Sleep-disordered breathing and proteinuria in overweight and obese children and adolescents.
OBJECTIVE
To assess whether sleep-disordered breathing (SDB) in overweight children and adolescents has an additional effect on the spectrum of urinary albumin to protein loss, as markers of early kidney dysfunction.


METHODS
Prospective study in a clinical sample of overweight children and adolescents. Each subject underwent anthropometry, blood sampling, oral glucose tolerance test and polysomnography. From a 24-hour urine collection, albumin excretion rate and total urinary protein to creatinine ratio (UPCR) were calculated.


RESULTS
94 nondiabetic subjects were included (mean age = 11.0 +/- 2.5, 42 boys). Average BMI z-score was 2.25 +/- 0.47 (26 overweight subjects and 68 obese subjects). There was no difference in albumin excretion rate or UPCR between subjects with and without SDB. None of the SDB parameters correlated with the transformed albumin excretion rate or UPCR. Albumin excretion rate significantly correlated with fasting insulin and C-peptide and with post-challenge glucose, insulin and C-peptide levels, while UPCR correlated with fasting and post-challenge C-peptide levels. Multiple regression indicated that post-challenge glucose levels were the most important predictors of albumin excretion rate.


CONCLUSIONS
Insulin resistance, and not SDB, was associated with increased levels of albuminuria, indicating early renal dysfunction, in this clinical sample of overweight children and adolescents.
Verhulst
S L
SL
Department of Pediatrics, Antwerp University Hospital, Antwerp, Belgium. stijn.verhulst@ua.ac.be
Van Hoeck
K
K
Schrauwen
N
N
Haentjens
D
D
Rooman
R
R
Van Gaal
L
L
De Backer
W
W
Desager
K N
KN
D000293:Adolescent; D000419:Albuminuria / Q000503:physiopathology / Q000652:urine*; D015415:Biomarkers / Q000652:urine; D002648:Child; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine; D005260:Female; D005951:Glucose Tolerance Test / Q000379:methods; D006801:Humans; D007333:Insulin Resistance; D007674:Kidney Diseases / Q000209:etiology / Q000503:physiopathology / Q000652:urine; D008297:Male; D009765:Obesity / Q000150:complications / Q000503:physiopathology / Q000652:urine*; D017286:Polysomnography / Q000379:methods; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000503:physiopathology / Q000652:urine*
D015415:Biomarkers; D003404:Creatinine