion 2236. [DOI: 10.1097/hjh.0b013e328364bcbf] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Gunta SS, Mak RH. Is obesity a risk factor for chronic kidney disease in children? Pediatr Nephrol 2013; 28:1949-56. [PMID: 23150030 DOI: 10.1007/s00467-012-2353-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 10/04/2012] [Accepted: 10/05/2012] [Indexed: 12/13/2022]
Abstract
There is a rapid increase worldwide in the prevalence of obesity in adults and children. Obesity is not only a comorbidity for chronic kidney disease (CKD) but may also be a risk factor for CKD. Epidemiological correlations and pathophysiological changes have been observed associating obesity with CKD. Low birth weight may be associated with both obesity and low nephron mass, leading to CKD later in life. Elevated levels of adipokines, such as leptin and adiponectin, in obesity may be factors in CKD pathogenesis and progression. Furthermore, various other factors, such as hypertension, increased cardiovascular morbidity, insulin resistance, dyslipidemia, and lipotoxicity, may play significant roles in the pathogenesis of CKD in obesity. Reduction in obesity, which is a potentially modifiable risk factor, might help decrease the burden of CKD in the population. Apart from individualized options, community-based interventions have the potential to create a strong impact in this condition.
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Affiliation(s)
- Sujana S Gunta
- Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, 9500 Gilman Drive. MC 0634, La Jolla, CA 92093-0634, USA
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Doyon A, Schaefer F. The prodromal phase of obesity-related chronic kidney disease: early alterations in cardiovascular and renal function in obese children and adolescents. Nephrol Dial Transplant 2013; 28 Suppl 4:iv50-7. [PMID: 23975744 DOI: 10.1093/ndt/gft263] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Childhood overweight and obesity is a relevant health condition with multi-organ involvement. Obesity shows significant tracking into adult life and is associated with an increased risk of serious adverse health outcomes both during childhood and later adulthood. The classical sequelae of obesity such as hypertension, metabolic syndrome and inflammation do develop at a paediatric age. Cardiovascular consequences, such as increased carotid intima-media thickness, and left ventricular hypertrophy, as well as functional alterations of the heart and arteries, are commonly traceable at an early age. Renal involvement can occur at a young age and is associated with a high probability of progressive chronic kidney disease. There is solid evidence suggesting that consequent treatment including both lifestyle changes and pharmacological therapy can reduce cardiovascular, metabolic and renal risks in obese children and adolescents.
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Affiliation(s)
- Anke Doyon
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
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