Minerva Pediatrica 2020 Aug 04

DOI: 10.23736/S0026-4946.20.05812-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Early kidney damage in diabetic adolescents with increased blood pressure and glomerular hyperfiltration

Jolanta SOLTYSIAK ¹ ✉, Danuta OSTALSKA-NOWICKA ¹, Katarzyna MAĆKOWIAK-LEWANDOWICZ ¹, Bogda SKOWRONSKA ², Piotr FICHNA ², Witold STANKIEWICZ ², Katarzyna ZAORSKA ³, Jacek ZACHWIEJA ¹

¹ Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences, Poznan, Poland; Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, Poznan, Poland; Department of Histology and Embryology, Poznan University of Medical Sciences, Poznan, Poland

BACKGROUND: The early impact of type-1 diabetes mellitus (DM1), increased blood pressure and glomerular hyperfiltration (GHF) on kidney damage in adolescents using two urinary markers of kidney injury - neutrophil gelatinase-associated lipocalin (uNGAL) and transferrin (uTransf) was assessed.
METHODS: The study group consisted of 80 adolescents with DM1, of whom 42 were patients with increased blood pressure (IBP), and 38 were patients with normal blood pressure (NBP). Blood pressure was assessed by 24-hour ambulatory bloodpressure monitoring. All patients showed estimated glomerular-filtration rates (eGFRs) above 90 ml/min/1.73m2. The control group consisted of 19 healthy, age and gender-matched adolescents.
RESULTS: All diabetic children showed a significant increase in uNGAL (p<0.001). This increase was not related to blood pressure. The uNGAL was elevated in all patients with normal albuminuria, normal eGFR and NBP. The concentration of uTransf was not increased in the entire studied group and was not related to blood pressure. Children with GHF had significantly higher levels of both uTransf (p=0.010) and uNGAL (p<0.001). In patients with GHF, blood pressure was normal. Patients with IBP showed a significantly higher value for triglycerides (r=0.247; p=0.032) and a longer duration of diabetes (r=0.264; p=0.019).
CONCLUSIONS: Diabetes is the leading risk factor for early kidney injury. However, increased blood pressure does not lead to kidney damage, at least in the early stage of DM1. The uNGAL is the early indicator of kidney injury and increases in patients with normal albuminuria, normal glomerular filtration and normal blood pressure. Glomerular hyperfiltration seems to be a marker of diabetic-kidney involvement.

KEY WORDS: Diabetic kidney disease; Hypertension; Early markers of kidney damage