Regression and progression of microalbuminuria in adolescents with childhood onset diabetes mellitus
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Although microalbuminuria is considered as an early marker of nephropathy in diabetic adults, available information in diabetic adolescents is limited. The aim of this study was to investigate prevalence and frequency of regression of microalbuminuria in type 1 (T1DM) and type 2 diabetes mellitus (T2DM) patients with childhood onset. Methods: One hundred and nine adolescents (median, 18.9 years; interquartile range (IQR), 16.5–21.0 years) with T1DM and 18 T2DM adolescents (median, 17.9 years; IQR, 16.8–18.4 years) with repeated measurements of microalbuminuria (first morning urine microalbumin/creatinine ratios) were included. The median duration of diabetes was 10.1 (7.8–14.0) years and 5.0 (3.5–5.6) years, respectively, and follow-up period ranged 0.5–7.0 years. Growth parameters, estimated glomerular filtration rate, glycosylated hemoglobin (HbA1c) and lipid profiles were obtained after reviewing medical record in each subject. Results: The prevalence of microalbuminuria at baseline and evaluation were 21.1% and 17.4% in T1DM, and 44.4% and 38.9% in T2DM. Regression of microalbuminuria was observed in 13 T1DM patients (56.5%) and 3 T2DM patients (37.5%), and progression rate was 10.5% and 20% in T1DM and T2DM respectively. In regression T1DM group, HbA1c at baseline and follow-up was lower, and C-peptide at baseline was higher compared to persistent or progression groups. In T2DM, higher triglyceride was observed in persistent group. Conclusion: Considerable regression of microalbuminuria more than progression in diabetes adolescents indicates elevated urinary microalbumin excretion in a single test does not imply irreversible diabetic nephropathy. Careful monitoring and adequate intervention should be emphasized in adolescents with microalbuminuria to prevent rapid progression toward diabetic nephropathy.
Abstract
Purpose: Although microalbuminuria is considered as an early marker of nephropathy in diabetic adults, available information in diabetic adolescents is limited. The aim of this study was to investigate prevalence and frequency of regression of microalbuminuria in type 1 (T1DM) and type 2 diabetes mellitus (T2DM) patients with childhood onset. Methods: One hundred and nine adolescents (median, 18.9 years; interquartile range (IQR), 16.5–21.0 years) with T1DM and 18 T2DM adolescents (median, 17.9 years; IQR, 16.8–18.4 years) with repeated measurements of microalbuminuria (first morning urine microalbumin/creatinine ratios) were included. The median duration of diabetes was 10.1 (7.8–14.0) years and 5.0 (3.5–5.6) years, respectively, and follow-up period ranged 0.5–7.0 years. Growth parameters, estimated glomerular filtration rate, glycosylated hemoglobin (HbA1c) and lipid profiles were obtained after reviewing medical record in each subject. Results: The prevalence of microalbuminuria at baseline and evaluation were 21.1% and 17.4% in T1DM, and 44.4% and 38.9% in T2DM. Regression of microalbuminuria was observed in 13 T1DM patients (56.5%) and 3 T2DM patients (37.5%), and progression rate was 10.5% and 20% in T1DM and T2DM respectively. In regression T1DM group, HbA1c at baseline and follow-up was lower, and C-peptide at baseline was higher compared to persistent or progression groups. In T2DM, higher triglyceride was observed in persistent group. Conclusion: Considerable regression of microalbuminuria more than progression in diabetes adolescents indicates elevated urinary microalbumin excretion in a single test does not imply irreversible diabetic nephropathy. Careful monitoring and adequate intervention should be emphasized in adolescents with microalbuminuria to prevent rapid progression toward diabetic nephropathy.
