Hyperfiltration and uricosuria in adolescents with type 1 diabetes.
Hyperfiltration and uricosuria in adolescents with type 1 diabetes.
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DOI：
10.1007/s00467-015-3299-8
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发表时间：
2016-05
期刊：
影响因子：
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通讯作者：
Maahs DM
中科院分区：
文献类型：
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作者：
Bjornstad P;Roncal C;Milagres T;Pyle L;Lanaspa MA;Bishop FK;Snell-Bergeon JK;Johnson RJ;Wadwa RP;Maahs DM
尿酸（UUA）通过对肾小管细胞的影响参与糖尿病肾病的发病机制。我们假设UUA在1型糖尿病（T1 D）青少年中比那些没有。其次，我们假设与无高滤过的青少年相比，患有T1 D和高滤过（估计肾小球滤过率（eGFR）≥141 mL/min/1.73m2）的青少年的UUA和尿酸排泄分数（FeUA）更高。对患有T1 D（n=239）和未患有T1 D（n=75）的青少年进行了UUA测量和FeUA计算。使用血清肌酐和胱抑素C通过Zappitelli方程计算eGFR。T1 D青少年的eGFR较高（平均值±标准差（SD）：120±22 vs. 112±16 mL/min/1.73m2，p=0.0006），尿液pH值较低（6.2±0.8 vs. 6.5±1.0，p=0.01），UUA较高（37.7±18.6 vs. 32.8±18.1 mg/dL，p=0.049）和FeUA（中位数，IQR：6.2 [4.3-8.7] vs. 5.2 [3.6-7.0]%，p=0.02）。在T1 D青少年中，与未进行超滤的青少年相比，进行超滤的青少年的FeUA更高（8.6 [5.2-9.9] vs. 6.0 [4.2-8.3]%，p=0.02）。与非糖尿病对照组相比，患有T1 D的青少年具有更高的eGFR，更高的UUA和更酸性的尿液，这可能会增加他们的UUA结晶风险。患有T1 D和超滤的青少年的FeUA高于没有超滤的青少年。这些产生假设的观察结果可能表明尿酸尿和超滤之间存在潜在的病理生理学相关性。
Urine uric acid (UUA) has been implicated in the pathogenesis of diabetic nephropathy via its effect on tubular cells. We hypothesized that UUA would be greater in adolescents with type 1 diabetes (T1D) compared to those without. Second, we hypothesized that UUA and fractional uric acid excretion (FeUA) would be greater in adolescents with T1D and hyperfiltration (estimated glomerular filtration rate (eGFR) ≥141 mL/min/1.73m2) compared to those without hyperfiltration Adolescents with (n=239) and without T1D (n=75) had UUA measured and FeUA calculated. Serum creatinine and cystatin C were used to calculate eGFR by the Zappitelli equation. Adolescents with T1D had higher eGFR (mean±standard deviation (SD): 120±22 vs. 112±16 mL/min/1.73m2, p=0.0006), lower urine pH (6.2±0.8 vs. 6.5±1.0, p=0.01), higher UUA (37.7±18.6 vs. 32.8±18.1 mg/dL, p=0.049) and FeUA (median, IQR: 6.2 [4.3–8.7] vs. 5.2 [3.6–7.0]%, p=0.02) compared to non-diabetic adolescents. Among adolescents with T1D, those with hyperfiltration had higher FeUA (8.6 [5.2–9.9] vs. 6.0 [4.2–8.3]%, p=0.02) compared to those without hyperfiltration. Adolescents with T1D had higher eGFR, higher UUA and more acidic urine than non-diabetic controls, which may increase their risk of UUA crystallization. Adolescents with T1D and hyperfiltration had higher FeUA than those without hyperfiltration. These hypothesis-generating observations may suggest a potential pathophysiologic association between uricosuria and hyperfiltration.