Burlaka Ievgeniia A, Mityuryayeva Inga O, Shevchenko Tetiana A, Holoborodko Anastasiia D, Kovalchuk Ihor V, Lantukh Lilia O
Bogomolets National Medical University, Kyiv, Ukraine.
Glob Pediatr Health. 2021 Dec 22;8:2333794X211063052. doi: 10.1177/2333794X211063052. eCollection 2021.
Type 1 diabetes (T1D) is mainly a disease of children and young adults. Diabetic nephropathy (DN) is a common finding in diabetic patients. Microalbuminuria is the earliest clinical evidence of DN. Aim of the study was analysis of clinical, laboratory, instrumental, anamnestic examinations data in pediatric patients with T1D and early stage of DN in order to evaluate possible factors associated with early stage of DN and predictors of DN development and progression. A survey of 105 children (62 males, 43 females) with T1D and DN aged 5 to 17 years in Endocrinology unit on Clinical Pediatric Hospital №6 (Kyiv, Ukraine) done. Following clinical and biochemical characteristics found associated with an early DN: inflammatory phenotype (increased ESR, decreased albumin/globulin ratio), functional cardiovascular disorders (increased systolic blood pressure, "minor" ECG changes), signs of secondary metabolic disorders (high HbA1c, increased serum cholesterol level, increase ALAT and ASAT levels). Kidney function impairment at early stage of DN shows: higher MAU grade, GFR decline, rise in serum creatinine level as compared to T1D group. Presence of concomitant kidney and endocrine disease; positive family history found in a bigger number of patients with DN. DKA episodes number found as a factor associated with higher levels of MAU in children with DN. Patients who had microalbuminuria and more than 5 episodes of DKA/year (poorly controlled T1D) have higher progression rate to macroalbuminuria as compared to those who have less than 5 episodes of DKA/year after a 6-year follow-up study.
1型糖尿病（T1D）主要是一种儿童和青年成人疾病。糖尿病肾病（DN）在糖尿病患者中很常见。微量白蛋白尿是DN最早的临床证据。本研究的目的是分析1型糖尿病和DN早期儿科患者的临床、实验室、仪器检查及既往史检查数据，以评估与DN早期相关的可能因素以及DN发生和进展的预测因素。对乌克兰基辅第6临床儿童医院内分泌科的105名5至17岁患有T1D和DN的儿童（62名男性，43名女性）进行了调查。发现以下临床和生化特征与DN早期相关：炎症表型（血沉升高、白蛋白/球蛋白比值降低）、功能性心血管疾病（收缩压升高、心电图“轻微”变化）、继发性代谢紊乱迹象（糖化血红蛋白A1c升高、血清胆固醇水平升高、谷丙转氨酶和谷草转氨酶水平升高）。DN早期的肾功能损害表现为：微量白蛋白尿分级更高、肾小球滤过率下降、血清肌酐水平升高，与T1D组相比。合并肾脏和内分泌疾病；在更多的DN患者中发现有阳性家族史。发现糖尿病酮症酸中毒（DKA）发作次数是与DN儿童更高微量白蛋白尿水平相关的一个因素。在一项为期6年的随访研究后，与每年DKA发作次数少于5次的患者相比，患有微量白蛋白尿且每年DKA发作次数超过5次（T1D控制不佳）的患者向大量白蛋白尿进展的速率更高。
