https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/184 Tue, 11 Apr 2017 16:34:21 +0000 This study was conducted to assess the presence of microalbuminuria in newly detected diabetes mellitus (DM) cases in a small group of Bangladeshi population attending BIRDEM out patient department and to find out the relationship (if any) of microalbuminuria with different clinical and biochemical parameters. Out of 110 DM cases, 10 (9.1%) were found to have microalbuminuria. Blood pressure, both systolic (r=0.190) and diastolic (r = 0.30) had significant positive correlation with urinary albumin. There was no association of microalbuminuria with waist circumference, waist to hip ratio, serum triglycerides, HDL cholesterol, fasting blood glucose, age, sex, weight, height or BMI. This suggests that all newly detected diabetes mellitus should be screened for raised blood pressure and if found positive be given the same importance as blood glucose. They should be treated meticulously to revert or prevent microalbuminuria and thus prevent complications. Ibrahim Med. Coll. J. 2010; 4(1): 21-25 Introduction   This cross sectional study was conducted between January 2006 to May 2007 in the Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh. The subjects were selected purposively. The calculated sample size was 162. A total of 185 newly detected diabetic cases were selected which was 15% more than the calculated sample size. 75 cases could not be included in the final analysis, as 73 cases had UTI or gross proteinuria and in 2 cases ACR was more than 300 mg/g. As such, 110 cases were valid for analysis.   One hundred ten newly detected diabetes mellitus cases were studied.   Table-1: Clinical and biochemical characteristics of total study subjects (n=110)     Only diastolic blood pressure was significantly higher in the microalbuminuric patients (p< 0.005).       In this study efforts were made to detect risk factors in the development of microalbuminuria in newly detected diabetes mellitus cases. A cross sectional study conducted in USA also found strong association of microalbuminuria with high blood pressure.20 Other studies conducted in different countries have also found an association of microalbuminuria with hypertension.16,17-19 Increases in intraglomerular capillary pressure are thought to cause leakage of albumin.21 Clinically microalbuminuria may be an indicator of early vascular complication of hypertension.20 Signs of early endothelial dysfunction as manifested by microalbuminuria may herald impending renal impairment and may offer another focus for treatment.20 Waist circumference was not associated with microalbuminuria (p=0.16). In a study conducted in USA, large waist was not associated with microalbuminuria20 but other studies conducted in Europe23 and other places11,12 showed a significant association. The small sample size genetic factors and different cut-off points for abnormal value of waist circumference in this study may be the cause of the different findings and further studies with larger sample size is necessary to substantiate the findings. No relationship was found between serum triglyceride or serum HDL with microalbuminuria. Other studies also showed similar results.20,22 No association was found between the hip-circumference and microalbuminuria or waist hip ratio with microalbuminuria. One study in the Korean population22 found association of microalbuminuria with waist hip ratio. Ethnic differences may be an explanatory factor for these differences. In this study no association was seen between microalbuminuria and BMI. BMI was associated with microalbuminuria in previous studies25,26  but not in recent ones.27  No significant association was found in respect to age, sex, weight, height with microalbuminuria. Use of antihypertensive drugs did not show any type of correlation with microalbuminuria. This finding may be due to inadequate treatment of hypertension. Conclusion   1.   Vijay V, Seena R, Lalithas et al. Significance of microalbuminuria at diagnosis of type 2 diabetes. Int J Diab Dev Countries 1998; 18: 5-6. 3.   Dinneen SF, Gerstein HS. The association of microalbuminuria and mortality in non-insulin-dependent diabetes mellitus. A systematic overview of the literature. Arch Intern Med 1997; 157: 1413-1418. 5.   Pedrinelli R, Dell’Omo G, Giampietro O, Giorgi D, Di Bello V, Bandinelli S et al. Dissociation between albuminuria and insulinaemia in hypertensive and atherosclelotic men. J Hum Hypertens 1999; 13:    129-134. 7.   Knight EL, Kramer HM, Curhan GC. High-normal blood pressure and microalbuminuria. Am J Kidney Dis 2003; 41: 588-595. 9.   Basdevant A, Cassuto D, Gibaut T, Raison J, Guy-Gand B. Microalbuminuria and body fat distribution in obese subject. Int J Obese Relat Metab Disord 1994; 18: 806-811. 11.Hoffmann IS, Jimenez E, Cubeddu LX. Urinary albumin excretion in lean, overweight and obese glucose tolerant individuals: its relationship with dyslipidaemia, hyperinsulinaemia and blood pressure. J Hum Hyperts 2001; 15: 407-412. 13.Chen J, Muntner P, Humm LL, Jones DW, Batuman V, Fonseca V et al. The metabolic syndrome and chronic kidney disease in US adults. Ann Intern Med 2004; 140: 167-174. 15.Chan J, Muntner P, Hamm L, Jones D, Batuman V, Fonseca V et al. The metabolic syndrome and chronic kidney disease in US adults. Ann Intern Med 2004; 140: 167-174. 17.Liese AD, Hense HN, Doring A, Stieber J, Keil U. Microalbuminuria, central adiposity and hypertension in the non-diabetic urban population of MONICA Augsburg Survey 1994/95. J Hum Hypertensions 2001; 15: 799-804. 19.Jiang X, Srinivasan SR, Radhakrishnamurthy B, Dalferes ER Jr, Bao N, Berenson GS. Microalbuminuria in young adults related to blood pressure in a biracial (black-white) population. The Bogalusa Heart Study. Am J Hypertension 1994; 7: 794-800. 21.Brenner BM. Hemodynamically mediated glomarular injury and the progressive nature of kidney disease. Kidney Int 1983; 23: 647-655. 23.Bonnet F, Marre M, Halimi J et al. Waist circumference and the metabolic syndrome predict the development of elevated albuminuria in non diabetic subjects: the DESIR study. Journal of Hypertension 2006; 24: 1157-1163. 25.Valensi P, Assayag M, Busby M et al. Microalbuminuria in obese patients with or without hypertension. Int J Obesity Relat Metab Disorders 1996; 20: 574-579. 27.Pascual JM, Rodi Ua E, Gonzalez C, Perez-Hoyoss et al. Long-term impact of systolic blood pressure and glycemia on the development of microalbuminuria in essential hypertension. Hypertension 2005; 45: 1125-1130. 2026 Ibrahim Medical College. All rights reserved.