RELATIONSHIP OF RISK FACTORS FOR DIABETIC KIDNEY DISEASE

这是一个建议，密切审查的演变，微量白蛋白尿 在一个独特的基于人群的队列中，595名个体在 胰岛素依赖型糖尿病的诊断。 本研究将 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）的发展中， 排泄20- 200微克/毫克）。 只有通过研究如此庞大而独特的 从糖尿病诊断的前瞻性人群可能是中心问题 关于识别个人在高风险的发展， 微量白蛋白尿应注意。 唯一的机会就是 比较血压的变化和绝对值， 在一个大的， 一组儿童和年轻人从糖尿病诊断的时间。 跟踪这些人的主要目标是：1）确定 血压和微量白蛋白尿之间的关系;以及2） 确定肾小球超滤和 微量白蛋白尿 纵向血糖控制和青春期阶段将 在这些关系中作为可能的混杂因素或影响进行检查 修饰语 标准化方案将用于每年测量估计的 GFR、血压、青春期状态和尿白蛋白排泄率。 这项研究还将利用以前的数据和标本 从这个人群中收集。 收集的信息将使 及早识别有高风险的个人， 微量白蛋白尿，并可能导致建议干预之前， 肾脏疾病不可逆进展的开始。 唯一性 这项研究的重点在于：认真，全面的后续行动， 代表性的，主要是儿科人群;观察期间 关键因素出现/加速的时间框架; 包括非白人的儿科队列;未来的标本库 新标记的测试（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).