Abstract: Essential hypertension (HTN) usually clusters with other cardiovascular risk factors such as age, overweight, diabetes, insulin resistance and dyslipidemia. The target organ damage (TOD) such as left ventricular hypertrophy, microalbuminuria (MA), acute coronary syndrome (ACS), stroke and cognitive dysfunction takes place early in course of hypertension. Though the prevalence of hypertension is high in India, the relationship between microalbuminuria and target organ damage in hypertension is not well studied. This study aim at detecting MA in essential hypertension and its relation to severity of HTN, duration of HTN, body mass index (BMI), age and TOD such as HTN retinopathy and acute coronary syndrome The present study was done in 100 patients of essential hypertension non diabetics admitted to B.L.D.E.University-s Sri B.M.Patil Medical College, Bijapur, from October 2008 to April 2011. The patients underwent detailed history and clinical examination. Early morning 5 ml of urine sample was collected & MA was estimated by immunoturbidometry method. The relationship of MA with the duration & severity of HTN, BMI, age, sex and TOD's like hypertensive retinopathy, ACS was assessed by univariate analysis. The prevalence of MA in this study was found to be 63 %. In that 42% were male & 21% were female. In this study a significant association between MA and the duration of hypertension (p = 0.036) & (OR =0.438). Longer the duration of hypertension, more possibility of microalbumin in urine. Also there was a significant association between severity of hypertension and MA (p=0.045) and (OR=0.093). MA was positive in 50 (79.4%) patients out of 63, whose blood pressure was >160/100 mm Hg. In this study a significant association between MA and the grades of hypertensive retinopathy (p =0.011) and acute coronary syndrome (p = 0.041) (OR =2.805). Gender and BMI did not pose high risk for MA in this study.The prevalence of MA in essential hypertension is high in this part of the community and MA will increase the risk of developing target organ damage.Early screening of patients with essential hypertension for MA and aggressive management of positive cases might reduce the burden of chronic kidney diseases and cardiovascular diseases in the community.
Abstract: Human immunodeficiency virus infection and
acquired immunodeficiency syndrome is a global pandemic with
cases reporting from virtually every country and continues to be a
common infection in developing country like India.
Microalbuminuria is a manifestation of human immunodeficiency
virus associated nephropathy. Therefore, microalbuminuria may be
an early marker of human immunodeficiency virus associated
nephropathy, and screening for its presence may be beneficial. A
strikingly high prevalence of microalbuminuria among human
immunodeficiency virus infected patients has been described in
various studies. Risk factors for clinically significant proteinuria
include African - American race, higher human immunodeficiency
virus ribonucleic acid level and lower CD4 lymphocyte count. The
cardiovascular risk factors of increased systolic blood pressure and
increase fasting blood sugar level are strongly associated with
microalbuminuria in human immunodeficiency virus patient. These
results suggest that microalbuminuria may be a sign of current
endothelial dysfunction and micro-vascular disease and there is
substantial risk of future cardiovascular disease events. Positive
contributing factors include early kidney disease such as human
immunodeficiency virus associated nephropathy, a marker of end
organ damage related to co morbidities of diabetes or hypertension,
or more diffuse endothelial cells dysfunction. Nevertheless after
adjustment for non human immunodeficiency virus factors, human
immunodeficiency virus itself is a major risk factor. The presence of
human immunodeficiency virus infection is independent risk to
develop microalbuminuria in human immunodeficiency virus patient.
Cardiovascular risk factors appeared to be stronger predictors of
microalbuminuria than markers of human immunodeficiency virus
severity person with human immunodeficiency virus infection and
microalbuminuria therefore appear to potentially bear the burden of
two separate damage related to known vascular end organ damage
related to know vascular risk factors, and human immunodeficiency
virus specific processes such as the direct viral infection of kidney
cells.The higher prevalence of microalbuminuria among the human
immunodeficiency virus infected could be harbinger of future
increased risks of both kidney and cardiovascular disease. Further
study defining the prognostic significance of microalbuminuria
among human immunodeficiency virus infected persons will be
essential. Microalbuminuria seems to be a predictor of cardiovascular
disease in diabetic and non diabetic subjects, hence it can also be
used for early detection of micro vascular disease in human
immunodeficiency virus positive patients, thus can help to diagnose
the disease at the earliest.