Predictors of renal complications in pediatric patients with type 1 diabetes mellitus: A prospective cohort study.

ABSTRACT

AIMS: Diabetic Nephropathy (DN) is rarely encountered in childhood, otherwise early subclinical abnormalities are detectable few years after diabetes diagnosis. Our aim was to evaluate the incidence rate of microalbuminuria in childhood onset type 1 diabetes (DM1) patients. Secondary aim was to examine which variables could influence the development of DN. METHODS: We longitudinally evaluated 137 young patients with DM1 from diagnosis (1994-2004) for a median of 11.8 years (1st-3rd q 9.7-15.0). Overnight albumin excretion rate, degree of metabolic control, presence of microangiopathic complications and autoimmune co-morbidities were retrospectively collected. RESULTS: DN was observed in 16/137 cases (11.7%), with an incidence rate of 10.0 per 1000 person-years. Young T1D patients with persistent micro/macro-albuminuria were more likely to have higher HbA1c concentrations over the last four years (P = 0.04), and were more likely to have retinopathy (P = 0.011) and subclinical peripheral neuropathy (P = 0.003). CONCLUSIONS: DN predictors were age at DM1 diagnosis and mean HbA1c levels. Even if DN incidence is lower than reported, periodical screening is mandatory. Moreover, borderline microalbuminuria as additional risk factor deserves attention.