Glucose metabolism disorders in children with refractory nephrotic syndrome

Takahashi, Toshiyuki; Okamoto, Takayuki; Sato, Yasuyuki; Hayashi, Asako; Ueda, Yasuhiro; Ariga, Tadashi

doi:10.1007/s00467-019-04360-1

Cited by 8 publications

(6 citation statements)

References 45 publications

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“…Though, the results demonstrated a notably elevated prevalence rate of IR in overweight and generally obese children [17,23]. The same results were obtained by T. Takahashi et al [24] that obese/overweight patients had significantly more glucose metabolism disorders than non-obese/non-overweight once. IR is usually one of the first metabolic damage diagnosed in obese children and the key risk factor for the development of comorbidities [25].…”

Section: Discussionsupporting

confidence: 58%

Insulin resistance: metabolic and somatic changes in children

Gromnatska

Sklyarova

Kulya

2022

Mìžnarodnij endokrinologìčnij žurnal

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Background. Insulin resistance is the major sign of etiology and pathogenesis of type 2 diabetes mellitus and metabolic syndrome and can precede its development for many years. Early identifying the beginning of insulin resistance in children is important to prevent diabetes mellitus in adult life. The purpose was to identify metabolic and somatic changes in children with insulin resistance. Material and methods. Out of 182 children of the general sample, who was estimated fasting plasma insulin and glucose, HOMA-IR, and glucose/insulin ratio, 2 groups were formed: group 1 — children with IR — 56 (30.8 %) and group 2 — 126 (69.2 %) children with normal insulin sensitivity. In children anthropometric data, lipid metabolism (total cholesterol, triglycerides, HDL-C, LDL-C, VLDL-C), blood pressure, leptin were determined. Results. From examined subjects 56 children were generally obese (BMI > 95th percentile), 71 children were abdominally obese (WC > 90th percentile), 55 children were with normal body mass (BMI < 90th percentile). Insulin resistance was identified in 21 (37.5 %) children with general obesity more rarely, than in 38 (39.4 %) children with abdominal obesity (p = .049) and in 7 (12.7 %) children with normal BMI (p = .003). In insulin-resistant children BMI, waist and hip circumference was larger than in children with normal insulin sensitivity. The lipid profile in children with different insulin sensitivity did not differ, but in insulin-resistant children an association of basal glucose with TG/HDL-C ratio (r = .53; p = .001), blood insulin with TG (r = .34; p = .018), and TG/HDL-C ratio (r = .54; p = .001) was estimated. The HOMA-IR significantly correlated with VLD-C (r = .40; p = .005), TG (r = .49; p = .001), TG/HDL-C ratio (r = .43; p = .002). The glucose/insulin ratio was in significant association with the TG/non-HDL-C ratio. The incidence of hypetension (> 95th percentile) diagnosis in insulin-resistant children was by 33.8 % higher (p = .001). Blood leptin concentration was 1.8 falled higher in insulin-resistant children and significantly correlates with waist circumference, fasting insulin, HOMA-IR, and diastolic blood pressure. Conclusions. Insulin resistance is related to cardiometabolic risks, such as general and abdominal obesity, hypertension, dyslipidemia, hyperleptinemia, and leptin resistance, and is a screening biomarker for children and adolescents with an increased risk of cardiometabolic diseases.

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Section: Discussionsupporting

confidence: 58%

Insulin resistance: metabolic and somatic changes in children

Gromnatska

Sklyarova

Kulya

2022

Mìžnarodnij endokrinologìčnij žurnal

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“…The OGTT should not be neglected, because evidence from studies on DM2 in adults shows that not performing an OGTT could lead to underdiagnosis of diabetes [ 24 ]. Furthermore, a study on children treated with steroids and CNIs because of the refractory NS showed that 40% of all glucose homeostasis disturbances were diagnosed only by the 2-hour OGTT [ 6 ].…”

Section: Review Of the Literaturementioning

confidence: 99%

“…However, it is generally considered that if the treatment does not damage the pancreatic β-cells in an irreversible way, the severity of glucose homeostasis impairment should be reduced partially (to pre-diabetes state) or totally (to euglycaemia) after the drug discontinuation. Research performed on a small group showed that the pre-diabetes states persisted in 71% of children with nephrotic syndrome (NS) treated with steroids and calcineurin inhibitors (CNIs) [ 6 ]. The series of case reports on a similar group indicates only a transient glucose metabolism disturbance [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Atypical diabetes mellitus in children – when to suspect drug-induced diabetes. A case-based review of the literature

