Microalbuminuria in Diabetic Children and Adolescents

Salardi, S; Cacciari, E; Pascucci, Matteo; Giambiasi, E.; Tacconi, M.; Tazzari, R; Cicognani, Alessandro; Boriani, Filippo; Puglioli, R.; Mantovani, W; Donati, Sara

doi:10.1111/j.1651-2227.1990.tb11490.x

Cited by 43 publications

(30 citation statements)

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“…Like somatic and renal growth, these processes are sexually dimorphic and may play a role in the postpubertal susceptibility to renal diseases or sexual differences in renal outcomes [1,2,3,4,5,6,7,8,9,16].…”

Section: Discussionmentioning

confidence: 99%

“…Diabetes mellitus produces different structural responses in the kidney, dependent on the age of the rat at the time of streptozocin injection [1,2]. The prepubertal years of diabetes are relatively protected from the clinical manifestations of diabetic kidney disease, and the renal structural response may be different during this period as well [3,4,5,6,7]. The mechanism for these differences is unclear, but may involve growth hormone, insulin-like growth factor, sex steroids, or other pubertal factors.…”

Section: Introductionmentioning

confidence: 99%

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Sex differences in the renal transforming growth factor-β1 system after puberty

Lane

Snelling

Babushkina-Patz

et al. 2001

Pediatric Nephrology

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Transforming growth factor-beta 1 (TGF-beta 1) has been implicated in many progressive kidney diseases. The present study examines this growth factor during the pubertal and early adult periods. Mixed-sex Munich-Wistar rat kidneys were obtained on selected days of life from birth through 6 months of age. A survey of the TGF-beta 1 system was performed, and then a second experiment focused on cortex and medulla from both sexes at 6 weeks and 16 weeks of age. Reverse transcription polymerase chain reaction for TGF-beta 1 and TGF-beta inducible gene H3 (beta IG-H3) was performed. Active and total levels of protein for TGF-beta 1 were isolated from tissue. Active levels of TGF-beta 1 were somewhat lower in older than in younger animals, without sex differences. beta IG-H3 levels were similar. At 16 weeks females had levels of total growth factor approximately threefold greater than males, while adult males appeared to activate the growth factor much more efficiently. These findings suggest that activation of TGF-beta 1 becomes more efficient following puberty in the male rat, while females appear to have reduced activation efficiency compensated by increased total growth factor. These differences may help explain the deterioration at puberty and sexual dimorphism noted with some progressive nephropathies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sex differences in the renal transforming growth factor-β1 system after puberty

Lane

Snelling

Babushkina-Patz

et al. 2001

Pediatric Nephrology

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“…38 Good glycaemic control during quality of long-term glycaemic control (data taken from Danne et al 26 ) puberty was found to be associated with a reduced risk for microalbuminuria, 89 while high serum growth hormone levels indicative of poor metabolic regulation However, even the calibration of HbA 1c values to the standard deviation range of control values may lead to were associated with an increased risk. 90 An acceleration of the development of retinopathy clinically relevant incorrect conclusions regarding the risk for microangiopathy. 77 Therefore, it may not be during puberty becomes apparent when the respective development of incipient and early background retinopertinent to translate published HbA 1c levels directly into results obtained from another laboratory.…”

Section: Development Of Microangiopathy Inmentioning

confidence: 99%

Diabetic angiopathy in children

et al. 1997

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“…Cross-sectional data describe abnormalities of the growth hormone (GH)/ IGF-I axis in relation to the development of diabetic complications (8). In type 1 diabetes, bioavailability of circulating IGF-I is low and GH secretion exaggerated (9,10), and these abnormalities may be more marked in female patients (10).…”

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confidence: 99%

Low IGF-I and Elevated Testosterone During Puberty in Subjects With Type 1 Diabetes Developing Microalbuminuria in Comparison to Normoalbuminuric Control Subjects

et al. 2003

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OBJECTIVE -To describe longitudinal variations in pubertal hormonal variables in subjects with and without microalbuminuria (MA).RESEARCH DESIGN AND METHODS -Blood samples collected annually from subjects recruited at diagnosis of type 1 diabetes and followed prospectively through puberty (median follow-up 9.3 years, range 4.7-12.8) were analyzed for total and free IGF-I, IGF binding protein-1, testosterone, sex hormone-binding globulin, and HbA 1c . A total of 55 subjects who developed MA (MA ϩ group) were compared with 55 age-, sex-, and duration-matched control subjects who did not develop MA (MA Ϫ group).RESULTS -For female subjects, total IGF-I (MA ϩ 1.2 mU/l vs. MA Ϫ 1.4 mU/l, P ϭ 0.03) and free IGF-I levels (MA ϩ 1,767 ng/l vs. MA Ϫ 2010 ng/l, P ϭ 0.002) were lower, whereas the free androgen index (MA ϩ 2.4 vs. MA Ϫ 2.0, P ϭ 0.03) was higher in those with MA. These changes were less pronounced in male subjects. For both sexes, in a Cox model after adjusting for puberty, the presence of MA was associated with lower free IGF-I levels, higher testosterone standard deviation score (SDS), and poor glycemic control. We found that 22 of 55 case subjects (40%) developed persistent MA, whereas 33 (60%) had transient MA. In the persistent MA group compared with the transient and control groups, total IGF-I levels were lower (1.1 vs. 1.3 vs. 1.4 mU/l, P ϭ 0.002) as were free IGF-I levels (1,370.9 vs. 1,907.3 vs. 1,886.7 ng/l, P Ͻ 0.001), whereas HbA 1c levels were higher (11.8 vs. 10.3 vs. 9.9%, P Ͻ 0.001).CONCLUSIONS -Poor glycemic control and differences in IGF-I levels and androgens, particularly in female subjects, accompany development of MA at puberty. These differences may in part account for the sexual dimorphism in MA risk during puberty and could relate to disease progression. Diabetes Care 26:1456 -1461, 2003M icroalbuminuria (MA) is a marker of incipient nephropathy in adult subjects with type 1 diabetes (1). There is an unequivocal relationship between poor glycemic control and the development of MA (2). However, independent of poor glycemic control, early diabetic complications risk is increased with the onset of puberty (3). In addition, MA risk is twofold greater in pubertal female patients compared with male patients (3), in contrast to lifetime risk of diabetic nephropathy, which is greater in male patients (4). Sexual dimorphism is also present during puberty for risk of attenuated growth, weight gain, and retinopathy, and again these observations are independent of glycemic control (5-7). These data suggest that the development of diabetic microvascular complications may be associated with abnormalities in hormonal variables related to pubertal development.Cross-sectional data describe abnormalities of the growth hormone (GH)/ IGF-I axis in relation to the development of diabetic complications (8). In type 1 diabetes, bioavailability of circulating IGF-I is low and GH secretion exaggerated (9,10), and these abnormalities may be more marked in female patients (10). Despite evidence of hepatic GH r...

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Microalbuminuria in Diabetic Children and Adolescents

Cited by 43 publications

References 22 publications

Sex differences in the renal transforming growth factor-β1 system after puberty

Sex differences in the renal transforming growth factor-β1 system after puberty

Diabetic angiopathy in children

Low IGF-I and Elevated Testosterone During Puberty in Subjects With Type 1 Diabetes Developing Microalbuminuria in Comparison to Normoalbuminuric Control Subjects

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