title: Macroalbuminuria and renal pathology in First Nation youth with type 2 diabetes.
abstract: OBJECTIVE
  To determine the prevalence of macroalbuminuria and to describe the clinical and renal pathological changes associated with macroalbuminuria in a population of Canadian First Nation children and adolescents with type 2 diabetes.
  
  
  METHODS
  We conducted a retrospective chart review at a single tertiary care pediatric diabetes center, and a case series was constructed. We collected data on microalbuminuria (>or=3 mg/mmol creatinine [26.5 mg/g]) and macroalbuminuria (>or=28 mg/mmol creatinine [247.5 mg/g]), estimated glomerular filtration rate, renal pathology, and aggravating risk factors (poor glycemic control, obesity, hypertension, glomerular hyperfiltration, hypercholesterolemia, smoking, and exposure to diabetes in utero).
  
  
  RESULTS
  We reviewed 90 charts of children and adolescents with type 2 diabetes. A total of 53% had at least one random urine albumin-to-creatinine ratio >or=3 mg/mmol (26.5 mg/g). There were 14 of 90 (16%) who had persistent macroalbuminuria at or within 8 years of diagnosis of diabetes. Of these 14 subjects, 1 had orthostatic albuminuria and 3 had spontaneous resolution of albuminuria. A total of 10 had renal biopsies performed. There were 9 of 10 who exhibited immune complex disease or glomerulosclerosis, and none had classic diabetic nephropathy.
  
  
  CONCLUSIONS
  This study suggests that the diagnosis of renal disease in children with type 2 diabetes cannot be reliably determined by clinical and laboratory findings alone. Renal biopsy is necessary for accurate diagnosis of renal disease in children and adolescents with type 2 diabetes and macroalbuminuria. The additional burden of nondiabetic kidney disease may explain the high rate of progression to end-stage kidney failure in this population.
authors.affiliation: Department of Pediatrics and Child Health, University of Manitoba, British Columbia, Canada. esellers@exchange.hsc.mb.ca
authors.forename: Elizabeth A C
authors.initials: EA
authors.lastname: Sellers
authors.forename: Tom D
authors.initials: TD
authors.lastname: Blydt-Hansen
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Dean
authors.forename: Ian W
authors.initials: IW
authors.lastname: Gibson
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Birk
authors.forename: Malcolm
authors.initials: M
authors.lastname: Ogborn
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D000419:Albuminuria / Q000453:epidemiology*; D001323:Autoantibodies / Q000097:blood; D001794:Blood Pressure; D002170:Canada / Q000453:epidemiology; D002648:Child; D002784:Cholesterol / Q000097:blood; D003404:Creatinine / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology* / Q000276:immunology; D016640:Diabetes, Gestational / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D009035:Mothers; D009765:Obesity / Q000453:epidemiology; D011247:Pregnancy; D012907:Smoking / Q000453:epidemiology
chemical_list: D001323:Autoantibodies; D002784:Cholesterol; D003404:Creatinine