Okruszko¹,

Szabłowski²,

Pochodowicz³

et al. 2022

pedm

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Introduction: Drug-induced diabetes mellitus (DIDM) could be defined as a heterogenic group of diabetes caused by pharmacotherapy. The DIDM is considered to be reversible after discontinuation of diabetogenic treatment, but there is a risk of persistence, which is related to the duration of treatment, prescribed medication, and body mass index. Case presentation: A 13-year-old boy treated for nephrotic syndrome with the use of tacrolimus and prednisone was diagnosed with diabetes during a check-up visit. On admission, he showed a cushingoid appearance and complained of dry mouth, which was not accompanied by polyuria or polydipsia. Blood tests showed elevated levels of glucose, and glycated A 1c fraction of haemoglobin (HbA 1c = 10.2%). Pancreatic islet autoantibodies were negative. The fasting and postprandial C-peptide levels were within the normal range. Diabetic ketoacidosis was excluded. Intensive insulin therapy was initially introduced; the daily dose of insulin per kilogram was low (TDD/kg = 0.31 U/kg). Those findings prompted us to consider diabetes mellitus type 2 or DIDM. Moreover, the TDD/kg and HbA 1c additionally decreased after the steroid withdrawal. Because he was constantly on diabetogenic therapy and experienced periodical hyperglycaemia, DIDM could not be excluded. Therefore, our patient remained on insulin treatment. Conclusions: DIDM in children is challenging for all specialists. Diabetologists need to remember about this rare subtype of diabetes, and other specialist should perform screening on their patients who are at risk of DIDM. There is a great need for guidelines that would provide a standardized approach for diagnosing and treating DIDM in the paediatric population.

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“…Glucocorticoids remain the mainstream of treatment for INS after excluding the possible secondary factors and have obtained excellent results in improving survival of both patients and kidney function [ 10 ]. However, patients with refractory INS are at high risk of medication-induced glucose metabolism disorders, such as diabetes [ 11 , 12 ]. The prevalence of steroid-induced diabetes mellitus (SIDM) in INS was 6.2% [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of high density lipoprotein cholesterol (HDL-C) on renal outcome in patients with nephrotic syndrome complicated with steroid-induced diabetes mellitus(SIDM)

Ding

Liu

et al. 2023

BMC Nephrol

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Objective We aimed to investigate the renal prognosis of patients with idiopathic nephrotic syndrome (INS) complicated with steroid-induced diabetes mellitus (SIDM), the association of high-density lipoprotein cholesterol (HDL-C) before glucocorticoid treatment with renal prognosis, and the risk for persistent diabetes among patients with INS who had withdrawn from steroid therapy. Materials and methods We retrospectively analyzed 239 patients with INS complicated with SIDM at the National Clinical Research Center of Kidney Diseases, Jinling Hospital, from January 2008 to December 2019. The primary endpoint was the composite renal outcome defined as the development of end-stage renal disease (ESRD) or a 50% decrease in estimated glomerular filtration rate (eGFR) for more than 24 months after glucocorticoid withdrawal. The secondary endpoint was persistent diabetes, defined as fulfilling the criteria for diagnosing diabetes or using antidiabetic medications for at least 24 months after glucocorticoid withdrawal. Results After glucocorticoid withdrawal for over 24 months, 35 (14.6%) patients reached the composite renal endpoint: end-stage renal disease (n = 14) or a 50% decrease in eGFR (n = 21). Before glucocorticoid therapy, a level of HDL-C greater than 1.45 mmol/L worsened renal survival in patients with INS complicated with SIDM. The log10 the level of HDL-C before glucocorticoid treatment was an independent risk factor for the renal outcome. A prediction model was generated: Hazard ratio (renal outcome) = 0.94 * hypertension before glucocorticoid therapy + 2.29 * log10 level of HDL-C before glucocorticoid treatment + 0.90 * the grade of interstitial tubule injury (AUROC, 0.75; 95% CI, 0.63 to 0.87; P < 0.01). Meanwhile, a level of fasting plasma glucose (FPG) before glucocorticoid treatment greater than 5.2 mmol/L enhanced the likelihood of persistent diabetes for at least 24 months after glucocorticoid withdrawal. Conclusions Increased level of HDL-C before glucocorticoid therapy was independently associated with a higher risk for renal outcome and thus may be useful in the renal prognosis of patients with INS complicated with SIDM.

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Glucose metabolism disorders in children with refractory nephrotic syndrome

Cited by 8 publications

References 45 publications

Insulin resistance: metabolic and somatic changes in children

Insulin resistance: metabolic and somatic changes in children

Atypical diabetes mellitus in children – when to suspect drug-induced diabetes. A case-based review of the literature

Effect of high density lipoprotein cholesterol (HDL-C) on renal outcome in patients with nephrotic syndrome complicated with steroid-induced diabetes mellitus(SIDM)

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