Correlation between soluble receptor for advanced glycation end products levels and coronary artery disease in postmenopausal nondiabetic women

BACKGROUND The established cardiovascular risk factors cannot explain the overall risk of coronary artery disease(CAD),especially in women.Therefore,there is a growing need for the assessment of novel biomarkers to identify women at risk.The receptor for advanced glycation end products(RAGE)and its interaction with the advanced glycation end product(AGE)ligand have been associated with atherogenesis.The soluble fraction of RAGE(sRAGE)antagonizes RAGE signaling and exerts an antiatherogenic effect.AIM The study aim was to explore the association between plasma levels of sRAGE and CAD in nondiabetic postmenopausal women.METHODS This case-control study included 110 nondiabetic postmenopausal women who were enrolled in two groups.Group I included 55 angiographically proven CAD subjects with>50%stenosis in at least one of the major coronary arteries and Group II included 55 healthy control women who did not have CAD or had<50%stenosis of the coronary arteries.Stenosis was confirmed by invasive angiography.Plasma sRAGE was determined by an enzyme-linked immunosorbent assay.RESULTS We observed significantly lower plasma sRAGE concentrations in subjects with CAD vs healthy controls(P<0.05).Univariate and multivariate logistic regression analysis also revealed a significant correlation between plasma sRAGE levels and CAD(P=0.01).Multivariate odds ratios for CAD revealed that subjects with sRAGE concentrations below 225 pg/mL(lowest quartile)had a 6-fold increase in CAD prevalence independent of other risk factors.CONCLUSION Our findings indicated that low sRAGE levels were independently associated with CAD in nondiabetic postmenopausal women.Risk assessment of CAD in postmenopausal women can be improved by including sRAGE along with other risk factors.

Clinicopathological Features of Nondiabetic Renal Diseases from Different Age Groups:An Observational Cross-sectional Study

Background:Diabetes mellitus (DM)has become the leading cause of chronic kidney disease (CKD).Nondiabetic renal diseases (NDRDs) have different clinicopathological features and prognosis from those of diabetic nephropathy.Our study sought to analyze the clinical and pathological features of NDRDs,in different age groups through a cross-sectional study. Methods:All patients with type 2 DM at our center who underwent renal biopsy between March 1997 and March 2017 were screened and divided into three groups by age:Group 1 (youth group),18-44 years old;Group 2 (middle-aged group),45-59 years old;and Group 3 (elderly group),≥60 years old.We analyzed the clinicopathological data and risk factors by univariate and multivariate logistic regression for NDRD of the patients to identify the features of NDRD in different age groups. Results:We included 982 patients in the final analysis.Patients with NDRD accounted for 64.4%of all patients.IgA nephropathy (IgAN) was the most common pathological pattern in young patients with NDRD,accounting for 26.3%.In the middle-aged group,the two most common pathological patterns were IgAN and membranous nephropathy.Membranous nephropathy was the most common pathological pattern in elderly patients with NDRD,accounting for 29.3%.Consistent with pathological features,glomerular hematuria is a risk factor for NDRD in Group 1 (odds ratio [OR],26.514;95%confidence interval [CI],2.503-280.910;P =0.006).On the other hand,rapidly increasing proteinuria or nephrotic syndrome is a risk factor for NDRD in Group 2 (OR,5.921;95% CI,2.061-17.013;P =0.001)and Group 3 (OR,90.409;95%CI,6.198-1318.826;P =0.001). Conclusions:This single-center study showed that the proportion and composition of NDRD differ among different age groups. Consistent with pathological features,some clinical indices such as hematuria and proteinuria showed different features among different age groups.

