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von Willebrand factor and its propeptide in children with diabetes. Relation between endothelial dysfunction and
Alberto Verrotti1, Rita Greco, Fania Basciani
1Department of Medicine, Section of Pediatrics, University of Chieti, Oespedale Policlinico, Chieti, Italy.
Insights
Elevated von Willebrand factor (vWF) and its propeptide levels in children with insulin-dependent diabetes mellitus can predict the development of microalbuminuria. This finding aids in identifying at-risk individuals for early intervention in diabetic nephropathy.
Area of Science:
- Endocrinology
- Nephrology
- Hematology
Background:
- Patients with insulin-dependent diabetes mellitus often exhibit elevated von Willebrand factor (vWF) plasma concentrations.
- Microalbuminuria is an early indicator of diabetic nephropathy.
- Predictive markers for microalbuminuria in pediatric diabetes are crucial for timely intervention.
Purpose of the Study:
- To investigate if increased plasma concentrations of von Willebrand factor (vWF) and its propeptide precede and predict the development of persistent microalbuminuria in children with insulin-dependent diabetes mellitus.
- To evaluate the role of vWF and its propeptide as early biomarkers for incipient nephropathy in pediatric diabetes.
Main Methods:
- Longitudinal study of 102 children with insulin-dependent diabetes mellitus, followed for at least 8 years.
- Patients were divided into groups based on the presence or absence of microalbuminuria at follow-up.
- Plasma concentrations of fibrinogen, vWF, and its propeptide were measured and compared to 80 age- and sex-matched healthy controls.
Main Results:
- No significant initial differences in fibrinogen, vWF, or its propeptide between patients and controls.
- A significant increase in plasma vWF and its propeptide was observed in patients who later developed microalbuminuria, starting 3 years prior and becoming statistically significant 2 years before onset.
- Fibrinogen levels remained within the normal range throughout the study in all patient groups.
Conclusions:
- Elevated plasma concentrations of vWF and its propeptide precede the onset of microalbuminuria in children with insulin-dependent diabetes mellitus.
- vWF and its propeptide serve as valuable predictive markers for identifying children at risk of developing diabetic nephropathy.
- Monitoring vWF and propeptide levels can facilitate early detection and management of incipient nephropathy in pediatric diabetes.
Abstract:
It has been shown that patients with insulin-dependent diabetes mellitus have elevated von Willebrand factor (vWF) plasma concentrations. Plasma fibrinogen, vWF, and its propeptide concentrations have been evaluated in 102 children with insulin-dependent diabetes mellitus to determine whether an increase of vWF and its propeptide levels precedes and may predict the development of persistent microalbuminuria. The patients have been divided into two groups according to the presence or absence of microalbuminuria at the end of follow-up. They have been followed up for at least 8 y. Control group consisted of 80 age- and sex-matched healthy volunteers. At the beginning of the study there was no significant difference in fibrinogen, vWF, and its propeptide levels between patients and control subjects. During the follow-up, a significant increase of plasma vWF and its propeptide has been observed in the group of patients who later developed microalbuminuria but not in those who remained normoalbuminuric. This increase started 3 y and become statistically significant (p < 0.01) 2 y before the onset of microalbuminuria, persisting until the end of the study. During the entire follow-up plasma values of fibrinogen persisted in the normal range. In conclusion, an increase in plasma concentration of vWF and its propeptide precedes microalbuminuria and, therefore, can be useful to identify children with insulin-dependent diabetes mellitus at risk to develop incipient nephropathy later in life.