Regression and progression of microalbuminuria in adolescents with childhood onset diabetes mellitus

Son, Mi Kyung; Yoo, Ha Young; Kwak, Byung Ok; Park, Hye Won; Kim, Kyo Sun; Chung, Sochung; Chae, Hyun Wook; Kim, Ho-Seong; Kim, Duk Hee

doi:10.6065/apem.2015.20.1.13

Cited by 14 publications

(27 citation statements)

References 30 publications

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“…4 Other longitudinal, observational studies have replicated these results in children and adults, in type 1 and type 2 diabetes, and in individuals from North America, Asia, and Europe. [5][6][7][8][9] Taken together, these studies provide strong evidence that microalbuminuria may not be the ideal marker of progression after all.…”

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confidence: 87%

Insights into Diabetic Kidney Disease Using Urinary Proteomics and Bioinformatics

Van

Scholey

Konvalinka

2017

JASN

106

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A number of proteomic and peptidomic analyses of urine from diabetic subjects have been published in the quest for a biomarker that predicts progression of nephropathy. Less attention has been paid to the relationships between urinary proteins and the underlying biological processes revealed by the analyses. In this review, we focus on the biological processes identified by studying urinary proteins and protein-protein interactions at each stage of diabetic nephropathy to provide an overview of the events underlying progression of kidney disease reflected in the urine. In uncomplicated diabetes, proteomic/peptidomic analyses indicate that early activation of fibrotic pathways in the kidney occurs before the onset of microalbuminuria. In incipient nephropathy, when albumin excretion rates are abnormal, proteomic/peptidomic analyses suggest that changes in glomerular permselectivity and tubular reabsorption account, at least in part, for the proteins and peptides that appear in the urine. Finally, overt nephropathy is characterized by proteins involved in wound healing, ongoing fibrosis, and inflammation. These findings suggest that there is a spectrum of biological processes in the diabetic kidney and that assessing protein networks may be more informative than individual markers with respect to the stage of disease and the risk of progression.

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confidence: 87%

Insights into Diabetic Kidney Disease Using Urinary Proteomics and Bioinformatics

Van

Scholey

Konvalinka

2017

JASN

106

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“…Urine albumin to creatinine ratio (UACR) in a spot sample is an early marker of kidney injury [13, 14]. Further, the presence of proteinuria has also been described as a risk factor for rapid progression and poorer prognosis of CKD [15, 16].…”

Section: Introductionmentioning

confidence: 99%

Early renal damage among children living in the region of highest burden of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka

et al. 2018

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BackgroundChronic kidney disease of unknown origin (CKDu) in Sri Lanka is grouped with several other epidemics of similar nature across the world as Chronic Interstitial Nephritis in Agricultural Communities (CINAC). In CKDu endemic countries, the focus has mainly been on adults. We hypothesized that studying distribution and factors associated with elevated urine albumin to creatinine ratio (UACR), an early marker of kidney injury, among children living in a CKDu endemic area may provide important clues about the onset and progression of the disease.MethodsThis cross sectional study was performed in rural primary schools in North Central Province of Sri Lnaka, a CKDu high endemic region. Total of 2880 students aging 5 to 11 years from 67 schools were enrolled for urinalysis in a random spot urine sample. Bedside Schwartz formula was used to measure estimated glomerular filtration rate (eGFR) on all children with UACR > 30 mg/g in Polonnaruwa district and a group of age matched controls. A standard multiple linear regression using log transformed UACR as the dependent variable was performed. Mean eGFR were compared between UACR elevated group and controls using independent sample t test.ResultsMedian UACR was 10.3 mg/g. Sex, ethnicity, history of having a chronic disease and age uniquely contributed to the multiple regression model which only explained 2.8% of the variance in the log of the UACR (p < 0.001). Only 15 (0.5%) had UACR> 300 mg/g while 8.2% (n = 236) had UACR between 30 to 300 mg/g and 89.8% (n = 203) of them did not have a chronic disease (Chi square 2.21, p = 0.091). Mean eGFR was significantly lower in the group with elevated UACR (88.9 mg/dl/1.73 m2, 95% CI for mean 86.4- 91.3) compared to group with normal UACR (93.7 mg/dl/1.73 m2,95% CI 91.1- 96.3) (t 2.7, p 0.007). Three out of the four students with eGFR less than 60 mg/dl/1.73 m2 had moderately elevated UACR.ConclusionThis study provides evidence to suggest that children in CKDu endemic regions are having an early renal damage. This observation needs to be investigated further in order to understand the worldwide epidemic of CKDu.

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“…Microalbuminuria has been reported to occur in approximately 15% of children, especially those who demonstrate hyperfiltration. However, microalbuminuria has been shown to remit in a substantial portion of children and adults with other hyperfiltration disorders, notably diabetes mellitus . Therefore, the prognostic value of microalbuminuria in pediatric patients with SCD remains to be established.…”

Section: Introductionmentioning

confidence: 99%

Diffusion tensor imaging MRI of sickle cell kidney disease: initial results and comparison with iron deposition

Donnola

Piccone

et al. 2018

NMR in Biomedicine

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Chronic kidney disease (CKD) occurs in over one-third of patients with sickle cell disease (SCD) and can progress to end-stage renal disease. Unfortunately, current clinical assessments of kidney function are insensitive to early-stage CKD. Previous studies have shown that diffusion magnetic resonance imaging (MRI) can sensitively detect regional renal microstructural changes associated with early-stage CKD. However, previous MRI studies in patients with SCD have been largely limited to the detection of renal iron deposition assessed by T * relaxometry. In this pilot imaging study, we compare MRI assessments of renal microstructure (diffusion) and iron deposition (T *) in patients with SCD and in non-SCD control subjects. Diffusion tensor imaging (DTI) and T * relaxometry MRI data were obtained for pediatric (n = 5) and adult (n = 4) patients with SCD, as well as for non-SCD control subjects (n = 10), on a Siemens Espree 1.5-T MRI scanner. A region-of-interest analysis was used to calculate mean medullary and cortical values for each MRI metric. MRI findings were also compared with clinical assessments of renal function and hemolysis. Patients with SCD showed a significant decrease in medullary fractional anisotropy (FA, p = 0.0001) in comparison with non-SCD subjects, indicative of microstructural alterations in the renal medulla of patients with SCD. Cortical and medullary reductions in T * (increased iron deposition, p = ≤0.0001) were also observed. Significant correlations were also observed between kidney T * assessments and multiple measures of hemolysis. This is the first DTI MRI study of patients with SCD to demonstrate reductions in medullary FA despite no overt CKD [estimated glomerular filtration rate (eGFR) > 100 mL/min/1.73 m ]. These medullary FA changes are consistent with previous studies in patients with CKD, and suggest that DTI MRI can provide a useful measure of kidney injury to complement MRI assessments of iron deposition.

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Regression and progression of microalbuminuria in adolescents with childhood onset diabetes mellitus

Cited by 14 publications

References 30 publications

Insights into Diabetic Kidney Disease Using Urinary Proteomics and Bioinformatics

Insights into Diabetic Kidney Disease Using Urinary Proteomics and Bioinformatics

Early renal damage among children living in the region of highest burden of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka

Diffusion tensor imaging MRI of sickle cell kidney disease: initial results and comparison with iron deposition

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