Development and progression of microalbuminuria in a clinic sample of patients with insulin dependent diabetes mellitus

Abstract

The evolution of abnormal albumin excretion and its association with suggested risk factors were studied in 233 children with insulin dependent diabetes mellitus (IDDM) attending a single paediatric diabetic clinic over an eight year period. Yearly albumin:creatinine ratios (ACR; measured in mg/mmol) in early morning urine samples, glycated haemoglobin (HbA1c), and blood pressure were recorded. Thirty four (14.5%) children had a persistently raised ACR (ACR > 2.5 mg/ mmol on at least three consecutive occasions) and 21 (9%) had an intermittently raised ACR (ACR > 2.5 mg/mmol on at least two occasions). Factors associated with a persistently raised ACR compared with normal albuminuria in IDDM included longer duration of diabetes, raised median HbA1c during the first five years after diagnosis, and final age adjusted systolic and diastolic blood pressure represented as standard deviation scores. The onset of persistently raised ACR in 13 of 34 children was before puberty and in 23 of 34 children it was within the first four years of diagnosis. The cross sectional prevalence of raised ACR was 12.9% at one year, 18.3% at five years, and 33% at 10 years after diagnosis. Raised ACR occurs frequently before puberty and in the early stages of childhood diabetes. (Arch Dis Child 1998;78:518-523)

Risk of nephropathy can be detected before the onset of microalbuminuria during the early years after diagnosis of type 1 diabetes.

“…RESEARCH DESIGN AND METHODS -Between 1986 and 1995, 511 subjects aged Ͻ16 years were recruited at diagnosis and followed for a median of 6 years (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. In 78 subjects (designated cases), an annual assessment of the albumin-to-creatinine ratio (ACR) in three morning first-void urine samples detected MA (males: ACR Ն3.5 mg/mmol, females: ACR Ն4.0 mg/mmol in two of three urine samples).…”

“…Nevertheless, only a proportion (30-50%) of subjects with type 1 diabetes is at risk for nephropathy (1), and genetic factors are thought to be important in determining susceptibility (2). During adolescence, HbA 1c , sex, and puberty (3,4) are also important determinants of the risk for incipient nephropathy (microalbuminuria [MA]). However, it may be possible to detect individuals at risk at an earlier stage in the pathogenesis of nephropathy.…”

Microvascular and Macrovascular Complications in Children and Adolescents with Type 1 Diabetes

“…Most studies investigating microalbuminuria have been cross-sectional and clinic based, with only a few being longitudinal, but mainly with a retrospective design. Jones et al (Jones et al, 1998) reported a prevalence of 14.5% during 8.5 years of diabetes duration, whereas Rudberg et al (Rudberg et al, 1993) reported a prevalence of 24% after 15 years diabetes duration. The most recent data from the Oxford Regional Prospective Study (ORPS), a population-based inception cohort of children with type 1 diabetes, has shown a cumulative prevalence of microalbuminuria of 25.7% after 10 years and of 50.7% after 19 years of diabetes duration (Amin et al, 2008).…”

“…Microalbuminuria often develops during puberty, whereas its prevalence during prepubertal years is rare (Janner et al, 1994;Lawson et al, 1996;Norgaard et al, 1989;Rudberg et al, 1993). The overall prevalence of microalbuminuria in youth with type 1 diabetes ranges between 4 and 26% (Bojestig et al, 1996;Cook and Daneman, 1990;Dahlquist and Rudberg, 1987;Joner et al, 1992;Jones et al, 1998;Mathiesen et al, 1986;Moore and Shield, 2000;Norgaard et al, 1989;Olsen et al, 2000;Rudberg et al, 1993;Schultz et al, 1999b). This large variation in the prevalence of microalbuminuria is due to differences in study design, duration of diabetes, age range, and glycemic control.…”

“…Microalbuminuria is the most common abnormal finding in children and adolescents with type 1 diabetes, whereas overt proteinuria is found in less than 1-1.5% of them (Jones et al, 1998;Schultz et al, 1999b). Microalbuminuria often develops during puberty, whereas its prevalence during prepubertal years is rare (Janner et al, 1994;Lawson et al, 1996;Norgaard et al, 1989;Rudberg et al, 1993).…”