Multifaceted relationship between diabetes and kidney diseases:Beyond diabete

Diabetes mellitus is one of the most common causes of chronic kidney disease.Kidney involvement in patients with diabetes has a wide spectrum of clinical presentations ranging from asymptomatic to overt proteinuria and kidney failure.The development of kidney disease in diabetes is associated with structural changes in multiple kidney compartments,such as the vascular system and glomeruli.Glomerular alterations include thickening of the glomerular basement membrane,loss of podocytes,and segmental mesangiolysis,which may lead to microaneurysms and the development of pathognomonic Kimmelstiel-Wilson nodules.Beyond lesions directly related to diabetes,awareness of the possible coexistence of nondiabetic kidney disease in patients with diabetes is increasing.These nondiabetic lesions include focal segmental glomerulosclerosis,IgA nephropathy,and other primary or secondary renal disorders.Differential diagnosis of these conditions is crucial in guiding clinical management and therapeutic approaches.However,the relationship between diabetes and the kidney is bidirectional;thus,new-onset diabetes may also occur as a complication of the treatment in patients with renal diseases.Here,we review the complex and multifaceted correlation between diabetes and kidney diseases and discuss clinical presentation and course,differential diagnosis,and therapeutic opportunities offered by novel drugs.

Diabetic nephropathy:Is it time yet for routine kidney biopsy?

Diabetic nephropathy(DN)is one of the most important long-term complications of diabetes.Patients with diabetes and chronic kidney disease have an increased risk of all-cause mortality,cardiovascular mortality,and kidney failure.The clinical diagnosis of DN depends on the detection of microalbuminuria.This usually occurs after the first five years from the onset of diabetes,and predictors of DN development and progression are being studied but are not yet implemented into clinical practice.Diagnostic tests are useful tools to recognize onset,progression and response to therapeutic interventions.Microalbuminuria is an indicator of DN,and it is considered the only noninvasive marker of early onset.However,up to now there is no diagnostic tool that can predict which patients will develop DN before any damage is present.Pathological renal injury is hard to predict only with clinical and laboratory findings.An accurate estimate of damage in DN can only be achieved by the histological analysis of tissue samples.At the present time,renal biopsy is indicated on patients with diabetes under the suspicion of the presence of nephropathies other than DN.Results from renal biopsies in patients with diabetes had made possible the classification of renal biopsies in three major groups associated with different prognostic features:diabetic nephropathy,non-diabetic renal disease(NDRD),and a superimposed non-diabetic condition on underlying diabetic nephropathy.In patients with type 2 diabetes with a higher degree of suspicion for NDRD,it is granted the need of a renal biopsy.It is important to identify and differentiate these pathologies at an early stage in order to prevent progression and potential complications.Therefore,a more extensive use of biopsy is advisable.

Factors Associated with Increases in Glucose Levels in the Perioperative Period in Non-Diabetic Patients

Background: Blood glucose levels are elevated during the perioperative period as a result of the neuro-endocrine response to the stress of surgery. In nondiabetic patients, blood glucose levels are not a part of routine preoperative testing nor are they monitored during surgery or in the post anesthesia care unit (PACU). We measured blood glucose levels in nondiabetic patients during the perioperative period to identify how many patients had high glucose levels and what factors were associated with increases in blood glucose levels. Methods: This prospective observational study included two hundred and ninety five nondiabetic patients between the ages of 18 and 80 years, undergoing elective noncardiac surgery. Blood glucose levels were measured preoperatively and at frequent, predetermined intervals during surgery and in the PACU. Patient characteristics, surgical and anesthetic factors, and pain scores in the PACU were recorded, as were postoperative complications. Results: Forty nine percent (49%) of the patients had maximum intraoperative glucose levels of 126 mg/dl or higher and fifty three percent (53%) had maximum postoperative glucose levels of 126 mg/dl or higher. Preoperative glucose levels, family history of diabetes and amount of blood loss were statistically significantly associated with both max-intra-op and max-post-op glucose levels. Additionally, blood administration, surgery duration and race were significantly associated with max-intra-op glucose levels, while amount of intravenous fluids and sex were significantly associated with max-post-op glucose levels. Conclusion: A large number of nondiabetic patients in our study had maximum glucose levels >126 mg/dl in the perioperative period. Certain patient characteristics, as well as surgical/anesthetic factors, were associated with increases in the glucose levels. More studies are indicated to determine which patients may benefit from glucose monitoring in the perioperative period.