Objectives: The aim of this study was to determine the prevalence of MetS among different African populations using the new Joint Statement Criteria. Hereafter we aimed to determine whether waist or neck circumference is the best predictor of MetS risk after ethnic, gender and age-specific cut-points were developed. Lastly, we aimed to determine whether afore-mentioned cut-point can predict albumin:creatinine ratio as a marker of target organ damage. Methods: The study sample (N=409) comprised of urban African (men, N=101; women, N=99) and Caucasian (men, N=101; women, N=108) teachers from the Dr. Kenneth Kaunda Education district in the North-West Province, South Africa. Participants were aged between 25 and 65 years. Anthropometric measurements, albumin:creatinine ratio and other markers of the metabolic syndrome (MetS) (systolic and diastolic blood pressure [SBP and DBP], glucose, triglycerides [TG] and high density lipoprotein [HDL]) were determined. Results: Africans (65 and 63 % for men and women) and Caucasian men (73%) showed high prevalence of MetS; ROC analysis determined neck circumference (NC) cut-points of 39 and 35 cm for young and older African men, 32 and 35 cm for young and older African women, 40 and 41 cm for Caucasian men and 34 and 33 cm for Caucasian women. This NC cut-point can be used to determine metabolic syndrome risk in all groups, except in African women; ROC developed waist circumference (WC) cut-points were 91 cm for all African male groups, 84, 81 and 84 cm for young, older and total group of African women. Suggested WC cut-points for Caucasian men were 93 cm for the young group and 97 cm for older as well as total Caucasian male groups, while cut-points for Caucasian women were 87 cm, 79 cm and 84 cm for young, older and total Caucasian women. These WC cut-points were good measures of metabolic syndrome risk in all groups; neither cut-point of WC nor NC could increase the risk of albumin:creatinine ratio. Conclusion: African women as a group present with few MetS risk factors and glucose is associated with renal function risk in Africans; NC cut-points may be used as an additional anthropometric marker to predict the metabolic syndrome in a South African cohort, but not in African women; WC cutpoints demonstrated to be good predictors of the metabolic syndrome in the same South African cohort, especially among men; WC would seem to be the best measure of MetS risk in all African populations, although NC can also be used for this purpose in all African populations, except in African women. / Thesis (PhD (Human Movement Science))--North-West University, Potchefstroom Campus, 2012

Hypertension is associated with end organ damage (EOD). Since EOD is a risk factor for cardio- and cerebrovascular complications, it is a major requirement for these to be detected, prevented and treated. A total of 147 consecutive patients with newly-diagnosed essential hypertension and attending the outpatient clinic were included in this study based on a set of inclusion and exclusion criteria (patients with co-morbid illnesses were excluded from the investigation). Among them, 86% (70 male (M) and 56 female (F)) had one or more EODs, an observation which was very close to statistically significance (P=0.054). The presence of one or more EODs in newly-detected hypertension indicates widespread vascular damage which carries the high risk for cardio- and cerebrovascular morbidity and mortality. Although thyroid dysfunctions exert significant effects on blood pressure (BP), published literature available has revealed contradictory data. Objective of our study was to explore the inter-relationships between selected thyroid dysfunctional status (hyper and hypothyroid) and established biomarkers [thyroid stimulating hormone (TSH) and thyroxine (T4)]; and BP components [specifically Systolic BP (SBP), Diastolic BP (DBP), and Mean Arterial Pressure (MAP), and uniquely SBP:DBP ratio]. We followed rigid criteria in order to select adults with hyperthyroidism (n=71) and hypothyroidism (n=300), together with healthy age-matched controls (n =300), and applied a series of statistical analyses on the datasets acquired. We have observed thyroid dysfunctional status is associated with elevated BP, and increasing BP is positively-correlated with elevated serum thyroid biomarkers, hyper and hypothyroid disorders should be recognized and treated early in order to avoid critical hazards presented by high BP. Also, we have studied awareness among public and physicians in managing hypertension. Overall, the levels of knowledge and awareness among both groups are sub-optimal. Hence there is an urgent need for empowerment among both groups to enhance awareness and to bring effective standard of care.

