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Microvascular permeability to albumin and glomerular filtration rate in diabetic and normal children
Insights
Diabetic children show elevated glomerular filtration rates but normal kidney microvessel permeability to large molecules like albumin. Further research is needed on albumin mass and escape rates in diabetes.
Area of Science:
- Pediatric Nephrology
- Diabetology
- Microvascular Physiology
Background:
- Diabetic microangiopathy is a significant complication.
- Early detection of microvascular changes in children with diabetes is crucial.
Purpose of the Study:
- To investigate microvessel permeability in diabetic children without clinical signs of microangiopathy.
- To compare kidney function and macromolecule handling between diabetic and healthy children.
Main Methods:
- Studied glomerular filtration rate (GFR), urinary albumin and beta 2-microglobulin excretion.
- Measured intravascular albumin mass and transcapillary escape rate of albumin (TERa).
- Compared 26 diabetic children with 28 healthy controls.
Main Results:
- Diabetic children had significantly higher GFR (138 vs. 109 ml/min/1.73 m2).
- Urinary excretion of albumin and beta 2-microglobulin did not differ between groups.
- Intravascular albumin mass was lower in diabetic girls compared to diabetic boys and healthy girls.
- TERa was lower in diabetics with <10 years of disease duration (7.14%/h vs. 8.90%/h) and correlated positively with disease duration (r=0.47).
Conclusions:
- Diabetic children exhibit elevated GFR similar to adult short-term diabetics.
- Glomerular membrane permeability to macromolecules appears normal in this cohort.
- Further investigation is required for interpreting findings on intravascular albumin mass and TERa.
Abstract:
In order to examine the permeability of microvessels in diabetic children, the glomerular filtration rate, urinary excretion rates of albumin and beta 2-microglobulin, intravascular mass of albumin, and transcapillary escape rate of albumin were studied in 26 diabetic children without clinical signs of microangiopathy (age: 7-14 years; duration of disease: 3-14 years). Similar measurements were made in 28 healthy school children (age: 8-14 years). Mean glomerular filtration rate in the diabetic children was higher than in the normal children (138 versus 109 ml/min per 1.73 m2, p less than 0.01). Urinary excretion rates of albumin and beta 2-microglobulin did not differ in diabetics. Mean intravascular albumin mass in the diabetic girls (1.64 g/kg body weight) was lower (p less than 0.01) than in the diabetic boys (1.89 g/kg body weight) and also lower (p less than 0.02) than in the normal girls (1.94 g/kg body weight). Mean transcapillary escape rate of albumin in the twenty diabetics with duration of diabetes less than 10 years (7.14%/h) was lower (p less than 0.01) than that in normal children (8.90%/h); the escape rate showed a positive correlation with duration of diabetes (r=0.47; p less than 0.02). Thus glomerular filtration rate in diabetic children is elevated to the same extent as in adult short-term juvenile diabetics while the permeability of the glomerular membrane to macromolecules is normal. Interpretation of the results on intravascular albumin mass and transcapillary escape rate of albumin requires further investigation.