PREVALENCE OF PROTEINURIA IN OVERWEIGHT ADOLESCENTS

超重青少年中蛋白尿的患病率

• 批准号: 8167347
• 负责人: Mona Khurana
• 金额: $ 8.81万
• 依托单位: CHILDREN'S RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-01-20 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8167347
• 关键词: Academy; Adolescent; Adult; Age; American; Animals; Autopsy; Body mass index; Case Series; Case Study; Centers for Disease Control and Prevention (U.S.); Child; Childhood; Chronic; Clinical; Comorbidity; Computer Retrieval of Information on Scientific Projects Database; Cross-Sectional Studies; Data; Development; Diabetes Mellitus; Diet; Early Diagnosis; End stage renal failure; Enrollment; Epidemic; Excretory function; Experimental Models; Funding; Grant; Health; Height; High Prevalence; Hypertension; Injury; Institution; Kidney; Kidney Diseases; Link; Measurement; Medical center; Obesity; Overweight; Participant; Pathologic; Pediatrics; Population; Population Study; Prevalence; Prevention Guidelines; Prospective Studies; Proteins; Proteinuria; Race; Renal function; Reporting; Research; Research Personnel; Resources; Risk Factors; Sampling; Screening procedure; Series; Source; Time; United States; United States National Institutes of Health; Urinalysis; Urine; Weight; design; obesity in children; sex

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The prevalence of obesity in the United States has steadily increased in both adults and children over the past three decades and has currently reached epidemic proportions in both sexes and all racial groups [1-4]. The association between chronic obesity and the subsequent development of hypertension and diabetes mellitus type ii is well established in adults [5]. These obesity-related co-morbidities are currently the leading two causes of end stage renal disease (ESRD) in the adult population. Despite these links to ESRD, obesity is not traditionally identified as a risk factor for renal disease, and its direct effects on renal function are not well understood. Proteinuria was first reported in obese adults over thirty years ago [35]. Subsequent case reports [24, 35, 36], case series [24, 37], and autopsy series [10, 25] have further described associations between proteinuria and obesity. Growing data suggests that proteinuria is not only a marker of renal disease but is also an effector of renal injury. This is supported by a number of experimental models of diet-induced obesity in animals which demonstrate proteinuria as well as renal functional and structural adaptations in glomeruli and the tubulointerstitium. Multiple prospective studies have recently demonstrated that proteinuria is a strong, independent predictor of progression of chronic glomerulopathies [29-33]. Furthermore, the rate of decline in renal function and progression to ESRD significantly decrease with amelioration in proteinuria [34], suggesting that early detection of proteinuria and its amelioration can help preserve renal function for a longer period of time. The clinical implications of this are manifold as current screening practices for proteinuria rely on infrequent urine dipstick analysis. Despite the growing epidemic of childhood obesity, the American Academy of Pediatrics currently recommends screening urinalyses only twice in childhood [26], making it difficult to establish the true prevalence of proteinuria in the obese U.S. pediatric population. Only one study has examined the difference in urine protein excretion between obese children versus lean counterparts [38]. While this study demonstrated a higher level of proteinuria in the obese group versus the lean group, no prevalence data was reported. To date, there has been no large scale, systematic study examining the prevalence of proteinuria in obese children and adolescents. ?? ?? The overall objective of this study is to determine whether there is an association between increased body mass index and proteinuria. We hypothesize that the prevalence of pathologic proteinuria will be higher in overweight adolescents when compared with lean adolescents. The aim of the study is to determine the prevalence of pathologic proteinuria in overweight adolescents. This is a cross-sectional study pilot designed to determine the prevalence of pathologic proteinuria in overweight adolescents, ages 12 to 21 years, seen in the Adolescent Health Center which are affiliated with Children's National Medical Center. Upon study enrollment, each participant will undergo standardized height and weight measurements. The participant's body mass index (BMI) will be calculated and BMI percentile for sex and age will be determined using the Centers for Disease Control and Prevention guidelines. Those participants with a BMI 95th percentile for sex and age will be categorized as overweight. A minimum of one and maximum of two urine samples will be collected per participant for the duration of the study. The first urine sample will be obtained at the time of recruitment. Comparisons will be made between values obtained from lean versus overweight adolescents to determine whether there is a higher prevalence of pathologic proteinuria in the study population.

这个子项目是许多利用 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 在过去的三十年里，美国成人和儿童的肥胖患病率稳步上升，目前已在男女和所有种族群体中达到流行病的比例[1-4]。在成人中，慢性肥胖与高血压和II型糖尿病的后续发展之间的相关性已得到充分证实[5]。这些肥胖相关的合并症是目前成人人群中终末期肾病（ESRD）的两大主要原因。尽管与终末期肾病有这些联系，但传统上肥胖并不是肾脏疾病的危险因素，其对肾功能的直接影响也不清楚。 三十多年前，蛋白尿首次在肥胖成年人中报道[35]。随后的病例报告[24，35，36]、病例系列[24，37]和尸检系列[10，25]进一步描述了蛋白尿和肥胖之间的相关性。越来越多的数据表明，蛋白尿不仅是肾脏疾病的标志物，也是肾损伤的效应物。这得到了动物中饮食诱导的肥胖症的许多实验模型的支持，这些模型证明了蛋白尿以及肾小球和肾小管中的肾功能和结构适应。最近多项前瞻性研究表明，蛋白尿是慢性肾小球疾病进展的一个强有力的独立预测因子[29-33]。此外，随着蛋白尿的改善，肾功能下降和进展为ESRD的速率显著降低[34]，这表明蛋白尿的早期检测及其改善有助于在更长时间内保护肾功能。这一点的临床意义是多方面的，因为目前的蛋白尿筛查实践依赖于不频繁的尿试纸分析。尽管儿童肥胖症的流行日益严重，但美国儿科学会目前建议在儿童时期只进行两次尿分析筛查[26]，因此很难确定美国肥胖儿童人群中蛋白尿的真实患病率。只有一项研究检查了肥胖儿童与瘦儿童之间尿蛋白排泄的差异[38]。虽然这项研究表明肥胖组的蛋白尿水平高于瘦组，但没有报告患病率数据。到目前为止，还没有大规模的，系统的研究检查蛋白尿的患病率在肥胖儿童和青少年。 ?? ?? 本研究的总体目标是确定体重指数增加和蛋白尿之间是否存在关联。我们推测，病理性蛋白尿的患病率将在超重青少年比瘦青少年更高。本研究的目的是确定超重青少年病理性蛋白尿的患病率。 这是一项横断面研究试点，旨在确定12至21岁超重青少年中病理性蛋白尿的患病率，这些青少年在隶属于儿童国家医学中心的青少年健康中心就诊。研究入组后，每名受试者将接受标准化身高和体重测量。将计算受试者的体重指数（BMI），并使用疾病控制和预防中心指南确定性别和年龄的BMI百分位数。那些BMI在性别和年龄上达到第95百分位数的参与者将被归类为超重。研究期间，每例受试者将采集至少1份、最多2份尿样。将在招募时采集第一份尿样。将对从瘦与超重青少年中获得的值进行比较，以确定研究人群中病理性蛋白尿的患病率是否更高。