Orientador: Luis Cuadrado Martin / Resumo: A presença de albuminúria constitui fator prognóstico desfavorável nos pacientes diabéticos do tipo 1 e precede a elevação da PA de consultório em três anos. A monitorização ambulatorial de pressão arterial (MAPA) pode identificar a atenuação ou desaparecimento do descenso noturno, o que prediz o risco cardiovascular, independentemente da pressão arterial de 24 h. Entretanto, apenas um estudo avaliou o papel preditivo da atenuação do descenso noturno para o desenvolvimento da albuminúria no diabetes do tipo 1. Assim, o objetivo do corrente trabalho é de avaliar, em coorte brasileira, se o descenso noturno atenuado pode predizer o desenvolvimento de albuminúria no diabetes do tipo 1. Foi realizado estudo observacional prospectivo que visou avaliar o poder preditivo da ausência ou atenuação do descenso noturno em relação ao surgimento de albuminúria em pacientes diabéticos tipo 1 normoalbuminúricos. Os pacientes foram submetidos à MAPA e dosada a albuminúria por mais de 2 vezes. Ao cabo de um ano a albuminúria foi reavaliada. A frequência de evolução para albuminúria ente os pacientes com descenso noturno ausente/atenuado ou presente foi comparada pelo teste de Fisher. As médias de pressão arterial (PA) foram comparadas por teste "t" para amostras independentes. Foi realizada regressão linear para avaliar a associação entre descenso noturno e elevação da albuminúria no seguimento. O nível de significância foi estabelecido em 5 %. Foram avaliados 24 pacientes com idade de 24 ±8,... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

A avaliação de microalbuminúria (MA) é frequentemente utilizada em medicina humana para o diagnóstico precoce de doença renal precoce em humanos que pode evoluir concomitantemente durante o curso de várias outras afecções. Quando a doença renal progride para insuficiência renal, a albuminúria pode atingir concentrações elevadas (>30 mg/dL), que recebe, neste momento, a denominação de macroalbuminúria, que, por sua vez, resulta em proteinúria maciça. A coexistência de hipertensão arterial sistêmica pode acelerar a progressão da doença. Em Medicina Veterinária, não há relatos sobre a magnitude desta albuminúria em cães já diagnosticados com insuficiência renal crônica (IRC) como também sobre o grau de coexistência de hipertensão, parâmetros estes que constituíram o escopo do presente estudo. As concentrações urinárias de albumina, detectadas pela técnica ELISA, foram determinadas em 40 cães com IRC e em 40 cães sadios (controles). As pressões sangüíneas sistólicas também foram mensuradas para comparações. A concentração de albumina normalizada (AN), relação albumina:creatinina (RAC) e relação proteína:creatinina (RPC) foram calculadas para todos os cães. Todos os cães controles apresentaram valores abaixo da faixa de microalbuminúria para ambos os índices (AN e RAC).. Nos cães com IRC, 42,5% e 65% apresentaram-se dentro da faixa microalbuminúrica segundo seus valores de AN e RAC, respectivamente. Um aumento gradual nos valores de RPC foi seguido por um aumento igualmente gradual nos valores de RAC. Similarmente, um aumento nos valores de RAC foi acompanhado por um aumento na porcentagem de cães doentes com hipertensão, a qual compreendeu de 87,5 % e 85,7% dos cães macroalbuminúricos, segundo seus valores de AN e RAC, respectivamente. Finalmente, os cães com IRC hipertensos (> 180 mmHg de pressão sistólica) apresentaram valores mais altos de RAC que os cães não hipertensos (P = 0,023). Portanto, como primeiro relato na literatura veterinária, foi demonstrado que a hipertensão pode exercer um efeito adverso sobre o rim de cães com IRC, similarmente ao que é observado na medicina humana. / Detection of microalbuminuria (MA) is commonly recommended by human clinicians to diagnose early renal disease in people presenting different diseases. When kidney disease has progressed to renal failure, albuminuria can reach higher levels (>30 mg/dL), considering that stage as macroalbuminuria, which, in turn, eventually results in overt proteinuria. In veterinary medicine, no data related to what levels of albuminuria can be observed in dogs with chronic renal failure (CRF), as well as the degree of correlation with systemic hypertension, is available, being therefore, the scope of this study. Urinary albumin concentrations, detected by ELISA, were determined in 40 dogs with CRF and 40 healthy dogs (controls). Arterial pressures were registered for comparisons. Normalized albumin concentrations (NAC), urinary albumin to urinary creatinine ratio (UAC) and urinary protein to urinary creatinine ratio (UPC) were calculated for all dogs. All control dogs were below the microalbuminuric range for both parameters. In dogs with CRF, 42,5% and 65% were within the microalbuminuric range based on their AN and UAC values, respectively. A gradual increase in the level of UPC was followed by an also gradual increase in UAC values. Similarly, an increase in the UAC values was accompanied by an increase of the percentage of dogs with hypertension, which affected 87,5 % and 85.7% of the macroalbuminuric CRF dogs, according to their AN and RAC values, respectively. Finally, hypertensive CRF dogs (>180 mmHg mean systolic pressure) had greater UAC values than normotensive CRF dogs (P = 0.023). Thus, for the first time in veterinary literature, it is shown that hypertension seems to exert an adverse effect on renal function of CRF dogs, similarly to what is observed in human medicine.

