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Persisting glomerular hyperfiltration in short-term diabetic children without microalbuminuria
C Levy-Marchal1, K Laborde, C Kindermans
1Services de Diabétologie Pédiatrique, Hospital des Enfants Malades, Paris, France.
Insights
Diabetic children often show persistent glomerular hyperfiltration, an early indicator of potential kidney issues. Regular monitoring of renal function is crucial for managing diabetic nephropathy in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Diabetology
- Renal Physiology
Background:
- Diabetic nephropathy is a common complication of type 1 diabetes.
- Early detection of renal dysfunction in diabetic children is essential for timely intervention.
- Glomerular hyperfiltration is an early sign of renal changes in diabetes.
Purpose of the Study:
- To investigate the long-term changes in renal function in children with type 1 diabetes.
- To assess the prevalence and persistence of glomerular hyperfiltration in this population.
- To evaluate the relationship between glomerular filtration rate (GFR) and renal plasma flow (RPF).
Main Methods:
- Longitudinal study of 29 children with type 1 diabetes over 3 years.
- Assessment of glomerular filtration rate (GFR) using inulin clearance.
- Measurement of renal plasma flow (RPF) and urinary albumin excretion.
Main Results:
- Significantly elevated GFR observed in diabetic children compared to controls at baseline and follow-up.
- A high proportion (over 50%) exhibited persistent glomerular hyperfiltration.
- Elevated RPF was positively correlated with GFR; no significant differences in albuminuria were noted.
Conclusions:
- Persistent glomerular hyperfiltration is common in diabetic children without overt nephropathy.
- Elevated GFR may be an important marker for predicting diabetic nephropathy.
- Regular renal function evaluation is vital for managing diabetic children.
Abstract:
The renal function in a group of diabetic children (n=29;age;4-17 yr; IDDM duration: 1,5-13 yr) was studied with a 3 year interval. At the first evaluation glomerular filtration rate (GFR) as assessed by inulin clearance was significantly increased compared to control values (167 +/- 32 vs. 124 +/- 18 ml/min/1.73 m2; pl less than 0.01). Eighteen out of 29 children exhibited a glomerular hyperfiltration (GFR greater than 160). Three years later mean GFR was identical (169 +/- 25 ml/min/1.73 m2) and 16 children were hyperfiltrating. Among them, 11 have had a persisting glomerular hyperfiltration over the 3-year period. Renal plasma flow (RPF) was positively correlated to GFR (r=0.7; p less than 0.01) and remained elevated at both evaluations (794 +/- 163 and 812 +/- 157 ml/min/1.73 m2, p greater than 0.01 vs, control values). When the children were separated into 3 groups according to IDDM duration no significant differences were observed in the results for GFR and RPF, Mean urinary albumin excretion was comparable at the 3-year interval, and not significantly different from the control values (5.2 +/- 3.7 and 8.2 +/- 6.6 respectively vs. 8.65 +/- 4 microgram/min). None of the children demonstrated a persistent microalbuminuria. This study reveals a high proportion of diabetic children with a persisting glomerular hyperfiltration, without any other symptom of incipiens nephropathy, If elevated GFR plays an important role in the development of diabetic nephropathy, this study emphasizes the value of regular evaluation of renal function in diabetic children.