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Şen S, Özalp Kızılay D, Taneli F, Özen Ç, Ertan P, Özunan İ, Yıldız R, Ersoy B. Urinary NGAL is a Potential Biomarker for Early Renal Injury in Insulin Resistant Obese Non-diabetic Children. J Clin Res Pediatr Endocrinol 2021; 13:400-407. [PMID: 34013756 PMCID: PMC8638630 DOI: 10.4274/jcrpe.galenos.2021.2021.0020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Neutrophil gelatinase-associated lipocalin (NGAL) is one of the new biomarkers for detecting acute renal injury. There are studies showing the relationship between NGAL and renal injury in obese children. The aim of this study was to investigate whether urinary levels of NGAL, kidney injury molecule-1, and serum cystatin C are increased in insulin resistance (IR) patients before the development of diabetes. METHODS Cross-sectional, case-controlled study that included non-diabetic obese children and adolescent patients with IR and a non-diabetic obese control group with no IR, who attended a tertiary center pediatric endocrinology outpatient clinic between 2016-2018. Those with diabetes mellitus and/or known renal disease were excluded. NGAL and creatinine (Cr) levels were evaluated in the morning spot urine from all participants. Serum renal function was evaluated. RESULTS Thirty-six control and 63 IR patients were included in the study, of whom 68 (68.7%) were girls. The mean age of all participants was 13.12±2.64 years and no statistically significant difference was found between the two groups in terms of age or gender distribution. Median (range) spot urinary NGAL (u-NGAL) values in the IR group were significantly higher at 26.35 (7.01-108.7) ng/mL than in the control group at 19.5 (3.45-88.14) ng/mL (p=0.018). NGAL/Cr ratio was also significantly higher in the IR group compared to the control group (p=0.018). CONCLUSION Obese pediatric patients with IR were shown to have elevated levels of u-NGAL, a marker of renal injury. u-NGAL examination may show early renal injury before development of diabetes.
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Affiliation(s)
- Semra Şen
- Celal Bayar University Faculty of Medicine, Department of Pediatrics, Manisa, Turkey,* Address for Correspondence: Celal Bayar University Faculty of Medicine, Department of Pediatrics, Manisa, Turkey Phone: +90 236 444 42 28 E-mail:
| | - Deniz Özalp Kızılay
- Celal Bayar University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrionology, Manisa, Turkey
| | - Fatma Taneli
- Celal Bayar University Faculty of Medicine, Department of Medical Biochemistry, Manisa, Turkey
| | - Çınar Özen
- Celal Bayar University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Manisa, Turkey
| | - Pelin Ertan
- Celal Bayar University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Manisa, Turkey
| | - İpek Özunan
- Celal Bayar University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Manisa, Turkey
| | - Raziye Yıldız
- Celal Bayar University Faculty of Medicine, Department of Medical Biochemistry, Manisa, Turkey
| | - Betül Ersoy
- Celal Bayar University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrionology, Manisa, Turkey
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Stambolliu E, Kollias A, Bountzona I, Ntineri A, Servos G, Vazeou A, Stergiou GS. Nighttime Home Blood Pressure in Children: Association with Ambulatory Blood Pressure and Preclinical Organ Damage. Hypertension 2021; 77:1877-1885. [PMID: 33840203 DOI: 10.1161/hypertensionaha.121.17016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Emelina Stambolliu
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (E.S., A.K., I.B., A.N., G.S.S.)
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (E.S., A.K., I.B., A.N., G.S.S.)
| | - Ioanna Bountzona
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (E.S., A.K., I.B., A.N., G.S.S.)
| | - Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (E.S., A.K., I.B., A.N., G.S.S.)
| | - George Servos
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (E.S., A.K., I.B., A.N., G.S.S.)
| | - Andriani Vazeou
- First Department of Pediatrics (A.V.), P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (E.S., A.K., I.B., A.N., G.S.S.)
