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Familial and perinatal risk factors for micro- and macroalbuminuria in young IDDM patients
S Rudberg1, E L Stattin, G Dahlquist
1Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden.
Insights
Familial hypertension and maternal smoking during pregnancy increase the risk of diabetic nephropathy in young patients with type 1 diabetes. Poor glycemic control exacerbates these risks, highlighting the importance of family history and prenatal factors.
Area of Science:
- Nephrology
- Endocrinology
- Cardiovascular Medicine
Background:
- Diabetic nephropathy pathogenesis may involve hereditary factors like hypertension and cardiovascular disease (CVD), alongside intrauterine growth.
- Investigating familial and perinatal influences on micro- and macroalbuminuria in young insulin-dependent diabetes mellitus (IDDM) patients is crucial.
Purpose of the Study:
- To examine the impact of familial and perinatal risk factors on the development of micro- and macroalbuminuria in young IDDM patients.
- To identify independent risk factors for incipient nephropathy in individuals with type 1 diabetes.
Main Methods:
- A nested case-control study was conducted on 1,150 young IDDM patients with at least 5 years of disease duration.
- Data collected included family history (hypertension, CVD, diabetes), perinatal factors (birth weight, gestational age, breastfeeding), and maternal factors (education, smoking, hypertension, proteinuria).
- Logistic regression analysis was used to identify independent risk factors, adjusting for multiple variables including glycemic control (HbA1c).
Main Results:
- Univariate analysis showed significant associations between parental hypertension, parental CVD, maternal smoking during pregnancy, and low maternal education with albuminuria.
- Independent risk factors identified were parental hypertension, maternal smoking during pregnancy, and low maternal education (in full-term patients), after adjusting for other variables.
- Poor glycemic control amplified the risk associated with familial CVD, parental hypertension, maternal smoking, and low maternal education.
Conclusions:
- Familial hypertension, CVD, maternal smoking during pregnancy, and low maternal education are independent risk factors for incipient diabetic nephropathy in full-term offspring with IDDM.
- Effective management of glycemic control in IDDM patients is essential to mitigate the impact of these identified risk factors.
- These findings underscore the importance of considering both genetic predispositions and prenatal environmental exposures in the development of diabetic kidney disease.
Abstract:
It has been suggested that hereditary risk for hypertension and cardiovascular disease (CVD) as well as intrauterine growth may be involved in the pathogenesis of diabetic nephropathy. In the present study, we investigated the influence of familial and perinatal risk factors on the occurrence of micro- and macroalbuminuria in young IDDM patients. A cohort of 1,150 young patients with > or =5 years' duration of IDDM was screened for microalbuminuria. Data on family history of hypertension, CVD, IDDM, and NIDDM; perinatal factors such as birth weight, gestational age, and duration of breastfeeding; and maternal education, smoking, hypertension, and proteinuria during pregnancy were collected. We identified 75 patients with an albumin excretion rate > or =15 microg/min in more than two overnight urinary samples and compared them in a nested case-control study with three normoalbuminuric control subjects per patient from the same cohort, matched for diabetes duration. Perinatal factors were analyzed in all patients born at term (+/- 2 weeks), 59 of the 75 patients and 155 of the 225 control subjects. In univariate analysis, hypertension in parents (odds ratio [OR] 4.21), CVD in parents and grandparents (OR 1.26), maternal smoking during pregnancy (OR 3.21), and a low level of maternal education (OR 2.33) were significantly associated with the development of micro- and macroalbuminuria. When adjusted for other familial and perinatal factors, current mean blood pressure, HbA1c, smoking, BMI, sex, age, and postpubertal diabetes duration, using logistic regression analyses, only parental hypertension in all patients and maternal smoking during pregnancy and low level of maternal education in full-term patients were independent risk factors. When patients with poor glycemic control were analyzed separately, familial CVD, poor metabolic control, parental hypertension, maternal smoking during pregnancy, and level of maternal education were independent risk factors, with the adjusted OR markedly increased, compared with the matched subgroup with better HbA1c. In conclusion, familial hypertension and CVD, maternal smoking during pregnancy, and low level of maternal education may independently increase the risk for incipient nephropathy in full-term offspring who later develop IDDM. Current poor glycemic control seemed to increase the effect of these risk factors.