참고문헌 (29)
- de Jong PE, "Screening, monitoring, and treatment of albuminuria: Public health perspectives", J Am Soc Nephrol, 17, pp.2120~2126 (2006)
- Gerstein HC, "Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals", JAMA, 286, pp.421~426 (2001)
- Allen KV, "Microalbuminuria and mortality in long-duration type 1 diabetes", Diabetes Care, 26, pp.2389~2391 (2003)
- Bangstad HJ, "Early glomerulopathy is present in young, type 1 (insulin-dependent) diabetic patients with microalbuminuria", Diabetologia, 36, pp.523~529 (1993)
- Ibsen H, "Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE Study", Kidney Int Suppl, (92), pp.S56~S58 (2004)
- Amin R, "Risk of microalbuminuria and progression to macroalbuminuria in a cohort with childhood onset type 1 diabetes: prospective observational study", BMJ, 336, pp.697~701 (2008)
- 권아름, "1형 당뇨병 환자에서 미세혈관 합병증의 발생 빈도와 위험 인자", Annals of Pediatirc Endocrinology & Metabolism, 17(1), pp.16~26 (2012), 대한소아내분비학회[DOI]
- Farmer AJ, "Optimal strategies for identifying kidney disease in diabetes: properties of screening tests, progression of renal dysfunction and impact of treatment - systematic review and modelling of progression and cost-effectiveness", Health Technol Assess, 18, pp.1~128 (2014)
- Donaghue KC, "Microvascular and macrovascular complications in children and adolescents", Pediatr Diabetes, 15(Suppl 20), pp.257~269 (2014)
- Perkins BA, "Regression of microalbuminuria in type 1 diabetes", N Engl J Med, 348, pp.2285~2293 (2003)
- Hovind P, "Predictors for the development of microalbuminuria and macroalbuminuria in patients with type 1 diabetes:inception cohort study", BMJ, 328, pp.1105~ (2004)
- Montgomery KA, "Implementation of a clinical practice guideline for identification of microalbuminuria in the pediatric patient with type 1 diabetes", Nurs Clin North Am, 48, pp.343~352 (2013)
- Steinke JM, "The early natural history of nephropathy in Type 1 Diabetes: III. Predictors of 5-year urinary albumin excretion rate patterns in initially normoalbuminuric patients", Diabetes, 54, pp.2164~2171 (2005)
- Bogdanovic R., "Diabetic nephropathy in children and adolescents", Pediatr Nephrol, 23, pp.507~525 (2008)
- Bennett PH, "Screening and management of microalbuminuria in patients with diabetes mellitus", Am J Kidney Dis, 25, pp.107~112 (1995), National Kidney Foundation from an ad hoc committee of the Council on Diabetes Mellitus of the National Kidney Foundation
- Dinneen SF, "The association of microalbuminuria and mortality in non-insulin-dependent diabetes mellitus. A systematic overview of the literature", Arch Intern Med, 157, pp.1413~1418 (1997)
- Ono T, "Factors associated with remission and", or regression of microalbuminuria in type 2 diabetes mellitus, 2014, pp.68, 235~241
- Salardi S, "High rate of regression from micromacroalbuminuria to normoalbuminuria in children and adolescents with type 1 diabetes treated or not with enalapril: the influence of HDL cholesterol", Diabetes Care, 34, pp.424~429 (2011)
- Svensson M, "Early glycemic control, age at onset, and development of microvascular complications in childhood-onset type 1 diabetes: a population-based study in northern Sweden", Diabetes Care, 27, pp.955~962 (2004)
- Giorgino F, "Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study", Diabetologia, 47, pp.1020~1028 (2004)
- Alberti KG, "Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation", Diabet Med, 15, pp.539~553 (1998)
- Maahs DM, "Higher prevalence of elevated albumin excretion in youth with type 2 than type 1 diabetes: the SEARCH for Diabetes in Youth study", Diabetes Care, 30, pp.2593~2598 (2007)
- Gambara V, "Heterogeneous nature of renal lesions in type II diabetes", J Am Soc Nephrol, 3, pp.1458~1466 (1993)
- Araki S, "Factors associated with frequent remission of microalbuminuria in patients with type 2diabetes", Diabetes, 54, pp.2983~2987 (2005)
- Gaede P, "Remission to normoalbuminuria during multifactorial treatment preserves kidney function in patients with type 2 diabetes and microalbuminuria", Nephrol Dial Transplant, 19, pp.2784~2788 (2004)
- Roett MA, "Diabetic nephropathy: the family physician's role", Am Fam Physician, 85, pp.883~889 (2012)
- Stone ML, "Natural history and risk factors for microalbuminuria in adolescents with type 1 diabetes: a longitudinal study", Diabetes Care, 29, pp.2072~2077 (2006)
- de Boer IH, "Kidney disease and related findings in the diabetes control and complications trial", epidemiology of diabetes interventions and complications study, 2014, pp.37, 24~30
- Chiarelli F, "Treatment of hypertension and microalbuminuria in children and adolescents with type 1 diabetes mellitus", Pediatr Diabetes, 3, pp.113~124 (2002)