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Stergiou G, Stambolliu E, Bountzona I, Ntineri A, Kollias A, Vazeou A, Soldatou A. Home Blood Pressure Monitoring in Children and Adolescents: Systematic Review of Evidence on Clinical Utility. Curr Hypertens Rep 2019; 21:64. [PMID: 31240404 DOI: 10.1007/s11906-019-0967-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW For the accurate diagnosis and management of hypertension, out-of-office blood pressure evaluation using ambulatory (ABPM) or home monitoring (HBPM) is currently recommended. In children, there is considerable evidence on the clinical utility of ABPM, whereas the evidence on HBPM is limited. This systematic review presents (i) the benefits of HBPM in children; (ii) the evidence on normal range, diagnostic accuracy, and relationship with preclinical organ damage; and (iii) guidance for devices, monitoring schedule, and interpretation. RECENT FINDINGS HBPM is a useful adjunct to the conventional office measurements for the evaluation of children with suspected or treated hypertension. HBPM is feasible in children and has good reproducibility, diagnostic accuracy and acceptability by users, and relatively low cost. Thus, it has greater potential for widespread and long-term use than ABPM, which is more expensive and often not available or not tolerated. Automated monitors that have been clinically validated specifically in children should be used with appropriate cuff size. HBPM for 7 days (minimum 3) with duplicate morning and evening measurements (minimum 12 readings) should be performed in children with suspected or treated hypertension before each office visit. Until more data become available, in case of diagnostic disagreement between office blood pressure and HBPM, treatment decisions should be based on ABPM. HBPM is clinically useful in children with hypertension. More research is needed on its clinical application, and more automated devices need to be clinically validated in this population.
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Affiliation(s)
- George Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece.
| | - Emelina Stambolliu
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Ioanna Bountzona
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Andriani Vazeou
- First Department of Pediatrics, P&A Kyriakou Children's Hospital, Athens, Greece
| | - Alexandra Soldatou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, P&A Kyriakou Children's Hospital, Athens, Greece
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Kır M, Cetin B, Demir K, Yılmaz N, Kızılca O, Demircan T, Unal N, Bober E, Saylam GS. Can ambulatory blood pressure monitoring detect early diastolic dysfunction in children with type 1 diabetes mellitus: correlations with B-type natriuretic peptide and tissue Doppler findings. Pediatr Diabetes 2016; 17:21-7. [PMID: 25384349 DOI: 10.1111/pedi.12234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/08/2014] [Accepted: 10/08/2014] [Indexed: 01/20/2023] Open
Abstract
AIM To evaluate the relationship between 24-h blood pressure (BP) measurements and diastolic heart function evaluated by Doppler tissue imaging and B-type natriuretic peptide (BNP) levels in children with type 1 diabetes mellitus (DM). PATIENTS AND METHODS A total of 32 diabetic and 18 healthy children were enrolled. Spectral Doppler analysis and tissue Doppler measurements were performed by conventional echocardiography. The 24-h ambulatory BP and serum BNP levels were measured. RESULTS Analysis of ambulatory blood pressure monitoring (ABPM) recordings showed that median daytime diastolic BP load were significantly higher in diabetic patients compared to controls [12.35 (4.23-27.23) vs. 2.5 (0-8.7), p = 0.007]. Patients with elevated daytime systolic and diastolic BP loads had significantly higher BNP values compared to patients with normal BP load (31.4 ± 24.36 vs. 11.84 ± 11.25 pg/mL, p = 0.03 and 23.21 ± 15.12 vs. 12.12 ± 14.65 pg/mL, p = 0.03, respectively). Isovolemic contraction time (47.43 ± 7.84 vs. 42.27 ± 7.47, p = 0.045), isovolemic relaxation time (68.84 ± 10.43 vs. 58.77 ± 10.02, p = 0.02), and myocardial performance index (0.45 ± 0.10 vs. 0.37 ± 0.09, p = 0.02) as determined by tissue Doppler echocardiography were significantly high in diabetic patients compared to that of control cases. Ratio of mitral peak early diastolic flow velocity (E) to peak early diastolic myocardial velocities by tissue Doppler echocardiography (E') was also higher in patients with elevated daytime systolic BP load (E/E', 6.71 ± 1.97 vs. 4.91 ± 1.02, p = 0.04). CONCLUSION Elevated BP loads detected by 24-h ambulatory BP measurements in children with type 1 diabetes are associated with increased BNP levels and abnormal tissue Doppler echocardiography indices, indicating early stage cardiac dysfunction.
