Marcia Murussi

High‐normal levels of albuminuria predict the development of micro‐ and macroalbuminuria and increased mortality in Brazilian Type 2 diabetic patients: an 8‐year follow‐up study

Aim  To analyse the risk factors for the development of micro‐ and macroalbuminuria and mortality rates in a cohort of normoalbuminuric Type 2 diabetes mellitus (DM) patients.

Detecção precoce da nefropatia diabética

Due to the unfavorable prognosis of advanced stages of diabetic nephropathy (DN), the ideal approach is to identify renal involvement as early as possible. It is recommended to measure urinary albumin excretion (UAE) annually, in random urine samples, in order to detect the stages of DN [microalbuminuria (UAE 17-174 mg/l or 30-300 mg albumin/g of creatinine) and macroalbuminuria (> 174 mg/l or > 300 mg/g)]. However, it has been suggested that UAE levels below the threshold of consensus could already signal the risk for DN progression and increased mortality, indicating the need to revise cutoff values. As a substantial amount of UAE (the immunounreactive fraction), is not detected by conventional methods, HPLC would be more sensitive to identify the presence of damage by measuring total UAE (immunoreactive + immunounreactive). Another recent observation is that diminished glomerular filtration rates (GFR) occurs in the presence of normoalbuminuria. Therefore, besides evaluating UAE, it is recommended to estimate GFR with equations employing creatinine; such as the Modification of Diet in Renal Disease (MDRD) study, available at www.mdrd.com. Owing to the known limitations of creatinine, alternative endogenous markers are being studied, and cystatin-C is a promising marker under investigation. Finally, new strategies that could detect DN even earlier, include biomarkers such as proteomics, defining a profile of urinary protein excretion able to identify the subsequent risk of renal disease.

Nefropatia diabética no diabete melito tipo 2: fatores de risco e prevenção

ABSTRACT Diabetic Nephropathy in Type 2 Diabetes Mellitus: Risk Factors and Prevention.Diabetic nephropathy (DN) is responsible for the increasing number ofpatients on dialysis in developing countries, and is already the most commoncause of renal replacement therapy in the developed ones. In this manu-script, we review the risk factors and point out strategies to prevent thismicrovascular complication in type 2 diabetic patients (DM2). There are someknown genetic and non-genetic risk factors related to the development andprogression of DN in DM2 patients. Candidate genes have been analysed, butthere are still controversy about the genetic markers of the disease. Recog-nized non-genetic risk factors are poor glycemic, pressoric and lipidic control.Additionally, it has been suggested that the presence of diabetic retinopathy,autonomic neuropathy, smoking habit, higher protein ingestion, and highernormal levels of albuminuria (even within the normal range) are associatedwith an increased risk of developing DN. Some strategies have been investi-gated and proved to prevent or at least to postpone DN, such as to controlblood pressure, glycemic levels and dyslipidemia. Furthermore, angiotensin-converting enzyme inhibitors and angiotensin-II blockers have independenteffects, not explained by blood pressure control alone. Other therapeuticitems are to consume a low protein diet and to quit smoking. (Arq BrasEndocrinol Metab 2003;47/3:207-219)Keywords: Risk factors; Diabetic nephropathy; Type 2 diabetes mellitus; Pre-vention

Effects of chronic ethanol consumption on gestation and lactation in rats

Chronic consumption of ethanol during pregnancy and lactation may lead to abnormalities in the fetus or infant. A group of female Wistar rats was submitted to ethanol treatment over a period of a month. A pair-fed control group received sucrose solution isocaloric to ethanol and the control group received water “ad libitum.” Afterward, the females were mated with males over a period of 20 days. At birth, each litter was maximized to eight pups and the remaining ones were decapitated to remove the fetal blood and brains. No significant difference was observed in fetal body and brain weight at birth. During lactation the ethanol and pair-fed groups gained less weight than the control group. After weaning, their weight became similar. Fetal blood glucose levels were decreased in the ethanol-treated group. One hundred percent of the pair-fed and control females delivered live fetuses at term and all survived; only 40% of the females in the ethanol group delivered, and one pup did not survive. Chronic ethanol treatment pointed to a possible reduction in the fertility. It seems likely that the change in body weight of ethanol-fed dams was caused by undernutrition.

Punção aspirativa de tireóide com agulha fina em um hospital geral: estudo de 754 punções

Fine-needle aspiration (FNA) biopsy is considered the routine initial and the most cost-effective procedure in the evaluation of thyroid nodules. Notwithstanding the advantages of the procedure, it depends heavily on the pathologists experience and on technical skills to obtain adequate smears. The aim of this paper is to evaluate the procedure efficacy in a general teaching hospital. Smears obtained from 754 FNA were examined over a 3-year period. Each palpable nodule was aspirated by an endocrinology resident with a fine-needle 4 to 6 times. Material were stained by Giemsa and Papanicolaou techniques. Histopathologic examination was done on 93 patients. FNA biopsy was performed in 663 patients (613F/50M), mean age of 50±14 years (range 12 - 93). FNA results were: colloid nodule (58.5%), follicular neoplasm or suspicious (8.2%), Hashimotos thyroiditis (5.3%), papillary carcinoma (2.3%), anaplastic carcinoma (0.4%), medullary carcinoma (0.1%), and unsatisfactory (25.2%). Neoplasias were detected in 41 (44%) of 93 surgeries undertaken, and most of the carcinomas were of papillary type (65.6%). There were 24% follicular carcinomas among the follicular neoplasms. The FNA data analysis revealed: sensitivity 92% (CI= 78.6 to 98.3%), specificity 80% (CI= 65.4 to 90.4%), positive predictive value 79.5% (CI= 64.7 to 90.2%), negative predictive value 92.3% (CI= 79.1 to 98.4%), and accuracy 86% (CI= 76.1 to 92.3%). FNA established a diagnosis in 66.6% of the patients, decreasing costs and the number of surgeries. As a result of better patient selection, the yield of thyroid carcinomas in excised nodules has increased from 19.4% to 31.2% in a period of 11 years in our hospital.