RELATIONSHIP OF RISK FACTORS FOR DIABETIC KIDNEY DISEASE

这是一项密切研究微量白蛋白尿演变的建议。 在一个独特的以人口为基础的队列中，有595人在 胰岛素依赖型糖尿病的诊断。这项研究将 评估血压和肾小球高滤过的重要性 在早期肾病(持续性尿白蛋白)发生中的作用 排泄量20-200毫克/毫克)。只有通过研究如此庞大和独特的 被诊断为糖尿病的人群可能是中心问题 关于识别高危人群的问题 解决微量白蛋白尿的问题。这里唯一的机会是 比较血压的变化和绝对值以及是否存在 高滤过与每年大量微量白蛋白尿的发展 这组儿童和年轻人从诊断糖尿病的时候起就开始了。 对这些人进行跟踪的主要目标是：1)确定 血压与微量白蛋白尿的关系；2) 确定肾小球高滤过与糖尿病的关系 微量白蛋白尿。纵向血糖控制与青春期意志 在这些关系中被检查为可能的混淆因素或影响 修饰符。 标准化协议将用于估计的年度测量 肾小球滤过率、血压、青春期状态和尿白蛋白排泄率。 这项研究还将利用之前的数据和样本 从这群人身上收集的。收集到的信息将使 及早识别高危人群患上糖尿病 微量白蛋白尿，并可导致之前的干预建议 肾脏疾病不可逆转进展的开始。独特性 这项研究的关键在于：仔细、全面地跟踪 有代表性的，主要是儿科人群；在 关键因素出现/加速的时间框架；第一次研究 包括非白人在内的儿科队列；未来的标本库 测试新的标记(例如，新的DNA分析)。

This is a proposal to closely examine the evolution of microalbuminuria in a unique population-based cohort of 595 individuals enrolled at diagnosis of insulin-dependent diabetes mellitus. This study will evaluate the importance of blood pressure and glomerular hyperfiltration in the development of incipient nephropathy (persistent urinary albumin excretion 20-200mug/mig). Only by studying such a large and unique population prospectively from diabetes diagnosis can be central question about identifying individuals at high risk for development of microalbuminuria be addressed. The singular opportunity here is to compare changes and absolute values of blood pressure and presence of hyperfiltration with development of microalbuminuria yearly in a large group of children and young adults from the time of diabetes diagnosis. The primary goals in following up these individuals are to: 1) determine the relationship between blood pressure and microalbuminuria; and to 2) determine the relationship between glomerular hyperfiltration and microalbuminuria. Longitudinal glycemic control and pubertal stage will be examined in these relationships as possible confounder or effect modifiers. Standardized protocols will be used for yearly measurements of estimated GFR, blood pressure, pubertal status and urinary albumin excretion rate. This study will also take advantage of data and specimens previously collected from this population. The information collected will enable early identification of individuals at high risk for development of microalbuminuria and can lead to recommendations for interventions before the onset of irreversible progression in kidney disease. The uniqueness of this study lies with: careful, comprehensive follow-up of a representative, primarily pediatric population; observation during the time frame in which key factors appear/accelerate; first study of a pediatric cohort that includes non-whites; specimen bank for future testing of new markers (e.g., new DNA assays).