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Affiliation(s)
- Mustafa Kır
- Department of Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, 35340, Turkey
| | - Benhur Cetin
- Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, 35340, Turkey
| | - Korcan Demir
- Department of Pediatric Endocrinology, Dokuz Eylul University Faculty of Medicine, Izmir, 35340, Turkey
| | - Nuh Yılmaz
- Department of Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, 35340, Turkey
| | - Ozgur Kızılca
- Department of Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, 35340, Turkey
| | - Tulay Demircan
- Department of Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, 35340, Turkey
| | - Nurettin Unal
- Department of Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, 35340, Turkey
| | - Ece Bober
- Department of Pediatric Endocrinology, Dokuz Eylul University Faculty of Medicine, Izmir, 35340, Turkey
| | - Gul Sagin Saylam
- Department of Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, 35340, Turkey
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Conkar S, Yılmaz E, Hacıkara Ş, Bozabalı S, Mir S. Is Daytime Systolic Load an Important Risk Factor for Target Organ Damage in Pediatric Hypertension? J Clin Hypertens (Greenwich) 2015; 17:760-6. [PMID: 26140344 PMCID: PMC8031531 DOI: 10.1111/jch.12608] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 03/13/2015] [Accepted: 04/15/2015] [Indexed: 11/30/2022]
Abstract
The aim of this study was to compare ambulatory blood pressure (BP) monitoring (ABPM) data and determine which hypertension type is a risk factor in target organ damage. A total of 82 children (47 boys) with suspected hypertension based on office BP measurements and considered hypertensive by ABPM were studied. Target organ damage included the following: 35.3% hypertensive retinopathy, 25.6% microalbuminuria, 15.8% increased left ventricular mass index, 29.2% increased carotid intima-media thickness (cIMT), 24.3% high augmentation index (AIx), and 19.5% high pulse wave velocity (PWV). The association between BP load, PWV, and cIMT was statistically significant. There were significant correlations between daytime systolic BP load, PWV, AIx, and cIMT. A statistically significant difference was also detected between nighttime systolic BP load, PWV, and cIMT values and nighttime diastolic BP load levels and values of AIx and cIMT. There was also a statistically significant difference between the high level of nighttime diastolic BP load and cIMT. The authors found that target organ damage was seen more often in children with primary hypertension who had systolic loads.
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Affiliation(s)
- Seçil Conkar
- Department of Pediatric NephrologyEge University Medical FacultyIzmirTurkey
| | - Ebru Yılmaz
- Dr. Behcet Uz Children Diseases Teaching and Research Hospital Pediatric NephrologyIzmirTurkey
| | - Şükriye Hacıkara
- Department of Pediatric NephrologyEge University Medical FacultyIzmirTurkey
| | - Sibel Bozabalı
- Department of Pediatric CardiologyEge University Medical FacultyIzmirTurkey
| | - Sevgi Mir
- Department of Pediatric NephrologyEge University Medical FacultyIzmirTurkey
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Redon J, Lurbe E. Ambulatory Blood Pressure Monitoring Is Ready to Replace Clinic Blood Pressure in the Diagnosis of Hypertension. Hypertension 2014; 64:1169-74; discussion 1174. [DOI: 10.1161/hypertensionaha.114.03883] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Josep Redon
- From the Hypertension Clinic, Hospital Clinico, Research Institute INCLIVA (J.R.), and Pediatric Department, Consorcio Hospital General (E.L.), University of Valencia, Valencia, Spain; and CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain (J.R., E.L.)
| | - Empar Lurbe
- From the Hypertension Clinic, Hospital Clinico, Research Institute INCLIVA (J.R.), and Pediatric Department, Consorcio Hospital General (E.L.), University of Valencia, Valencia, Spain; and CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain (J.R., E.L.)
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Yan L, Ma J, Guo X, Tang J, Zhang J, Lu Z, Wang H, Cai X, Wang L. Urinary albumin excretion and prevalence of microalbuminuria in a general Chinese population: a cross-sectional study. BMC Nephrol 2014; 15:165. [PMID: 25308236 PMCID: PMC4209030 DOI: 10.1186/1471-2369-15-165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/08/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Microalbuminuria has been shown to be a risk factor for cardiovascular and renal disease in patients with hypertension and diabetes as well as in the general population. Urinary albumin excretion over 24 h is considered a 'gold standard' to detect microalbuminuria. Few studies have used 24-h urinary albumin excretion to analyze the prevalence of and related factors for microalbuminuira in a general Chinese population. METHODS This study included 1980 adults aged 18-69 years from the Shandong-Ministry of Health Action on Salt and Hypertension (SMASH) Project 2011 survey. Blood pressure, height, weight and waist circumference were measured, and a venous blood and timed 24-h urine samples were collected from each participant. Linear and logistic regression analyses were used to test associations between established cardiovascular risk factors and microalbuminuria. RESULTS The median (25th-75th percentile) of 24-h urinary albumin excretion was 6.1 mg/d (4.5-8.7 mg/d) for all adults, 6.0 mg/d (4.4-8.5 mg/d) for men and 6.2 mg/d (4.6-8.9 mg/d) for women. The overall prevalence of microalbuminuria was 4.1% (95% confidence interval [CI]: 3.2-5.0%), 3.7% (95% CI: 2.9-4.5%) for men and 4.6% (95% CI: 3.7-5.5%) for women. Microalbuminuria was present in 8.1% (95% CI: 6.9-9.3%) of individuals with hypertension, 11.4% (95% CI: 10.0-12.8%) of those with diabetes and 15.6% (95% CI: 14.0-17.2%) of those with both. Multiple logistic regression analysis indicated that systolic blood pressure (odds ratio [OR] 1.02; 95% CI: 1.01-1.03) and fasting blood glucose (OR 1.19; 95% CI: 1.05-1.35) were the independent risk factors for microalbuminuria. CONCLUSIONS Adults in the general population of Shandong Province have a moderate prevalence of microalbuminuria. Those with hypertension and diabetes are at high risk of having microalbuminuria, suggesting the need for screening and early intervention for microalbuminuria among these individuals.
