A STUDY ON PREVALENCE AND ETIOLOGICAL BASIS OF ALBUMINURIA IN GERIATRIC PATIENTS:

A HOSPITAL BASED STUDY.

Presented by

Tanoy Bose

Co-Authors: Laskar B, Kalita BC, Borah D, Dutta A

The Department of MedicineAssam Medical College &

Hospital Dibrugarh

The APICON : Assam Chapter2008

Dated: The 29th of November, 2008

Introduction & Historical Perspective

2400 years ago Hippocrates noted the association between

bubbles on the surface of the urine & kidney

diseases.

1.Geriatrics & agingVolume 3, Number 10, December 2000, Pages 12, 30

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.

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.

Background

To find out the prevalence of ALBUMINURIA in geriatric age group of indoor patients

To ascertain the etiological basis of ALBUMINURIA among those population

Objectives:

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

Methodology:

Inclusion & Exclusion criteria

Inclusion criteria

Age > 60 years

Presence of macroalbuminuria by dipstick method

Exclusion criteria

Patients on drugs that may cause proteinuria eg. NSAIDs, COX inhibitors, Aspirin, Lithium etc

Patients having microalbuminuria

Total number of cases admitted in dept of Medicine during study period was :

8696

Number of patients with age > 60 years:

1287 (14.8%)

Total number of nonrandomly selected study population:

160

Total number of patients having macroscopic albuminuria:

100

Case selection

44% patients were in the age group of 60-65ys.

62.5% had macroscopic albuminuria

72% cases with macroscopic albuminuria were male

92% had subnephrotic range of proteinuria

65% of cases had complaints of terminal dribbling of urine with hesitancy f/b ↑frequency (60%) & burning micturation (50%)

Pallor ( 72%) was the most common physical finding followed by poor nutrition (65%) & hypertension (52%)

Results:

39%

31%11%

19%

UTI

Diabetic Nephropa-thy

CRF

Others

Results continued:

UTI Diabetic Nephropathy

CRF Others

19%

23%

11%

19%20%

8%

0% 0%

MALE FEMALE

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]

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

Discussion of results

In the study Urinary tract infection (24%) turned out to be commonest cause of albuminuria followed by diabetic nephropathy (19.3%)

Albuminuria due to urinary tract infection was also more common among females (71.4%) with respect to males (26.38%)

Discussion continued….

Among other principal causes of albuminuria were Chronic renal failure, Malignancy and Malaria

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

Discussion continued….

Proteinuria is quite frequent among the geriatric indoor patients

Though most of them have symptoms suggestive of urinary tract disorder, asymptomatic proteinuric patients were not infrequent (35%)

Urinary tract infection followed by diabetic nephropathy was the commonest cause of proteinuria

The prevalence of proteinuria increases with age.

Conclusion

Take Home Message

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.

Thank you