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Metabolic status in diabetes mellitus affects markers for glomerular filtration rate

Peter Holmquist1, Ole Torffvit, Sture Sjöblad

  • 1Pediatric Department, Division of Metabolism, Diabetology, and Endocrinology, University Hospital Lund, 22185 Lund, Sweden. Peter.Holmqvist@skane.se

Pediatric Nephrology (Berlin, Germany)
|April 17, 2003
PubMed

Insights

Diabetic children

Area of Science:

  • Pediatric Endocrinology
  • Nephrology
  • Clinical Chemistry

Background:

  • Diabetic ketoacidosis is a severe complication in newly diagnosed type 1 diabetes.
  • Accurate assessment of glomerular filtration rate (GFR) is crucial for monitoring kidney function in diabetic children.
  • Metabolic derangements, such as ketonuria, may impact the reliability of standard GFR estimation methods.

Purpose of the Study:

  • To evaluate the effect of metabolic derangement, specifically ketonuria, on common tests used to estimate glomerular filtration rate (GFR) in newly diagnosed diabetic children.
  • To compare the accuracy of serum creatinine, creatinine clearance, and serum cystatin C against iohexol clearance (a gold standard GFR measure) in the context of acute metabolic changes.

Main Methods:

  • A cohort of newly diagnosed diabetic children, with and without ketonuria, was studied.
  • Serum creatinine, creatinine clearance, serum cystatin C, and iohexol clearance were measured at diagnosis and after 20 days of treatment.
  • Iohexol clearance served as the reference standard for true GFR.

Main Results:

  • Serum creatinine and iohexol clearance (true GFR) were unaffected by acute metabolic status or ketonuria.
  • Serum cystatin C levels were significantly influenced by the presence of ketonuria.
  • Creatinine clearance proved to be an unreliable marker for GFR, irrespective of the metabolic state (deranged or balanced).

Conclusions:

  • Routine tests for glomerular filtration rate (GFR) in diabetic children can be affected by metabolic status.
  • Serum cystatin C is sensitive to ketonuria, limiting its utility in this context.
  • Creatinine clearance is not a reliable indicator of GFR in newly diagnosed diabetic children, especially during metabolic derangement.

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