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Affiliation(s)
- Liuxia Yan
- />National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050 China
| | - Jixiang Ma
- />National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050 China
| | - Xiaolei Guo
- />Academy of Preventive Medicine, Shandong University, Jinan, 250014 China
- />Shandong Center for Disease Control and Prevention, Jinan, 250014 China
| | - Junli Tang
- />Academy of Preventive Medicine, Shandong University, Jinan, 250014 China
- />Shandong Center for Disease Control and Prevention, Jinan, 250014 China
| | - Jiyu Zhang
- />Academy of Preventive Medicine, Shandong University, Jinan, 250014 China
- />Shandong Center for Disease Control and Prevention, Jinan, 250014 China
| | - Zilong Lu
- />Academy of Preventive Medicine, Shandong University, Jinan, 250014 China
- />Shandong Center for Disease Control and Prevention, Jinan, 250014 China
| | - Huicheng Wang
- />Chinese Center for Disease Control and Prevention, Beijing, 102206 China
| | - Xiaoning Cai
- />National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050 China
| | - Linhong Wang
- />National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050 China
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Maahs DM, Daniels SR, de Ferranti SD, Dichek HL, Flynn J, Goldstein BI, Kelly AS, Nadeau KJ, Martyn-Nemeth P, Osganian SK, Quinn L, Shah AS, Urbina E. Cardiovascular disease risk factors in youth with diabetes mellitus: a scientific statement from the American Heart Association. Circulation 2014; 130:1532-58. [PMID: 25170098 DOI: 10.1161/cir.0000000000000094] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Automated office blood pressure is associated with urine albumin excretion in hypertensive subjects. Am J Hypertens 2012; 25:969-73. [PMID: 22695505 DOI: 10.1038/ajh.2012.76] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND We aimed to investigate the association between automated office blood pressure (AOBP) readings and urine albumin excretion (UAE), and to assess if this association is as close as that between 24-h ambulatory blood pressure (ABP) and UAE. A strong association would suggest that AOBP may serve as an indicator of early renal impairment. METHODS In a sample of 162 hypertensives, we compared AOBP with ABP measurements and their associations with UAE in two consecutive 24-h urine collections measured by an immunoturbidimetric assay. Microalbuminuria was defined as UAE of 30-300 mg/24 h. RESULTS The age of the subjects was 53 ± 13 (mean ± s.d.) years. Twenty-two were microalbuminuric. In those, AOBP and 24-h ABP were higher than in the normoalbuminuric subjects: 152 ± 19 and 147 ± 20 vs. 138 ± 15 and 130 ± 11 mm Hg for systolic blood pressure (SBP), and 97 ± 15 and 92 ± 14 vs. 86 ± 10 and 82 ± 8 mm Hg for diastolic blood pressure (DBP) (P < 0.001). Correlations between AOBP and 24-h ABP with log-transformed urine albumin were 0.30 (P < 0.001) and 0.43 (P < 0.001) for SBP and 0.27 (P < 0.001) and 0.33 (P < 0.001) for DBP. Adjusting for age, sex, body mass index, and estimated glomerular filtration rate, both AOBP and 24-h ABP were independently associated with urine albumin (P < 0.001 for both associations). Receiver operating characteristics curve analysis showed a similar predictive ability for microalbuminuria for AOBP and for 24-h ABP (area under the curve: 0.819 (P < 0.001) for SBP, 0.836 (P < 0.001) for DBP vs. 0.830 (P < 0.001) for SBP and 0.845 (P < 0.001) for DBP). CONCLUSIONS In this study, microalbuminuria correlated similarly with high-quality AOBP and ABP readings, further supporting the use of AOBP in the clinical setting.
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