Early detection of diabetic nephropathy in children and adolescents with type 1 diabetes mellitus

Abstract EN

Background: Recent studies have demonstrated that the onset and course of diabetic nephropathy can be ameliorated to a very significant degree by several interventions but these interventions would have their greatest impact if instituted at a point very early in the course of development of this complication.

This study has been designed to explore the problem of diabetic nephropathy in type 1 Diabetes Mellitus particularly its early detection in a sample of children and adolescent patients up to 18 yrs of age.

Objectives: Estimating the prevalence of microalbuminuria and hyperfiltration, and assessing the relationship between microalbuminuria and GFR in type 1 diabetic children and adolescents.

Patients and methods: A cross-sectional design and a consecutive sampling procedure were adopted to enroll 115 patients (59 males and 56 females) who met the inclusion criteria, from those attending the National Diabetic Center of Al Mustansiriyah University / Baghdad during the period from the 1st of August 2005 to the end of July 2006.

Micral test II was used to screen early morning (spot) urine samples for increased albumin excretion rate while the novel use (in Iraq) of Schwartz formula made possible estimating the GFR from serum creatinine and demographic characteristics.

The results were used for assessing the relationship between microalbuminuria and GFR.

Important risk factors including patients age and disease duration, have also been evaluated.

Results: The mean patients age was 14.05 (±2.95) years, and the mean disease duration was 6.52 (±2.85) years.The prevalence of microalbuminuria in the study sample was (48.70%) , estimated as increased urinary albumin excretion ( 20-200mg/l ).

Statistically significant associations were found between microalbuminuria and longer duration of diabetes (p value = 0.017),and older age of diabetic patients ( p value = 0.031 ).

The overall prevalence of hyperfiltration (estimated as GFR of ≥130ml/min/1.73m2) was (16.52%), comprising (63%) normoalbuminuric and (37%) exhibiting microalbuminuria.

Male preponderance was evident (89.48%).

Factors showing significant association with hyperfiltration state were: male gender (p value = 0.013),and older age of diabetic patients (p value = 0.031) There was a statistically significant inverse correlation between the different levels of albumin excretion rate and the levels of estimated GFR.

(r = - 0.79 P value = 0.024 ).