Objectives: The aim of this study was to determine the prevalence of MetS among different African populations using the new Joint Statement Criteria. Hereafter we aimed to determine whether waist or neck circumference is the best predictor of MetS risk after ethnic, gender and age-specific cut-points were developed. Lastly, we aimed to determine whether afore-mentioned cut-point can predict albumin:creatinine ratio as a marker of target organ damage. Methods: The study sample (N=409) comprised of urban African (men, N=101; women, N=99) and Caucasian (men, N=101; women, N=108) teachers from the Dr. Kenneth Kaunda Education district in the North-West Province, South Africa. Participants were aged between 25 and 65 years. Anthropometric measurements, albumin:creatinine ratio and other markers of the metabolic syndrome (MetS) (systolic and diastolic blood pressure [SBP and DBP], glucose, triglycerides [TG] and high density lipoprotein [HDL]) were determined. Results: Africans (65 and 63 % for men and women) and Caucasian men (73%) showed high prevalence of MetS; ROC analysis determined neck circumference (NC) cut-points of 39 and 35 cm for young and older African men, 32 and 35 cm for young and older African women, 40 and 41 cm for Caucasian men and 34 and 33 cm for Caucasian women. This NC cut-point can be used to determine metabolic syndrome risk in all groups, except in African women; ROC developed waist circumference (WC) cut-points were 91 cm for all African male groups, 84, 81 and 84 cm for young, older and total group of African women. Suggested WC cut-points for Caucasian men were 93 cm for the young group and 97 cm for older as well as total Caucasian male groups, while cut-points for Caucasian women were 87 cm, 79 cm and 84 cm for young, older and total Caucasian women. These WC cut-points were good measures of metabolic syndrome risk in all groups; neither cut-point of WC nor NC could increase the risk of albumin:creatinine ratio. Conclusion: African women as a group present with few MetS risk factors and glucose is associated with renal function risk in Africans; NC cut-points may be used as an additional anthropometric marker to predict the metabolic syndrome in a South African cohort, but not in African women; WC cutpoints demonstrated to be good predictors of the metabolic syndrome in the same South African cohort, especially among men; WC would seem to be the best measure of MetS risk in all African populations, although NC can also be used for this purpose in all African populations, except in African women. / Thesis (PhD (Human Movement Science))--North-West University, Potchefstroom Campus, 2012

A avaliação de microalbuminúria (MA) é frequentemente utilizada em medicina humana para o diagnóstico precoce de doença renal precoce em humanos que pode evoluir concomitantemente durante o curso de várias outras afecções. Quando a doença renal progride para insuficiência renal, a albuminúria pode atingir concentrações elevadas (>30 mg/dL), que recebe, neste momento, a denominação de macroalbuminúria, que, por sua vez, resulta em proteinúria maciça. A coexistência de hipertensão arterial sistêmica pode acelerar a progressão da doença. Em Medicina Veterinária, não há relatos sobre a magnitude desta albuminúria em cães já