Pediatric Nephrology

, Volume 25, Issue 8, pp 1445–1451

Normal-range albuminuria does not exclude nephropathy in diabetic children

Authors

    • Department of Pediatric NephrologyPoznan University of Medical Sciences
  • Jolanta Soltysiak
    • Department of Pediatric NephrologyPoznan University of Medical Sciences
  • Piotr Fichna
    • Department of Pediatric Endocrinology and DiabetesPoznan University of Medical Sciences
  • Katarzyna Lipkowska
    • Department of Pediatric NephrologyPoznan University of Medical Sciences
  • Witold Stankiewicz
    • Department of Pediatric Endocrinology and DiabetesPoznan University of Medical Sciences
  • Bogda Skowronska
    • Department of Pediatric Endocrinology and DiabetesPoznan University of Medical Sciences
  • Pawel Kroll
    • Department of Pediatric UrologyPoznan University of Medical Sciences
  • Maria Lewandowska-Stachowiak
    • Department of Pediatric NephrologyPoznan University of Medical Sciences
Original Article

DOI: 10.1007/s00467-010-1443-z

Cite this article as:
Zachwieja, J., Soltysiak, J., Fichna, P. et al. Pediatr Nephrol (2010) 25: 1445. doi:10.1007/s00467-010-1443-z

Abstract

Clinically detectable diabetic nephropathy (DN) begins with the development of microalbuminuria (MA). However, early renal dysfunction may be overlooked despite using that method. On the other hand, the gold standard in DN detection—that is, renal biopsy—is highly invasive. The aim of this study was to evaluate the level of neutrophil-gelatinase-associated lipocalin (NGAL) and interleukin (IL)-18 and their relations to albumin excretion rate (AER) in children with normal-range albuminuria, e.g. in those considered as not presenting diabetic nephropathy. The study group consisted of 22 children (age 12.7 ± 3.5 years) with type 1 diabetes mellitus (T1DM). Long-term glycemic control was assessed on hemoglobin A1c (HbA1c) levels (8.52 ± 1.78%). All patients presented normal estimated glomerular filtration rate (eGFR) (141 ± 23 ml/min/1.73 m2) and normal urinary albumin excretion (13.09 ± 7.63 mg/24 h). Fourteen healthy children served as a control group. Children with T1DM showed increased NGAL values with respect to controls—interestingly, both in serum (sNGAL) (867.43 ± 341.98 vs. 655.29 ± 196.17 ng/ml; p = 0.04) and in urine (uNGAL) (420.04 ± 374.16 vs. 156.53 ± 185.18 ng/ml, p = 0.04). IL-18 levels were not different in both groups both in serum (58.52 ± 20.11 vs. 69.79 ± 58.76 ng/ml; NS) and in urine (14.53 ± 12.74 vs. 14.60 ± 10.92 ng/ml; NS). Despite the relatively small study group, the positive correlation between sNGAL and AER was found [AER (mg/24 h) = 3.1893 + 0.01141 × sNGAL (ng/ml); r = 0.51; p = 0.014] as well as between uNGAL and AER [AER (mg/24 h) = 8.7538 + 0.01032 × uNGAL (ng/ml); r = 0.51; p = 0.016]. No relationship between sNGAL and uNGAL, and GFR and HbA1c were found. Normal-range albuminuria does not exclude diabetic nephropathy defined as increased sNGAL and uNGAL concentration. NGAL measurement can be more sensitive than MA and may become a useful tool for evaluating renal involvement in diabetic children.

Keywords

Diabetic nephropathyBiomarkersNGALIL-18Children

Copyright information

© IPNA 2010