Rivista di formazione e di aggiornamento professionale del pediatra e del medico di base, realizzata in collaborazione con l'Associazione Culturale Pediatri
M&B Pagine Elettroniche
Lo screening pediatrico della nefropatia diabetica
Azienda Ospedaliera Policlinico "Paolo Giaccone" di Palermo, Università di Palermo
Indirizzo per corrispondenza: firstname.lastname@example.org
The paediatric screening of diabetic nephropathy
Key words: Diabetic nephropathy, Diabetes Mellitus complication, Microalbuminuria
Objectives - The primary objective of the study is to evaluate the prevalence of transient and persistent microalbuminuria in children and adolescents affected by T1DM. The secondary objective is to correlate Albumin Excretion Rate (AER) with the degree of metabolic control, the age of patients, the age of onset and duration of diabetes.
Materials and Methods - The current study is conducted on 305 patients with T1DM (range 3.5-26 years old); the age of the T1DM onset is between 0.8 and 16 years old with duration of illness between 1.5 and 22 years. The values of the median age of patients, the age of onset and the duration of diabetes are respectively: 15, 7 and 7. The patients analyzed are treated with intensive insulin therapy (3-4 injections/day), monitored through HbA1c and microalbuminuria dosages.
Results - Transient microalbuminuria has been detected in 17 patients (6%), 8% in males and 4% in females and has been normalized by improving glycometabolic control in 12 patients and with a low-protein diet and glycometabolic control in the other 5 patients. Persistent microalbuminuria has been observed only in 4 patients (1.3%).
Conclusion - The presence of persistent microalbuminuria was detected in only 1.3% of patients, a much lower level compared with the results reported by paediatric literature, which shows values higher than 15%. No correlation has been found between AER and the degree of metabolic control, the duration of T1DM and the age of patients. The present article shows that it is possible to prevent the diabetic nephropathy by continuing the screening, according to ISPAD and SIEDP guidelines, and by monitoring the patients during their growth with periodic follow-ups.
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