title: Coeliac disease, gluten-free diet and the development and progression of albuminuria in children with type 1 diabetes.
abstract: OBJECTIVE
  Although a diagnosis of coeliac disease (CD) may be confronting to children with type 1 diabetes and their families, we hypothesize that children with CD have lower urinary albumin excretion, a marker of renal dysfunction.
  
  
  METHODS
  Twenty-four children with type 1 diabetes and biopsy-proven CD, on a gluten-free diet for at least 1 yr, were recruited from a single paediatric diabetes clinic alongside 55 children with type 1 diabetes but without CD matched for age, gender, duration of diabetes, and glycaemic control.
  
  
  RESULTS
  Despite comparable diabetes exposure, glycaemic control and nutritional status, children with type 1 diabetes and CD had a lower urinary albumin creatinine ratio than in diabetic subjects without CD (0.9 ± 0.3 mg/mmol vs. 1.6 ± 0.3 mg/mmol; p = 0.01). Participants with CD also showed slower progression in albuminuria over 5-yr of follow-up while a small but significant increase was observed in the children with diabetes alone (1.6 ± 0.3 mg/mmol; follow-up 2.4 ± 0.5 mg/mmol; p = 0.02).
  
  
  CONCLUSIONS
  As urinary albumin excretion is continuously associated with the risk of kidney disease, it is possible to speculate that CD or its management confers a degree of renoprotection. Larger studies are required to test this hypothesis.
authors.affiliation: Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Esha
authors.initials: E
authors.lastname: Gopee
authors.forename: Eva L M
authors.initials: EL
authors.lastname: van den Oever
authors.forename: Fergus
authors.initials: F
authors.lastname: Cameron
authors.forename: Merlin C
authors.initials: MC
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D041923:Adolescent Development; D000419:Albuminuria / Q000209:etiology / Q000517:prevention & control*; D015415:Biomarkers / Q000652:urine; D002446:Celiac Disease / Q000150:complications / Q000178:diet therapy* / Q000503:physiopathology / Q000652:urine; D002648:Child; D002657:Child Development; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000652:urine; D003928:Diabetic Nephropathies / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D055050:Diet, Gluten-Free; D018450:Disease Progression; D004198:Disease Susceptibility; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D012307:Risk Factors; D014739:Victoria / Q000453:epidemiology
chemical_list: D015415:Biomarkers
keywords: albuminuria; celiac disease; diabetic nephropathy