Ahn Moon Bae, Cho Kyoung Soon, Kim Seul Ki, Kim Shin Hee, Cho Won Kyoung, Jung Min Ho, Suh Jin-Soon, Suh Byung-Kyu
Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
Department of Pediatrics, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon 14647, Korea.
Children (Basel). 2021 May 19;8(5):417. doi: 10.3390/children8050417.
Diabetic nephropathy (DN) is a serious microvascular complication in childhood diabetes and microalbuminuria has been a solid indicator in the assessment of DN. Nevertheless, renal injury may still occur in the presence of normoalbuminuria (NA) and various tubular injury biomarkers have been proposed to assess such damage. This case-controlled study aimed to evaluate plasma and urinary neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 (KIM-1) levels in diabetic children particularly in those with normo- and high-NA stages and determine their role in predicting DN. Fifty-four children/adolescents with type 1 and 2 diabetes and forty-four controls aged 7-18 years were included. The baseline clinical and laboratory characteristics including plasma and urinary biomarkers were compared. The plasma KIM-1 levels were significantly higher in diabetic children than in the controls and in high-NA children than normo-NA children. Glycosylated hemoglobin (HbA1c) was identified as a significant risk factor for increased plasma KIM-1. The optimal cutoff for HbA1c when the plasma KIM-1 was > 23.10 pg/mL was 6.75% with an area under the curve of 0.77. For diabetic children with mildly increased albuminuria, the plasma KIM-1 complementary to MA may help increase the yield of detecting DN. Our findings also suggested an HbA1c cutoff of 6.75% correlated with increased plasma KIM-1.
糖尿病肾病（DN）是儿童糖尿病严重的微血管并发症，微量白蛋白尿一直是评估DN的可靠指标。然而，在正常白蛋白尿（NA）情况下仍可能发生肾损伤，并且已经提出了各种肾小管损伤生物标志物来评估此类损伤。这项病例对照研究旨在评估糖尿病儿童，特别是处于正常白蛋白尿和高白蛋白尿阶段儿童的血浆和尿液中性粒细胞明胶酶相关脂质运载蛋白及肾损伤分子-1（KIM-1）水平，并确定它们在预测DN中的作用。纳入了54例1型和2型糖尿病儿童/青少年以及44例7至18岁的对照者。比较了包括血浆和尿液生物标志物在内的基线临床和实验室特征。糖尿病儿童的血浆KIM-1水平显著高于对照组，高白蛋白尿儿童高于正常白蛋白尿儿童。糖化血红蛋白（HbA1c）被确定为血浆KIM-1升高的一个重要危险因素。当血浆KIM-1>23.10 pg/mL时，HbA1c的最佳截断值为6.75%，曲线下面积为0.77。对于轻度白蛋白尿增加的糖尿病儿童，与微量白蛋白（MA）互补的血浆KIM-1可能有助于提高DN的检出率。我们的研究结果还表明，HbA1c截断值为6.75%与血浆KIM-1升高相关。
