Title: Assessment of a Metabolic Map 3.0 (MM3.0) in association with Cardio Metabolic-Renal Syndrome (CMR-S)
Abstract:
Cardio Metabolic-Renal Syndrome (CMR-S) is a complex and chronic metabolism disturbance that affects kidney function. Obesity (OB), Hyperglicemia (HG), Dyslipidemia (DL), Systemic Arterial Hypertension (SAH), Atherosclerotic Microvascular Inflammation (AMI) and Early Kidney Injury (EKI) in different arrangements, at the same time, is a very difficult combination to interpret. Sometimes the interpretation is according to the expertise or the knowledge of the doctors instead of understanding the real clinical situation of the patients. The Metabolic Map 3.0 (MM3.0)- an adaptation of the Metabolic Map (MM)- is a semiological and clinical form of assessment that analyses each component of the CMR-S according to the table below. The MM3.0 has three different zones; green, yellow and red. Variables are: OB ?Body Mass Index (BMI) and Waist-to-Height Ratio (WHR); HG ? Fast Glucose (FG), Glycated Hemoglobin (GH), Insulin Level (IL) and Tg-HDL Ratio; DL ? Cholesterol (Ch), Triglycerides (Tg) High Density Lipoprotein (HDL) and Low Density Lipoprotein (LDL); SAH ?Systolic (SBP) and Diastolic (DBP) Blood Pressure (BP); AMI ?Uric Acid (UA), High Sensibility Reactive C Protein (Hs-RcP) and Fibrinogen (Fb); EKI? Albumin Creatinine Ratio (ACR) in a single sample in urine are used and interpreted according to this classification: a) GREEN ZONE: BMI: 18-25 Kg/m2; WHR <0,5; FG 70-99 mg/dL, GH <5.7%, IL <10 IU/mL, Tg-HDL Ratio <2; Ch <200 mg/dL, Tg <150 mg/dL, HDL >45 mg/dL, LDL < 130 mg/dL; BP normal; UA normal low, Fb 200-300 mg/dL, Hs-RcP <0,1 mg/dL and ACR <30 (mg/g); b) YELLOW ZONE: BMI: 26-30 Kg/m2; WHR 0,5-0,6; FG 100-126 mg/dL, GH 5.7%-6,4%, IL 10-15 IU/mL, Tg-HDL Ratio 2,0-4,0; Ch 200-250 mg/dL, Tg 150-200 mg/dL, HDL 40-45 mg/dL, LDL 130-160 mg/dL; SBP as SAH; UA normal high, Fb 300-400 mg/dL, Hs-RcP 0,1-0,3 mg/dL and ACR 30-299 (mg/g); c) RED ZONE: BMI: >30 Kg/m2; WHR >0,6; FG >126 mg/dL, GH >6,4%, IL >15 IU/mL, Tg-HDL Ratio >4,0; Ch >250 mg/dL, Tg >200 mg/dL, HDL <40 mg/dL, LDL >160 mg/dL; SBP and DBP as SAH; UA high, Fb >400 mg/dL, Hs-RcP >0,3 mg/dL and ACR >300(mg/g). Patients can have an individual clinical and laboratory presentation in each target. As an example: in one moment there is a red zone for OB, HG and ACR; yellow for DL and AMI; green for SAH. It shows that attention must be given to OB, HG and ACR first. Another example: red for DL and SAH; yellow for OB and ACR; green for HG and AMI. Now attention must be given to DL and SAH. Patients can show huge different forms of clinical presentation of CMR-S. The MM 3.0 helps to understand the true clinical evolution and the nutritional program, physical exercises, medications and surgery plans that must be prescribed in a customized manner.
