Risk markers of future microalbuminuria and hypertension based on clinical and morphological parameters in young type 1 diabetes patients.
BACKGROUND
Nephropathy is a severe complication of type 1 diabetes and develops in 30% of patients. Currently, it is not possible to identify young patients at risk prior to the development of microalbuminuria (MA) and/or hypertension (HT).


OBJECTIVE
To study predictors of MA and/or HT in young normoalbuminuric (NA) patients with type 1 diabetes.


METHODS
Forty-six NA and normotensive (NT) type 1 diabetes patients, regularly followed since onset with checks on metabolic control, kidney function, and MA, were investigated with kidney biopsies and 24-h ambulatory blood pressure measurements (ABPMs) after 10.6 yr of diabetes. The patients were followed another six and a half years with regard to the development of MA and HT.


RESULTS
Fifteen patients developed MA and/or HT during follow-up. The strongest risk markers were poor metabolic control after puberty, high day-time systolic blood pressure (BP), and increased BMT at 10 yr, which explained 62% of the outcome for MA and/or HT at 17 yr duration with 77% sensitivity and 65% specificity. The threshold values were long-term postpubertal HbA(1c) > 8.2%, day-time systolic BP > 130 mmHg, and BMT > 490 nm/1.73 m(2).


CONCLUSIONS
Normoalbuminuric and NT patients at risk of developing MA and HT could be identified and might benefit from an early start of antihypertensive therapy and improvement of metabolic control.
Perrin
Nina E S S
NE
Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Children's Hospital, Karolinska University Hospital, Stockholm, Sweden. Nina.Perrin@karolinska.se
Torbjörnsdotter
T
T
Jaremko
Georg A
GA
Berg
Ulla B
UB
D000293:Adolescent; D000419:Albuminuria / Q000175:diagnosis* / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D018660:Blood Pressure Monitoring, Ambulatory; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000209:etiology; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000209:etiology; D007668:Kidney / Q000503:physiopathology; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult
D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human