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Guntram Schernthaner, Kidney disease in diabetology: lessons from 2008, Nephrology Dialysis Transplantation, Volume 24, Issue 2, February 2009, Pages 396–399, https://doi.org/10.1093/ndt/gfn694
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Introduction
Micro- and macroalbuminuria are important markers for early and progressive diabetic kidney disease. Patients with type 1 diabetes carry a 20–50% risk of developing end-stage renal disease (ESRD) requiring dialysis or renal transplantation. The primary goal of managing childhood type 1 diabetes is to prevent or delay renal and retinal microvascular complications. In contrast to patients with type 2 diabetes, the cumulative incidence of nephropathy has significantly declined in patients with type 1 diabetes over the past three decades, which was due to more intensified treatment regimens for control of hyperglycaemia, hypertension and dyslipidaemia. However, many patients with type 1 diabetes have their manifestation of disease already at very young age, when strict diabetes control is more difficult to reach compared to patients with manifestation of diabetes later in life.
Microalbuminuria in type 1 diabetic children
Most of our knowledge of the relationship between control of diabetes and the risk of diabetic renal complications comes from data in adults and adolescents, so it is important to have a precise evaluation of the risk in children. Two recent studies performed in diabetic children in Germany [ 1 ] and in the UK [ 2 ] indicate that insufficient glycaemic control in diabetic childhood is an important contributor to the overall risk of developing diabetic kidney disease. In a nationwide, prospective German Diabetes Study [ 1 ] 27 805 patients who had at least two documented urine analyses with identical classification were included. The median age at diagnosis of type 1 diabetes was 9.9 years (interquartile range 5.8–14.3), and age at last visit was 16.3 years (12.5–22.2), with a mean HbA1c of 8.0%. Nephropathy was classified as normal in 26 605, microalbuminuric in 919, macroalbuminuric in 78 and end-stage renal disease (ESRD) in 203 patients. After calculated diabetes duration of 40 years, 25.4% had microalbuminuria and 9.4% had macroalbuminuria or ESRD. Significant risk factors for microalbuminuria were diabetes duration, HbA1c, LDL cholesterol and blood pressure, while diabetes onset at childhood was protective. Male sex was associated with the development of macroalbuminuria.
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