A STUDY ON PREVALENCE AND ETIOLOGICAL BASIS OF ALBUMINURIA IN GERIATRIC PATIENTS: A HOSPITAL BASED STUDY.<br />Presented by<br />Tanoy Bose<br />Co-Authors: Laskar B, Kalita BC, Borah D, Dutta A<br />The Department of Medicine<br />Assam Medical College & Hospital Dibrugarh<br />The APICON : Assam Chapter<br />2008<br />Dated: The 29th of November, 2008<br />
Introduction & Historical Perspective<br />2400 years ago Hippocrates noted the association between bubbles on the surface of the urine & kidney diseases. <br /><ul><li> Proteinuria, defined as the presence of urinary protein in concentrations greater than 0.3 g/d on a 24-hour collection, or greater than 1+ protein on a dipstick, is a common finding, which occurs in approximately 10% of elderly patients.
Although proteinuria has been regarded as "the first sign of serious renal disease", its presence can represent anything from a benign abnormality to the signpost of significant disease,1 with the potential for progressive renal insufficiency.
Because of the variable significance and multiple causes of proteinuria, the clinician requires a systematic approach for the work-up of this condition in the older patient. </li></ul>1.Geriatrics & agingVolume 3, Number 10, December 2000, Pages 12, 30 <br />
Background<br /><ul><li>In individuals with normally functioning kidneys a small amount of proteins are secreted in the urine everyday. However, urinary albumin excretion (UAE) above 30 mg/day is considered abnormal; UAE levels between 30-300 mg/day are considered as microalbuminuria, whereas every albumin or protein excretion above 300 mg/day represents macroalbuminuria or clinical proteinuria.
The prevalence of proteinuria in the general population is rather low, but it increases considerably in patients with diabetes or hypertension. The natural course of proteinuria is different in patients with diabetic or nondiabetic nephropathy; however its prognostic implications for renal and cardiovascular endpoints are the same, independently from the underlying kidney disease.
Both microalbuminuria and proteinuria today are considered risk factors for cardiovascular disease. Moreover, proteinuria is a typical manifestation of overt nephropathy and is associated with faster decline of renal function.
Roles of proteinuria are further supported by the fact that interventions that reduce UAE have been associated with slower decline in renal function and decrease in the risk of cardiovascular events. </li></li></ul><li>Objectives:<br /><ul><li> To find out the prevalence of ALBUMINURIA in geriatric age group of indoor patients
To ascertain the etiological basis of ALBUMINURIA among those population </li></li></ul><li>Methodology:<br /><ul><li>Nonrandomized hospital based prevalence study
Study undertaken in the Department of Medicine , Assam Medical College, Dibrugarh
Cases enrolled as per inclusion criteria from indoor patients during the period of August 2006 to July 2007
Detail medical history was taken and thoroughly examined for all systems. Routine & special investigations done as & when needed
Qualitative & quantitative urinary protein & albumin estimation was done
Data collected by multiple observers & final analysis done by one independent observer</li></li></ul><li>Inclusion & Exclusion criteria<br />Inclusion criteria<br /><ul><li> Age > 60 years
Presence of macroalbuminuria by dipstick method</li></ul>Exclusion criteria<br /><ul><li> Patients on drugs that may cause proteinuria eg. NSAIDs, COX inhibitors, Aspirin, Lithium etc
Patients having microalbuminuria </li></li></ul><li>Case selection<br />
Results:<br />44% patients were in the age group of 60-65ys.<br />62.5% had macroscopic albuminuria<br />72% cases with macroscopic albuminuria were male<br />92% had subnephrotic range of proteinuria<br />65% of cases had complaints of terminal dribbling of urine with hesitancy f/b ↑frequency (60%) & burning micturation (50%)<br />Pallor ( 72%) was the most common physical finding followed by poor nutrition (65%) & hypertension (52%)<br />
Discussion of results<br />In the study the prevalence of proteinuria was found to be 62.5% among geriatric population of hospitalized patients without any sex predilection. [M:F= 1:0.91]<br />Macroscopic albuminuria was more prevalent in the age group of 60-65 years ( 50.57%) but among the 8 patients above 75years all had proteinuria suggesting that the prevalence increases with age <br />
Discussion continued….<br />In the study Urinary tract infection (24%) turned out to be commonest cause of albuminuria followed by diabetic nephropathy (19.3%)<br />Albuminuria due to urinary tract infection was also more common among females (71.4%) with respect to males (26.38%)<br />
Discussion continued….<br />Among other principal causes of albuminuria were Chronic renal failure, Malignancy and Malaria<br />Hypertension was found to be prevalent among 52% of cases but direct attribution of albuminuria to hypertension could not be done due to overlap with DM, UTI and lack of renal biopsy<br />
Conclusion <br />Proteinuria is quite frequent among the geriatric indoor patients <br />Though most of them have symptoms suggestive of urinary tract disorder, asymptomatic proteinuric patients were not infrequent (35%)<br />Urinary tract infection followed by diabetic nephropathy was the commonest cause of proteinuria<br />The prevalence of proteinuria increases with age.<br />
Take Home Message<br /><ul><li>Even after keeping in consideration the physiological decline of renal function with age, proteinuria cannot be attributed to the process of aging
Proper evaluation is necessary to evaluate albuminuria in geriatric age group of patients to address the problem appropriately.</li></li></ul><li>Thank you<br />