Fetal exposure to maternal type 1 diabetes is associated with renal dysfunction at adult age.
OBJECTIVE
In animal studies, hyperglycemia during fetal development reduces nephron numbers. We tested whether this observation translates into renal dysfunction in humans by studying renal functional reserve in adult offspring exposed in utero to maternal type 1 diabetes.


METHODS
We compared 19 nondiabetic offspring of type 1 diabetic mothers with 18 offspring of type 1 diabetic fathers (control subjects). Glomerular filtration rate ((51)Cr-EDTA clearance), effective renal plasma flow ((123)I-hippurate clearance), mean arterial pressure, and renal vascular resistances were measured at baseline and during amino acid infusion, which mobilizes renal functional reserve.


RESULTS
Offspring of type 1 diabetic mothers were similar to control subjects for age (median 27, range 18-41, years), sex, BMI (23.1 ± 3.7 kg/m(2)), and birth weight (3,288 ± 550 vs. 3,440 ± 489 g). During amino acid infusion, glomerular filtration rate and effective renal plasma flow increased less in offspring of type 1 diabetic mothers than in control subjects: from 103 ± 14 to 111 ± 17 ml/min (8 ± 13%) vs. from 108 ± 17 to 128 ± 23 ml/min (19 ± 7%, P = 0.009) and from 509 ± 58 to 536 ± 80 ml/min (5 ± 9%) vs. from 536 ± 114 to 620 ± 140 ml/min (16 ± 11%, P = 0.0035). Mean arterial pressure and renal vascular resistances declined less than in control subjects: 2 ± 5 vs. -2 ± 3% (P = 0.019) and 3 ± 9 vs. -14 ± 8% (P = 0.001).


CONCLUSIONS
Reduced functional reserve may reflect a reduced number of nephrons undergoing individual hyperfiltration. If so, offspring of type 1 diabetic mothers may be predisposed to glomerular and vascular diseases.
Abi Khalil
Charbel
C
Diabetes Department, Groupe Hospitalier Bichat–Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France.
Travert
Florence
F
Fetita
Sabrina
S
Rouzet
François
F
Porcher
Raphael
R
Riveline
Jean-Pierre
JP
Hadjadj
Samy
S
Larger
Etienne
E
Roussel
Ronan
R
Vexiau
Patrick
P
Le Guludec
Dominique
D
Gautier
Jean-François
JF
Marre
Michel
M
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D001783:Blood Flow Velocity; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000503:physiopathology; D005220:Fathers; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009035:Mothers; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000453:epidemiology*; D014655:Vascular Resistance / Q000502:physiology; D055815:Young Adult