Early Detection of Nephropathy in Diabetic Children

Radhika, V (2007) Early Detection of Nephropathy in Diabetic Children. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: The development of protienuria in patients with diabetes mellitus has been described in the eighteenth century by Cotugno and it was Richard Bright who postulated in 1836 that albuminuria reflects renal disease. Although renal lesions in diabetic patients have been well known in the nineteenth century, they were usually regarded as non-specific consequences of hypertension. It was only in 1936 that Kimmelstiel and Wilson recognized nodular homogenous glomerular lesions (nodular diabetic glomerulosclerosis) as a diabetes specific complication 1, 2. Later documented that the renal lesion was part of the more general clinical syndrome of microangiopathy. Keen et al (1969) in the United Kingdom and Parving et al (1976) in Denmark were the first to note that urinary albumin excretion rates are elevated in some patients with types1 and 2 diabetes3,4. There is now consensus that a lowish but supranormal albumin excretion rate in the urine ('microalbuminuria') is a powerful predictor of renal (and cardiovascular) events 5. Persistent albuminuria, that is, greater than 300 mg/24 h or 200 μg/min, is the clinical hallmark of the manifestation of diabetic nephropathy (DN). This clinical definition is valid in both types 1 and 2 diabetes. DIMENSION OF THE PROBLEM: In most countries, DN has become the leading cause of ESRD6. According to the United States Renal Data System7 in 1999 DN was the primary diagnosis in 42.8 per cent (38,160 of 89,252) of incident patients7 an increase by 238 per cent compared to 1990. In 2000, the proportion of diabetics amongst patients reaching ESRD varied considerably between different countries, for example, 14.6 per cent in the Netherlands, 22 per cent in Australia, 25 per cent in Sweden, and 36.1 per cent in Germany, but it was consistently on the increase in all countries. The prevention and management of diabetes and its renal complications is thus an immense global challenge. Registry figures tend to underestimate the renal burden posed by diabetes because it is under represented as illustrated by our own observations8. In 1998–2000, diabetes mellitus was found as a comorbid condition in no less than 48.9 percent of patients admitted for renal replacement therapy in Heidelberg. AIM OF THE STUDY: 1. To determine the cross sectional prevalence of microalbuminuria in children attending our diabetic clinic. 2. To assess the factors likely to increase the risk of microalbuminuria. DISCUSSION: 125 children recruited for study from our diabetic clinic were, in the age group of 2 to 16 years, the mean age was 10.2 +/- 3.0. The youngest child was 2.4years of age. Literature review reveals studies on microalbuminuria in IDDM children with a mean age of 13 +/- 4 years Bravo et al93, 10-20 yrs in MIDAC study group84. How ever there is a similar study with age group of 2 to 16 years by Pedro et al 94.Most of the literature on microalbuminuria reveal the mean age of the population to be in the higher range, as adolescents are included in the pediatric population. 86.4% of our study group comprised of children above five years and only 13% of them were below 5 years i.e., pre-school children. Gender distribution of our population revealed that female children predominated in this study. They consisted about 56.8%, whereas the total male children were 43.2%. The male female ratio was 1:1.3.On the contrary it was 1:3 in MIDAC study group84. Age at diagnosis of diabetes mellitus was taken as the age of onset of diabetes and this revealed 60% of our children were in the age group between 5 to 11 years and about 1/3rd were below 5 years. Only 7.2% were above 11 years of age at onset. This shows that most of our children had pre pubertal onset of diabetes mellitus (93%). The diabetic age of our population revealed that majority of our children (89%) had a diabetic age of less than 5 years. Only 11% had diabetic duration over 5 years. The least duration being one month. Mean age, age of onset of diabetes and diabetic age of the female children were found to be higher when compared to male children, but this was not statistically significant. CONCLUSION: 1. The prevalence of microalbuminuria in the pediatric population attending our diabetic clinic is 5.6%. 2. Pubertal age and increasing duration of diabetes, appears to be associated with increased risk of microalbuminuria but is not statistically significant. · Gender and age at onset of diabetes were not associated with increased risk of persistent microalbuminuria. 3. In agreement with recommendations by the American Diabetes Association and the International Society for Pediatric and Adolescent Diabetology (ISPAD), the German Working Group on Pediatric Diabetology recommends screening for all patients with a duration of diabetes >5 years or with a chronological age >11 years. Following these guidelines, in our patient population 2 children with persistent proteinuria <11 years and 6 children with duration less than 5 years would have been missed.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Early Detection ; Nephropathy ; Diabetic Children
Subjects: MEDICAL > Paediatrics
Depositing User: Ravindran C
Date Deposited: 20 Apr 2018 08:05
Last Modified: 20 Apr 2018 08:05
URI: http://repository-tnmgrmu.ac.in/id/eprint/7164

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