diagnosticados com insuficiência renal crônica (IRC) como também sobre o grau de coexistência de hipertensão, parâmetros estes que constituíram o escopo do presente estudo. As concentrações urinárias de albumina, detectadas pela técnica ELISA, foram determinadas em 40 cães com IRC e em 40 cães sadios (controles). As pressões sangüíneas sistólicas também foram mensuradas para comparações. A concentração de albumina normalizada (AN), relação albumina:creatinina (RAC) e relação proteína:creatinina (RPC) foram calculadas para todos os cães. Todos os cães controles apresentaram valores abaixo da faixa de microalbuminúria para ambos os índices (AN e RAC).. Nos cães com IRC, 42,5% e 65% apresentaram-se dentro da faixa microalbuminúrica segundo seus valores de AN e RAC, respectivamente. Um aumento gradual nos valores de RPC foi seguido por um aumento igualmente gradual nos valores de RAC. Similarmente, um aumento nos valores de RAC foi acompanhado por um aumento na porcentagem de cães doentes com hipertensão, a qual compreendeu de 87,5 % e 85,7% dos cães macroalbuminúricos, segundo seus valores de AN e RAC, respectivamente. Finalmente, os cães com IRC hipertensos (> 180 mmHg de pressão sistólica) apresentaram valores mais altos de RAC que os cães não hipertensos (P = 0,023). Portanto, como primeiro relato na literatura veterinária, foi demonstrado que a hipertensão pode exercer um efeito adverso sobre o rim de cães com IRC, similarmente ao que é observado na medicina humana. / Detection of microalbuminuria (MA) is commonly recommended by human clinicians to diagnose early renal disease in people presenting different diseases. When kidney disease has progressed to renal failure, albuminuria can reach higher levels (>30 mg/dL), considering that stage as macroalbuminuria, which, in turn, eventually results in overt proteinuria. In veterinary medicine, no data related to what levels of albuminuria can be observed in dogs with chronic renal failure (CRF), as well as the degree of correlation with systemic hypertension, is available, being therefore, the scope of this study. Urinary albumin concentrations, detected by ELISA, were determined in 40 dogs with CRF and 40 healthy dogs (controls). Arterial pressures were registered for comparisons. Normalized albumin concentrations (NAC), urinary albumin to urinary creatinine ratio (UAC) and urinary protein to urinary creatinine ratio (UPC) were calculated for all dogs. All control dogs were below the microalbuminuric range for both parameters. In dogs with CRF, 42,5% and 65% were within the microalbuminuric range based on their AN and UAC values, respectively. A gradual increase in the level of UPC was followed by an also gradual increase in UAC values. Similarly, an increase in the UAC values was accompanied by an increase of the percentage of dogs with hypertension, which affected 87,5 % and 85.7% of the macroalbuminuric CRF dogs, according to their AN and RAC values, respectively. Finally, hypertensive CRF dogs (>180 mmHg mean systolic pressure) had greater UAC values than normotensive CRF dogs (P = 0.023). Thus, for the first time in veterinary literature, it is shown that hypertension seems to exert an adverse effect on renal function of CRF dogs, similarly to what is observed in human medicine.

