title: Risk markers of future microalbuminuria and hypertension based on clinical and morphological parameters in young type 1 diabetes patients.
abstract: 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.
authors.affiliation: Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Children's Hospital, Karolinska University Hospital, Stockholm, Sweden. Nina.Perrin@karolinska.se
authors.forename: Nina E S S
authors.initials: NE
authors.lastname: Perrin
authors.forename: T
authors.initials: T
authors.lastname: Torbjörnsdotter
authors.forename: Georg A
authors.initials: GA
authors.lastname: Jaremko
authors.forename: Ulla B
authors.initials: UB
authors.lastname: Berg
mesh_terms: 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
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human