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[Microalbuminuria as risk factor for nephropathy in children with insulin-dependent diabetes mellitus]
M A Baak1, R J Odink, H A Delemarre-van de Waal
1Academisch Ziekenhuis Vrije Universiteit, afd. Kindergeneeskunde, Amsterdam.
Insights
Microalbuminuria is present in 16% of children with insulin-dependent diabetes mellitus (IDDM), particularly in those who have entered puberty. Higher insulin doses and age at onset correlate with microalbuminuria, suggesting early intervention is key.
Area of Science:
- Pediatrics
- Endocrinology
- Nephrology
Background:
- Microalbuminuria is an early indicator of diabetic nephropathy.
- Early detection and intervention are crucial for managing complications in children with insulin-dependent diabetes mellitus (IDDM).
Purpose of the Study:
- To determine the prevalence of microalbuminuria in children diagnosed with insulin-dependent diabetes mellitus (IDDM).
Main Methods:
- A retrospective analysis was conducted on 71 children with IDDM.
- Albumin excretion rate was measured in 24-hour urine samples.
- Patients were categorized based on the presence or absence of microalbuminuria.
Main Results:
- The prevalence of microalbuminuria was 16% (11 out of 71 children).
- Microalbuminuria was more common in older children and those with an earlier age of IDDM onset.
- Higher daily insulin doses were associated with microalbuminuria.
Conclusions:
- Microalbuminuria can occur in prepubertal children but is more frequent after puberty onset in those with IDDM.
- Age at onset, age of development, and daily insulin dose are correlated with microalbuminuria.
- Angiotensin-converting enzyme (ACE) inhibition shows potential for secondary prevention of diabetic nephropathy.
Objective:
To assess the prevalence of microalbuminuria (> or = 30 mg/24 h) in children with insulin dependent diabetes mellitus (IDDM).
Design:
Retrospective.
Setting:
Department of Pediatrics, University Hospital, Free University of Amsterdam.
Methods:
Albumin excretion rate was assessed in 24-hour voiding volumes in 71 children, mean age 11.8 yrs (range 3.5-17.9; 27 boys and 43 girls). Mean duration of IDDM was 5.4 yrs (1.0-5.0). Patients with albuminuria were compared with patients without microalbuminuria. Results of angiotensin-converting enzyme inhibition (n = 4) are presented.
Results:
The prevalence of microalbuminuria was 16% (n = 11). In 7% (n = 5) the microalbuminuria was persistent; in 9% (n = 6) it was intermittent. The mean age of the children with microalbuminuria (14.0 years; 8.9-17.4) was significantly higher than the age of the children without this disorder (11.7 years; 3.5-17.9). Two prepubertal children had developed microalbuminuria. The group with microalbuminuria had a significantly higher age at onset of the disease (8.1 years; 1.9-13.0) than the group without microalbuminuria (5.8 jaar; 0.9-14.5). The daily dose of insulin in the group with microalbuminuria was significantly higher (1.15 U/kg; 0.6-1.56) than in the group without microalbuminuria (0.97 U/kg; 0.20-1.87). There was no correlation between microalbuminuria and the duration of the disease.
Conclusion:
Microalbuminuria may exist as early as the prepuberal period, but is found more frequently in children with IDDM who have entered puberty. There is a correlation between microalbuminuria and the age which it develops, the age at onset of the IDDM and the daily dose of insulin. Secondary prevention of diabetic nephropathy with ACE inhibition appears to be possible.