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Early renal functional changes in children with insulin-dependent diabetes mellitus--their relation to metabolic

U B Berg, B Thalme

    The International Journal of Pediatric Nephrology
    |March 1, 1984
    PubMed

    Insights

    Early changes in kidney function in children with insulin-dependent diabetes mellitus predict diabetic nephropathy. Poor metabolic control correlated with higher glomerular filtration rates, suggesting potential early kidney damage.

    Area of Science:

    • Pediatric Nephrology
    • Diabetology
    • Renal Physiology

    Background:

    • Diabetic nephropathy is a major complication of insulin-dependent diabetes mellitus.
    • Early detection of renal function changes is crucial for predicting disease progression.
    • Understanding the impact of disease duration on kidney function in pediatric diabetes is essential.

    Purpose of the Study:

    • To investigate the predicted effect of early renal function changes on the later development of diabetic nephropathy in children.
    • To analyze changes in glomerular filtration rate (GFR), filtration fraction, renal plasma flow, and fractional sodium excretion over 10 years of diabetes duration.
    • To explore the correlation between renal function parameters and metabolic control in pediatric diabetes.

    Main Methods:

    • Prospective study involving 128 children with insulin-dependent diabetes mellitus.
    • Renal function assessed using the clearance method at 0, 2, 5, and 10 years of disease duration.
    • Glomerular filtration rate (GFR), filtration fraction, renal plasma flow, and fractional sodium excretion measured.
    • Metabolic control evaluated clinically and via glucosylated hemoglobin concentration.

    Main Results:

    • Glomerular filtration rate (GFR) and filtration fraction were significantly increased at 0-5 years but normalized by 10 years.
    • Renal plasma flow did not differ significantly from controls.
    • Increased fractional sodium excretion was observed in recent-onset cases.
    • An inverse correlation was found between GFR and metabolic control (poor control associated with high GFR).

    Conclusions:

    • Elevated GFR and filtration fraction in early diabetes may indicate an increased risk for diabetic nephropathy in children.
    • Inadequate adaptation of proximal tubules or insulin therapy may contribute to altered renal function.
    • Poor metabolic control is linked to higher GFR, highlighting the importance of glycemic management in preventing kidney damage.

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