Predictors of albumin excretion rate (AER) abnormalities could provide earlier indicators of diabetic nephropathy risk. Data from the Natural History Study, a prospective 5-year observation of renal structure and function in young type 1 diabetic patients, were examined for predictors of AER patterns in normoalbuminuric type 1 diabetic patients. Included were 170 patients (96 females) (aged 16.7 ؎ 5.9 years, duration of diabetes 8.0 ؎ 4.3 years) with normal blood pressure, normoalbuminuria (AER <20 g/min), and eight or more follow-up visits over 5 years. AER, blood pressure, and HbA 1c (A1C) were determined quarterly and glomerular filtration rate (GFR) annually. Persistent microalbuminuria (PMA) was defined as 20 -200 g/min in two of three consecutive values within 6 -12 months. Four different AER patterns were identified. Group 1 (n ‫؍‬ 99): all values <20 g/min. Group 2 (n ‫؍‬ 49): intermittent levels >20 g/min but not meeting microalbuminuria criteria. Group 3 (n ‫؍‬ 14): PMA during follow-up but normoalbuminuria at study exit. Group 4 (n ‫؍‬ 8): microalbuminuria at study exit. Group 4 (497 ؎ 95 nm, P < 0.01) and group 3 (464 ؎ 113 nm, P ‫؍‬ 0.03) patients had greater baseline glomerular basement membrane (GBM) width versus group 1 (418 ؎ 67 nm). Baseline GFR in group 4 (163 ؎ 37 ml ⅐ min ؊1 ⅐ 1.73 m ؊2 ) was higher than group 1 (143 ؎ 28 ml ⅐ min ؊1 ⅐ 1.73 m ؊2 , P ‫؍‬ 0.04). A1C was higher in group 2 (9.0 ؎ 1.2%) than group 1 (8.4 ؎ 1.1%, P ‫؍‬ 0.008). Thus, greater increases in GBM width and GFR were predictors of PMA. Since 64% of the patients that developed microalbuminuria reverted to normoalbuminuria, the risk of diabetic nephropathy as defined by current microalbuminuria criteria is unclear. Diabetes 54:2164 -2171, 2005

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Tacrolimus (Tac) is a part of the standard immunosuppressive regimen after renal transplantation (RTx). However, its metabolism rate is highly variable. A fast Tac metabolism rate, defined by the Tac blood trough concentration (C) divided by the daily dose (D), is associated with inferior renal function after RTx. Therefore, we hypothesize that the Tac metabolism rate impacts patient and graft survival after RTx. We analyzed all patients who received a RTx between January 2007 and December 2012 and were initially treated with an immunosuppressive regimen containing Tac (Prograf®), mycophenolate mofetil, prednisolone and induction therapy. Patients with a Tac C/D ratio <1.05 ng/mL × 1/mg at three months after RTx were characterized as fast metabolizers and those with a C/D ratio ≥1.05 ng/mL×1/mg as slow metabolizers. Five-year patient and overall graft survival were noticeably reduced in fast metabolizers. Further, fast metabolizers showed a faster decline of eGFR (estimated glomerular filtration rate) within five years after RTx and a higher rejection rate compared to slow metabolizers. Calculation of the Tac C/D ratio three months after RTx may assist physicians in their daily clinical routine to identify Tac-treated patients at risk for the development of inferior graft function, acute rejections, or even higher mortality.

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Background and objectives: Although albumin excretion rates have been related to cardiovascular morbidity and mortality in both diabetic and nondiabetic adults, little is known about the relation between albuminuria and either cardiovascular risk factors or the insulin resistance syndrome in adolescents. A normal range for albumin excretion in adolescents was established, correlations between albumin excretion and cardiovascular risk factors were evaluated, and albumin excretion in normal adolescents was compared with that in type 1 diabetes mellitus adolescents.Design, setting, participants, & measurements: Albumin excretion rate was measured in 368 normal and 175 diabetic adolescents. Multiple regression analysis was used to predict the relation of age, sex, Tanner stage, body mass index, and systolic blood pressure to albumin excretion in both cohorts. In addition, correlations between albumin excretion and age, blood pressure, body mass index, lipids, and measurements of insulin resistance were performed in the normal adolescents.Results: Mean albumin excretion was significantly lower in normal adolescents (4.0 g/min) than in type 1 diabetic adolescents (5.0 g/min). Albumin excretion increased with age in diabetics. Albumin excretion did not significantly correlate with any measure of cardiovascular risk or insulin resistance but did significantly correlate with fasting insulin.Conclusions: Albumin excretion rate is not related to insulin resistance or traditional cardiovascular risk factors in adolescence but is related to fasting insulin. Diabetic adolescents have increased albumin excretion compared with normal adolescents.

Recent data suggest that elevated levels of uric acid (UA) might contribute to the progression of renal disease. Rasburicase, recombinant urate oxidase, is a highly safe and efficacious hypo-uricosuric agent for treatment of elevated UA levels from tumor lysis. We adopted the use of rasburicase for management of hyperuricemia in infants with acute kidney injury (AKI) and, herein, report our experience. We conducted a retrospective chart review of infants with hyperuricemia (UA > 8 mg/dl) secondary to AKI (serum creatinine > 1.5 mg/dl) treated with rasburicase. Seven infants (mean age 34 +/- 55 days, six male), with a mean weight of 3.2 +/- 1.2 kg, were identified. Rasburicase was administered intravenously as a single, onetime, bolus of 0.17 +/- 0.04 mg/kg body weight. Within 24 h, serum UA had decreased from 13.6 +/- 4.5 mg/dl to 0.9 +/- 0.6 mg/dl (P < 0.05), creatinine had decreased from 3.2 +/- 2.0 mg/dl to 2.0 +/- 1.2 mg/dl (P < 0.05), and urinary output had increased from 2.4 +/- 1.2 ml/kg per hour to 5.9 +/- 1.8 ml/kg per hour (P < 0.05). Continued improvements in UA, creatinine, and urinary output were observed in the week following administration of rasburicase, without rebound of the UA. We observed no treatment-related side effects. All patients demonstrated a normalization of uric acid level without need of renal replacement therapy. In conclusion, a single intravenously administered bolus of rasburicase appears to be a novel treatment for hyperuricemia in infants with AKI.