title: Renal tubular handling of potassium in children with insulin-dependent diabetes mellitus.
abstract: To clarify the mechanism by which renal potassium (K) excretion is reduced in children with insulin-dependent diabetes mellitus, we studied two groups of patients: (A) at diagnosis and (B) after at least 1 year of follow-up. Group A (15 children) was studied twice: on the day of admission and after 1 month of insulin therapy. On admission, urinary K excretion, fractional K excretion, and transtubular K concentration gradient (TTKG) were significantly decreased, but became normal after extended insulin therapy. TTKG was inversely correlated with blood glucose (P < 0.001) and hemoglobin A1c (HbA1c, P < 0.001). Group B (73 children with a mean follow-up of 54 +/- 36 months) was subdivided according to the TTKG: 30 patients had a low TTKG < 4.0 (median 3.2) and 43 patients had a normal TTKG > or = 4.0 (median 5.2). Patients had a low TTKG and those with a normal TTKG had an identical duration of follow-up and similar values for plasma renin activity, aldosterone concentration, calciuria, magnesiuria, albumin excretion rate, and creatinine clearance. However, those with a low TTKG had significantly higher blood HbA1c levels, urine volume, and glucosuria. Logistic regression analysis showed that the only independent variables predicting a low TTKG were blood HbA1c and glucosuria (P < 0.001). These data confirm that a reduced renal K excretion is a characteristic feature of diabetic children; this is reversible with appropriate insulin therapy, largely depends on the metabolic control of the disease, and, specifically, on the degree of hyperglycemia and/or glucosuria.
authors.affiliation: Department of Pediatrics, Hospital de Cruces, Bilbao, País Vasco, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Rodríguez-Soriano
authors.forename: A
authors.initials: A
authors.lastname: Vallo
authors.forename: G
authors.initials: G
authors.lastname: Ariceta
authors.forename: P
authors.initials: P
authors.lastname: Martul
authors.forename: I
authors.initials: I
authors.lastname: de la Rica
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000652:urine*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007684:Kidney Tubules / Q000378:metabolism*; D008297:Male; D011188:Potassium / Q000652:urine*; D012964:Sodium / Q000652:urine
chemical_list: D001786:Blood Glucose; D012964:Sodium; D011188:Potassium