Renal echo-3D and microalbuminuria in children of diabetic mothers: a preliminary study

Abstract

Maternal diabetes has assumed epidemic relevance in recent years and animal studies have provided some evidence that it may cause abnormalities in renal development and a reduction in nephron endowment in the offspring; however, human data are lacking. The renal cortex contains ∼95% of the glomeruli and its volume could be taken as a surrogate measure of glomerular number; based on this assumption, we measured renal cortex volume and in addition, microalbuminuria in a homogeneous sample of 42 children of diabetic (pregestational, n = 13, and gestational, n = 29) mothers, compared with 21 healthy children born of non-diabetic mothers. The offspring of diabetic mothers showed a significant reduction of renal cortex volume and higher albumin excretion compared with controls, possibly attributable to a reduction in the number of nephrons and the difference was statistically significant (P < 0.001). Although further studies on a larger sample are necessary, our preliminary findings suggest that maternal diabetes may affect renal development with sequelae later in life, requiring closer monitoring and follow-up. Furthermore, the importance of strict maternal diabetes management and control must be emphasized.

Increased Urinary Cystatin-C Levels Correlate with Reduced Renal Volumes in Neonates with Intrauterine Growth Restriction

“…The assessment of kidney growth is currently performed using 2D or estimating renal volume with 3D ultrasound scans [9,10,11]; however, to date, no biochemical marker has been evaluated in association with renal volume reduction and IUGR. Cystatin C (Cys-C) is a strongly basic secretory nonglycosylated protein produced at a constant rate in all nucleated cells [12].…”

The relationship between maternal obesity and diabetes during pregnancy on offspring kidney structure and function in humans: a systematic review

“…Included studies (n = 9) were published between 1994 and 2014 and were conducted in 12 countries including the United States of America, [28][29][30] Netherlands, 31,32 Canada, 33 France, 34 Italy 35 and Brazil. 36 The most common measures of kidney structure were kidney volume and length, while kidney function measures were albuminuria, albumin/creatinine and GFR.…”

“…Four studies did not specify the exact numbers for each sex. 29,31,35,36 There was a wide range in the age of offspring at the time of assessment, from late gestation to approximately 40 years of age.…”

Normal foetal kidney volume in offspring of women treated for gestational diabetes

“…While one study found normal foetal kidney volume in diabetic pregnancies (pregestational diabetes and GDM pregnancies grouped together), 38 another found increased foetal kidney volume in pregnancies of women with GDM. 40 Overall, evidence for the extent to which GDM affects developing human kidneys is not robust. 40 Overall, evidence for the extent to which GDM affects developing human kidneys is not robust.…”

“…39 A third preliminary study reported reduced renal cortical volume and increased albumin excretion in 3-year-old children whose mothers had GDM, taken to suggest a reduction in nephron endowment and glomerular impairment. 40 Overall, evidence for the extent to which GDM affects developing human kidneys is not robust. It is unclear what effect a period of hyperglycaemia has on foetal kidney development and growth, and subsequent renal physiology and function.…”