Check for microalbuminuria

Your pee can give you clues about your risk for heart or kidney disease.


Breakthroughs in the technology of medical testing offer a new and incredibly effective new way of catching heart disease in the bud. Testing for microalbuminurea in your urine can now predict how prone you are to heart disease!

When an individual’s urine has small but abnormal amounts of protein, this is referred to as microalbuminurea. This is measured at a time when the amounts are so small that they do not show up in the conventional dipstick method. (30-300mg of albumin excretion by the kidneys over a period of 24 hours.)

The dipstick method of measuring albumin in the urine, only detects protein excretion that exceeds 300 mg per 24 hours. This is the standard range that is currently denoted as macroalbuminuria, or gross proteinuria(high levels of protein in the urine). With new testing, even smaller levels of protein in urine can be spotted, which means that conditions like kidney and cardiac disease can be spotted at a very early stage and steps can be taken that may even be able to reverse the condition!

‘Albumin’ is the most common protein found in blood. In people with normal blood levels, the kidneys will not allow albumin to be excreted. So when there is albumin in the urine, it’s a sign that something may be wrong. Microalbumin in the urine is an early indicator of kidney disease. Microalbuminuria is almost unheard of in childhood and before adolescence. Factors that contribute to the incidence of microalbuminuria are: duration of diabetes, high blood pressure, genetic susceptibility.

Microalbuminuria is most commonly associated with diabetic nephropathy (kidney disease setting in as a result of diabetes), but there are other causes, which include glomerulonephritis, amyloidosis and other forms of kidney disease. Detecting microalbuminuria early is important because it is often a sign that the patient may be at risk of developing overt proteinuria (macroalbuminuria) and renal failure. It is also a risk factor for cardiovascular disease.

Nephrologists and diabetologists have been measuring microalbuminuria in their patients to check for the development and progression of kidney disease. But urine is also being increasingly recognized as a sensitive predictor for cardiovascular risk. Studies show a clear relationship between microalbuminuria and cardiovascular events. If this is identified early, medication can be used to work against the condition and have a beneficial effect on the cardiovascular system.

At present the incidence of type 2 diabetes is increasing world-wide, with half the population unaware that they are diabetic. The result is an increase in deaths that are caused by end-stage renal disease and cardiovascular disease. Type 2 diabetes mellitus is a silent killer, bringing with it many life-threatening complications on different organs like the kidney and heart. So there is a need for early identification of patients who are at greatest risk. By spotting the risk early, patients can start on renal and cardiovascular protective treatments early and have better quality of life.

As with every test, microalbuminuria too has the drawback of having false positive results. False positive reports happen when the patient has done strenuous exercise or has urinary tract infection, or severe hypertension, or some prolonged illness. But the chances of false positive in microalbuminuria are minimal. The best part of this new finding is that now, we can spot the onset of two potentially lethal conditions right when they start, and that too with something as simple as a urine test!

ROBOTS AS SURGEONS

Many years ago, when writers wrote about a world where machines would assist humans in daily life, it was called science fiction. As the years went by, and technology advanced, so many things that were fiction turned into fact. As recent as twenty years ago, cardiac operations were a big deal, a ‘serious’ operation, and you would not have believed it if someone had told you machines would be doing the job much better in a few years.

But this is now true, and H.G.Wells is probably saying ‘I told you so’. One of the latest approaches to cardiac surgery involves a recent innovation that uses robotic instrumentation to allow cardiothoracic surgeons to operate through a smaller opening for a minimally invasive surgery. It’s called the da Vinci Surgical System. 

For many heart patients, when medication and catheter-based treatments do not relieve the symptoms, surgery may be the only option for treatment. But just hearing about the procedures of traditional or open heart surgeries can make even the most stout-hearted among us to feel queasy. “First, your chest is cut open, then your breastbone is cracked open, then we reach in to your chest cavity…” you get the picture.

Thankfully, there have been major advances in surgical technology, which now brings to us minimally invasive surgery and unmanned surgery. Initially, the purpose of having a machine perform surgery was to facilitate remotely performed surgery in battlefields and other remote environments. But it was soon clear that the telesurgical robot was more useful for minimally invasive on-site surgery.

