Trutin Ivana, Bajic Zarko, Turudic Daniel, Cvitkovic-Roic Andrea, Milosevic Danko
Department of Pediatrics, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia.
Research Unit "Dr. Mirko Grmek", University Psychiatric Hospital "Sveti Ivan", Zagreb, Croatia.
Front Pediatr. 2022 Jul 29;10:962048. doi: 10.3389/fped.2022.962048. eCollection 2022.
Diabetic kidney disease (DKD) is the main cause of end-stage renal disease in patients with diabetes mellitus type I (DM-T1). Microalbuminuria and estimated glomerular filtration rate (eGFR) are standard predictors of DKD. However, these predictors have serious weaknesses. Our study aimed to analyze cystatin C, renal resistance index, and urinary kidney injury molecule-1 (KIM-1) as predictors of DKD.
We conducted a cross-sectional study in 2019 on a consecutive sample of children and adolescents (10-18 years) diagnosed with DM-T1. The outcome was a risk for DKD estimated using standard predictors: age, urinary albumin, eGFR, serum creatinine, DM-T1 duration, HbA1c, blood pressure, and body mass index (BMI). We conducted the analysis using structural equation modeling.
We enrolled 75 children, 36 girls and 39 boys with the median interquartile range (IQR) age of 14 (11-16) years and a median (IQR) duration of DM-T1 of 6 (4-9) years. The three focal predictors (cystatin C, resistance index, and urinary KIM-1) were significantly associated with the estimated risk for DKD. Raw path coefficients for cystatin C were 3.16 [95% CI 0.78; 5.53; = 0.009, false discovery rate (FDR) < 5%], for renal resistance index were -8.14 (95% CI -15.36; -0.92; = 0.027; FDR < 5%), and for urinary KIM-1 were 0.47 (95% CI 0.02; 0.93; = 0.040; FDR < 5%).
Cystatin C, renal resistance index, and KIM-1 may be associated with the risk for DKD in children and adolescents diagnosed with DM-T1. We encourage further prospective cohort studies to test our results.
糖尿病肾病（DKD）是1型糖尿病（DM-T1）患者终末期肾病的主要病因。微量白蛋白尿和估计肾小球滤过率（eGFR）是DKD的标准预测指标。然而，这些预测指标存在严重缺陷。我们的研究旨在分析胱抑素C、肾阻力指数和尿肾损伤分子-1（KIM-1）作为DKD的预测指标。
我们在2019年对连续抽样的确诊为DM-T1的儿童和青少年（10 - 18岁）进行了一项横断面研究。结局是使用标准预测指标估计的DKD风险，这些指标包括：年龄、尿白蛋白、eGFR、血清肌酐、DM-T1病程、糖化血红蛋白（HbA1c）、血压和体重指数（BMI）。我们使用结构方程模型进行分析。
我们纳入了75名儿童，其中36名女孩和39名男孩，年龄中位数（四分位间距，IQR）为14（11 - 16）岁，DM-T1病程中位数（IQR）为6（4 - 9）年。三个主要预测指标（胱抑素C、阻力指数和尿KIM-1）与估计的DKD风险显著相关。胱抑素C的原始路径系数为3.16 [95%置信区间（CI）0.78；5.53；P = 0.009，假发现率（FDR）< 5%]，肾阻力指数为 - 8.14（95% CI - 15.36； - 0.92；P = 0.027；FDR < 5%），尿KIM-1为0.47（95% CI 0.02；0.93；P = 0.040；FDR < 5%）。
胱抑素C、肾阻力指数和KIM-1可能与确诊为DM-T1的儿童和青少年的DKD风险相关。我们鼓励进一步开展前瞻性队列研究以验证我们的结果。