Submitted by Bruno Alves Silva (bruno-alves85@hotmail.com) on 2018-03-09T03:49:48Z No. of bitstreams: 1 modelo tese .pdf: 800649 bytes, checksum: 2fda907f3035e22e2a929fbb1d961881 (MD5) / Rejected by Luciana Pizzani null (luciana@btu.unesp.br), reason: Necessário fazer as seguintes correções no arquivo submetido: problema 1: ficha catalográfica A ficha deve ser incluída no arquivo PDF logo após a folha de rosto do seu trabalho. A submissão deve ser feita em arquivo único em formato PDF. Assim que tiver efetuado a correção submeta o arquivo em PDF novamente. Agradecemos a compreensão. on 2018-03-09T11:39:13Z (GMT) / Submitted by Bruno Alves Silva (bruno-alves85@hotmail.com) on 2018-03-09T14:28:30Z No. of bitstreams: 1 modelo tese 090318.pdf: 830156 bytes, checksum: 9f398d00113918a6efa0118851bebbe4 (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-03-09T20:34:16Z (GMT) No. of bitstreams: 1 silva_ba_me_bot.pdf: 830156 bytes, checksum: 9f398d00113918a6efa0118851bebbe4 (MD5) / Made available in DSpace on 2018-03-09T20:34:16Z (GMT). No. of bitstreams: 1 silva_ba_me_bot.pdf: 830156 bytes, checksum: 9f398d00113918a6efa0118851bebbe4 (MD5) Previous issue date: 2018-02-23 / A presença de albuminúria constitui fator prognóstico desfavorável nos pacientes diabéticos do tipo 1 e precede a elevação da PA de consultório em três anos. A monitorização ambulatorial de pressão arterial (MAPA) pode identificar a atenuação ou desaparecimento do descenso noturno, o que prediz o risco cardiovascular, independentemente da pressão arterial de 24 h. Entretanto, apenas um estudo avaliou o papel preditivo da atenuação do descenso noturno para o desenvolvimento da albuminúria no diabetes do tipo 1. Assim, o objetivo do corrente trabalho é de avaliar, em coorte brasileira, se o descenso noturno atenuado pode predizer o desenvolvimento de albuminúria no diabetes do tipo 1. Foi realizado estudo observacional prospectivo que visou avaliar o poder preditivo da ausência ou atenuação do descenso noturno em relação ao surgimento de albuminúria em pacientes diabéticos tipo 1 normoalbuminúricos. Os pacientes foram submetidos à MAPA e dosada a albuminúria por mais de 2 vezes. Ao cabo de um ano a albuminúria foi reavaliada. A frequência de evolução para albuminúria ente os pacientes com descenso noturno ausente/atenuado ou presente foi comparada pelo teste de Fisher. As médias de pressão arterial (PA) foram comparadas por teste "t" para amostras independentes. Foi realizada regressão linear para avaliar a associação entre descenso noturno e elevação da albuminúria no seguimento. O nível de significância foi estabelecido em 5 %. Foram avaliados 24 pacientes com idade de 24 ±8,2 anos, seis pacientes do sexo masculino. Seis pacientes tinham descenso noturno presente para PA sistólica (PAS) (média de PAS em 24 h: 119±7,5mmHg) destes, apenas um evoluiu para albuminúria. Dos 18 que tinham descenso noturno atenuado para PAS (média de PAS em 24 h: 122±8,4mmHg; p=0,36 em relação aos pacientes descenso noturno presente), 14 evoluíram para albuminúria (p=0,01). Em relação à PA diastólica (PAD), 12 pacientes tinham descenso noturno presente (média de PAD em 24 h: 72±5,2mmHg), destes, 6 evoluíram para albuminúria. Dos outros 12 que tinham descenso noturno ausente (média de PAD em 24 h: 74±5,6mmHg; p=0,31 em relação aos pacientes com descenso noturno presente), 9 evoluíram com microalbuminúria (p=0,40). A porcentagem de descenso noturno da PAS apresentou coeficiente de correlação com a variação da albuminúria de 0,40; p= 0,061. A porcentagem de descenso noturno da PAD apresentou coeficiente de correlação com a variação da albuminúria de 0,46; p=0,027. Em conclusão, a evolução para albuminúria associou-se à classificação descenso noturno atenuado para PAS, mesmo com PAS em 24 horas normal. Ou seja, a atenuação do descenso noturno para PAS precedeu o início da nefropatia diabética incipiente no diabetes do tipo 1. Estes resultados ressaltam a importância da realização da MAPA no momento do diagnóstico, e no seguimento, dos pacientes diabéticos tipo 1. / The presence of albuminuria constitutes an unfavorable prognosis in type 1 diabetic patients and precedes an increase in office BP in three years. Ambulatory blood pressure monitoring (ABPM) can identify an attenuation or disappearance of noc-turnal descent, which predicts cardiovascular risk, regardless of blood pressure of 24 h. There is no type 1 diabetes. Thus, the objective of the current evaluation work, in a Brazilian cohort, whether the attenuated nocturnal decline may predict the devel-opment of albuminuria in type 1 diabetes. A prospective observational study was carried out to evaluate the predictive power of the absence or attenuation of the noc-turnal descent in relation to