Robots as surgeons

Robotic surgery and research on this has been going on for some time. In 1988, the PROBOT was used to perform prostatic surgery. The ROBODOC was introduced in 1992 to ensure precise fittings in the thigh bone for hip replacement surgeries. These were the forefathers of the da Vinci Surgical System.

The da Vinci Surgical System provides surgeons and patients with the most effective, least invasive treatment alternative for even the most complex procedures, such as mitral valve repair. The best news for the patient who takes this option is that this process offers the potential for a better clinical outcome. Patients who choose this surgery have shorter recovery times than those who have open heart surgery.

How the da Vinci system works

In this process, instead of cutting open the chest, and parting the breastbone, a small working incision and three to five small incisions (ports) are made in the spaces between the ribs. The incisions are about the size of a fingertip. The surgical instruments (attached to the robotic arms) and one tiny camera are inserted through these ports. Motion sensors are attached to the robotic “wrist,” so the surgeon can control the movement and placement of the surgical instruments to perform the procedure.

The spirits of the sci-fi writers and scientific visionaries need to put the brakes on their celebrations though – the da Vinci still needs a surgeon to be in control of the robot. The system is an extremely sophisticated tool that enables the surgeon to perform the surgery with greater precision and control as well as minimal invasion on the body.

Apart from the advantage that the body does not need to take a severe trauma for the procedure, the da Vinci system also gives surgeons the option of performing the surgery on a ‘beating heart,’ in which case the patient is not placed on the heart-lung bypass machine (this is called“off-pump” surgery).

The Process

During the Robotic cardiac surgery procedure, the surgeon sits in a console to the left of the da Vinci console. The robotic arms are directly above the patient, and function as an extension of the surgeon’s hands, directed through the controls in the console.

A tiny camera attached to a robotic arm gives the surgeon a very detailed, 3D view of the operating space inside the chest. The robotic arms are very agile, and so the surgeon gets a greater range of motion than is possible with hand-manipulated moves in standard procedures.

Benefits of Minimally Invasive Surgery

• Quicker return to normal activities: Rather than waiting several weeks to heal, patients can return to work or other activities much more quickly–usually within 10 days.
• Shorter hospital stay:  Time spent in the hospital can sometimes be reduced by as much at 50 percent, compared to traditional procedures.
• No splitting of the breastbone (“cracking the chest”): Keeping the breastbone intact reduces the chance for post-surgical complications and infection.
• Smaller incisions: Depending upon the case, the operation may be performed through four to five fingertip-size incisions or through a 3- to 5-inch incision at the side of the chest. Traditional open-heart procedures demand a longer incision down the center of the chest.
• Much less pain: Decreased destruction to tissue and muscle results in less pain. Tylenol or aspirin are usually enough to manage pain after some procedures.
• Elimination of the heart-lung bypass machine: In most cases, avoiding the bypass machine decreases the risks for neurological complications and stroke.
• Minimal blood loss and less need for transfusion
• A reduced risk of infection
• Small scarring: Instead of a long chest scar, only a few tiny scars or a small, 3- to 5-inch scar remains.

Robotic heart surgery in India

Doctors at the Chettinad Health City, Chennai have successfully performed a rare robotic heart surgery on a 23- year-old patient. Dr. R. Ravi Kumar, the Director of the Institute of Cardiovascular Disease at the hospital, said that the robotically assisted procedure involved replacing both the mitral and the aortal valve simultaneously. Although the procedure is quite new in India, Dr. Ravi Kumar was positive about the system being used for a variety of procedures.

Just like for any successful surgery, minimally invasive procedures also need well qualified, trained hands. Since the procedure is very different from operating through a large chest incision, it requires doctors to be trained in a different manner. Even highly experienced surgeons must devote dozens of hours to learning how to use the techniques and equipment for minimally invasive surgery.

There are already several surgeons in India who are well trained in robotic surgery. Since the procedure has only advantages to offer, it is sure to be increasingly in demand in the future. Remember to research as well as discuss all of your surgical options with your doctor if you need surgery.