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Published online before print July 6, 2006 , doi: 10.1681/ASN.2006010097

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Abstract

Microalbuminuria is an early sign of progressive cardiovascular and renal disease in individuals with and without diabetes. Despite compelling data, at present only a minority of patients with diabetes and rarely individuals without diabetes are screened for albuminuria in a systematic way. All of the criteria to implement systematic albuminuria screening are fulfilled in diabetes, and most are nearly fulfilled for microalbuminuria screening in individuals without diabetes. Because of the growing evidence that treatment of microalbuminuria in individuals without diabetes may offer a cost-effective benefit to prevent cardiovascular disease, nephrologists and other health care providers should pay more attention to the early detection and subsequent treatment of individuals with microalbuminuria.

Microalbuminuria is an early sign of progressive cardiovascular and renal disease. We discuss whether screening for albuminuria is warranted and, if so, how screening and subsequent monitoring could be carried out.

The criteria that a screening program should fulfill have been described by Wilson and Jungner ( 1 ) and are given in Table 1 . As more data are available on the impact of elevated albuminuria on renal and cardiovascular prognosis in individuals with diabetes than in individuals without diabetes, we discuss separately the evidence that is available for the need for albuminuria testing in these two groups.

View this table:
Table 1.

The Wilson-Jungner criteria

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Albuminuria screening first may be used as a tool to detect individuals with undiagnosed chronic kidney disease (CKD). Elevated albuminuria (30 to 300 mg/d albumin is the definition of microalbuminuria) is an early predictor of progressive renal function loss in type 1 ( 2 , Under Armour MAGNETICO SELECT IN Indoor football boots black RczOiN6le
) and type 2 diabetes ( 4 , 5 ). At the time that microalbuminuria becomes manifest, GFR typically is normal or elevated or only modestly impaired (stage 1 or 2 CKD). Increased urinary albumin excretion (UAE) also may indicate a worse renal prognosis in individuals without diabetes. In a Japanese study, >100,000 individuals were tested for dipstick proteinuria. After a period of >17 yr, the likelihood of being on dialysis increased according to the degree of dipstick proteinuria at baseline ( 31 Phillip Lim Patent Leather Ankle Boots f6Sun0H3FW
). A similar finding was reported from the Prevention of Renal and Vascular End Stage Disease (PREVEND) study: After a 4.2-yr follow-up, the number of individuals who de novo had developed stage 3 or worse CKD was related to baseline albuminuria ( 7 ) ( Figure 1 ). By screening for elevated albuminuria, one of course will not only detect individuals with microalbuminuria but also individuals with macroalbuminuria (>300 mg/d), who most likely are already in stage 3 or 4 CKD.

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Management

Jan 14, 2014

It’s a crazy morning at home, and your spouse is furious at you. Harried, you slam the car door shut and race off to work where an important task awaits.

Your ability to tune out the situation at home and focus on the job at hand is facilitated by your emotional understanding. It’s a form of emotional intelligence, according to Jeremy Yip , a lecturer and research scholar at Wharton. Compartmentalizing enables a person to identify what is stressing them out and to allow other, unrelated factors in their life to stand on their own merits, Yip says.

But are people with high levels of emotional intelligence able to go one step further and take risks unrelated to what is stressing them out? Yes, notes Yip, whose research study, “ The Emotionally Intelligent Decision-Maker: Emotion Understanding Ability Reduces the Effect of Incidental Anxiety on Risk-taking ,” was published in the journal Psychological Science. His co-author is Stéphane Côté, professor of organizational behavior and human resource management at the University of Toronto.

The study shows that people with lower levels of emotional understanding allow unrelated stressors to make them more risk averse, while those with higher levels are more likely to take a chance. “By identifying the source of their emotions, those with high emotional intelligence realize whether their emotions are irrelevant to the decisions they need to make,” Yip notes. “As a result, they don’t experience that spillover effect. They might feel anxious, but they don’t let it affect their decision.”

In the study’s first experiment, the researchers gave 108 University of Toronto students the Mayer-Salovey-Caruso Emotional Intelligence Test, which measures levels of emotional intelligence.

The participants were then split into two groups. One was given an anxiety-provoking task: to prepare a speech in one minute. To ratchet up the pressure, members of that group were told they would be filmed, and that the footage would later be shown to peers studying academic and social standing at the university. (After the testing was concluded, participants were informed that there would be no speech after all.)

“By … discovering that these emotions are in fact unrelated to the decisions we are making, we may de-bias our decisions.” –Stéphane Côté

The other group was given a relatively relaxing assignment: They were asked to prepare a grocery list. For compensation, participants in both groups were given a separate choice: receive $1, or take a one in 10 chance to receive $10.

For those given the stressful speechwriting assignment, people who scored low on the emotional intelligence test made the riskier choice — going for the $10 — only 16.7% of the time. Those with higher levels of emotional intelligence, meanwhile, picked the riskier option 48.3% of the time.

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