Glomerular hyperfiltration increases the risk of developing microalbuminuria in diabetic children
Glomerular hyperfiltration increases the risk of developing microalbuminuria in diabetic children
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肾小球过度滤过会增加糖尿病儿童发生微量白蛋白尿的风险
DOI：
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发表时间：
1995
期刊：
影响因子：
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通讯作者：
G. Morgese
中科院分区：
文献类型：
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作者：
F. Chiarelli;A. Verrotti;G. Morgese
在 1 型糖尿病儿童和青少年以及没有任何其他早期糖尿病肾病证据的患者中，经常可以检测到肾小球滤过率 (GFR) 升高。 1982年，我们发现23名超滤患者（GFR>140 ml/min/1.73 m2），年龄9-15岁，糖尿病病程超过4年； 23 名年龄和性别匹配、病程相似且没有过度滤过的糖尿病患者作为对照。两组患者均随访至1992年3月，每12个月评估一次GFR，每6个月评估一次白蛋白排泄率，每3个月评估一次血压和糖化血红蛋白（HbA1）。超滤患者和对照组的膳食蛋白质摄入量相似。整个研究过程中除胰岛素外未使用其他药物。两组的胰岛素治疗方案相似。在研究开始时，两组之间的白蛋白排泄、血压和 HbA1 没有显着差异。在 23 名超滤患者中，7 名出现持续性微量白蛋白尿（定义为至少 5 次连续测量中每 1.73 平方米过夜白蛋白排泄率 >30 μg/min）；其中 2 名患者有明显的蛋白尿。只有 1 名 GFR 正常的糖尿病患者出现持续性微量白蛋白尿。初始 GFR>140 ml/min/1.73 m2 的微量白蛋白尿的阳性预测值为 63%；初始 GFR<140 ml/min/1.73 m2 的阴性预测值为 94%。白蛋白排泄率增加至微量白蛋白尿范围先于收缩压和舒张压升高。持续性肾小球高滤过是 1 型糖尿病儿童、青少年和年轻人发生微量白蛋白尿和早期肾病的危险因素。
An elevated glomerular filtration rate (GFR) is frequently detectable in type 1 diabetic children and adolescents and in those without any other evidence of incipient diabetic nephropathy. In 1982 we detected 23 patients with hyperfiltration (GFR>140 ml/min per 1.73 m2), aged 9–15 years, with diabetes for longer than 4 years; 23 age- and sex-matched patients with diabetes of a similar duration and without hyperfiltration served as controls. Both groups were followed until March 1992, by assessing GFR every 12 months, albumin excretion rate every 6 months, blood pressure and glycated haemoglobin (HbA1) every 3 months. Dietary protein intake was similar in patients with hyperfiltration and in controls. No other drug except insulin was used throughout the study. The insulin regimen was similar in the two groups. There was no significant difference between the two groups regarding albumin excretion, blood pressure and HbA1 at the beginning of the study. Of the 23 patients with hyperfiltration, 7 developed persistent microalbuminuria (defined as an overnight albumin excretion rate >30 μg/min per 1.73 m2 on at least 5 consecutive measurements); 2 of these patients had overt proteinuria. Only 1 of the diabetics with normal GFR developed persistent microalbuminuria. The positive predictive value for microalbuminuria of an initial GFR>140 ml/min per 1.73 m2 was 63%; the negative predictive value of an initial GFR<140 ml/min per 1.73 m2 was 94%. The increase of albumin excretion rate into the microalbuminuric range precedes the elevation of both systolic and diastolic blood pressure. Persistent glomerular hyperfiltration is a risk factor for the development of microalbuminuria and incipient nephropathy in type 1 diabetic children, adolescents and young adults.