the appearance of albuminuria in type 1 diabetic normoalbuminuric patients. The patients were submitted to ABPM and dosed albu-minuria by more than 2 times. After one year and albuminuria for reassessment. The frequency of progression to albuminuria in patients with absent / attenuated or pre-sent nocturnal descent was compared by Fisher's test. Blood pressure (BP) averag-es were compared by "t" test for independent samples. Linear regression was per-formed to evaluate an association between nocturnal descent and elevated albumi-nuria at follow-up. The level of significance was set at 5%. Twenty-four patients, aged 24 ± 8.2 years, six male patients were evaluated. Six pa-tients had a nocturnal decrease in systolic BP (SBP) (mean SBP in 24 h: 119 ± 7.5 mmHg), only one had progressed to albuminuria. Of the 18 patients who had an at-tenuated nocturnal decrease in SBP (mean SBP at 24 h: 122 ± 8.4 mmHg, p = 0.36 in relation to the patients present at night), 14 developed albuminuria (p = 0.01). In relation to the diastolic BP (DBP), 12 patients had nocturnal decrease present (mean DBP in 24 h: 72 ± 5.2 mmHg), of these, 6 evolved into albuminuria. Of the 12 others who had a nocturnal descent absent (mean PAD at 24 h: 74 ± 5.6 mmHg, p = .31 compared to patients with nocturnal decrease), 9 developed microalbuminuria (p = 0.40). The percentage of nocturnal SBP decrease had a correlation coefficient with albuminuria variation of 0.40; p = 0.061. The percentage of nocturnal decrease in DBP presented a correlation coefficient with albuminuria variation of 0.46; p = 0.027. In conclusion, the progression to albuminuria was associated with an attenuated nocturnal descent for SBP, even with SBP at normal 24 hours. That is, attenuation of nocturnal descent into SBP preceded the onset of incipient diabetic nephropathy in type 1 diabetes. These results suggest that ABPM should be performed at the time of diagnosis and follow-up of type 1 diabetic patients.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20987号 / 医博第4333号 / 新制||医||1027(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊達 洋至, 教授 長船 健二, 教授 一山 智 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

<p>Objective - To correlate blood pressure and inflammatory markers with urine albumin analysed with a point-of-care testing (POCT) instrument, nephelometric determination of albumin and creatinine related urine albumin in elderly males.</p><p>Methods and Results - The study population consisted of 103 diabetic and 603 nondiabetic males (age 77 years) in a cross-sectional study in central Sweden. We analyzed urine albumin with a HemoCue® Urine Albumin POCT instrument and a ProSpec® nephelometer and creatinine related urine albumin. There were strong correlation between both systolic and diastolic blood pressure and all three urine albumin methods (p<0.0001). There were also significant correlations between the different urine albumin measurements and SAA, hsCRP and IL-6.</p><p>Conclusions - Hypertension has a strong impact on hyperfiltration in diabetic and nondiabetic elderly males.</p>

Background: We aimed to assess the point prevalence of microalbuminuria (MAU) in a sample of unselected consecutive primary-care attendees, with particular focus on patients with diabetes mellitus (with and without additional concomitant diseases) and those with hypertension. Design: Cross-sectional observational study in a nationwide representative sample of 1912 primary-care practices and a patient population consisting of 39 125 primary-care attendees. Diagnoses for diabetes, hypertension and co-morbidities were provided by the treating physician and complemented by blood pressure (BP) measurements and selected lab tests. Screening for microalbuminuria (>20 and <200 μg/ml) was done with a spot urine dipstick test. Results: The clinical diagnosis of nephropathy was assigned to 7.6% of patients. The point prevalence of MAU was 19.0% in the total sample; the proportion was 33.6% in diabetics whereas the diagnosis was assigned to only 7.1% in the total sample. Amongst diabetic patients with MAU, 92.6% had BP above the target value of < 130/80 mmHg. Frequency rates rose with increasing BP (e.g. 20.6% in diabetic patients with BP< 120/70 mmHg, and 36.3% in diabetic patients with BP > 140/90 mmHg). Of note, patients with MAU had a higher burden of co-morbidity compared to those without MAU. Conclusions: We found a high prevalence of MAU in primary care, particularly in diabetic patients. The frequency of MAU was closely related to the BP level and the degree of co-morbidity. The present study underlines the magnitude of the problem of MAU in primary care, and should serve as a starting point to initiate measures to address this important public health issue.