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Normal-range albuminuria does not exclude nephropathy in diabetic children

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An Erratum to this article was published on 10 April 2010

Abstract

Clinically detectable diabetic nephropathy (DN) begins with the development of microalbuminuria (MA). However, early renal dysfunction may be overlooked despite using that method. On the other hand, the gold standard in DN detection—that is, renal biopsy—is highly invasive. The aim of this study was to evaluate the level of neutrophil-gelatinase-associated lipocalin (NGAL) and interleukin (IL)-18 and their relations to albumin excretion rate (AER) in children with normal-range albuminuria, e.g. in those considered as not presenting diabetic nephropathy. The study group consisted of 22 children (age 12.7 ± 3.5 years) with type 1 diabetes mellitus (T1DM). Long-term glycemic control was assessed on hemoglobin A1c (HbA1c) levels (8.52 ± 1.78%). All patients presented normal estimated glomerular filtration rate (eGFR) (141 ± 23 ml/min/1.73 m2) and normal urinary albumin excretion (13.09 ± 7.63 mg/24 h). Fourteen healthy children served as a control group. Children with T1DM showed increased NGAL values with respect to controls—interestingly, both in serum (sNGAL) (867.43 ± 341.98 vs. 655.29 ± 196.17 ng/ml; p = 0.04) and in urine (uNGAL) (420.04 ± 374.16 vs. 156.53 ± 185.18 ng/ml, p = 0.04). IL-18 levels were not different in both groups both in serum (58.52 ± 20.11 vs. 69.79 ± 58.76 ng/ml; NS) and in urine (14.53 ± 12.74 vs. 14.60 ± 10.92 ng/ml; NS). Despite the relatively small study group, the positive correlation between sNGAL and AER was found [AER (mg/24 h) = 3.1893 + 0.01141 × sNGAL (ng/ml); r = 0.51; p = 0.014] as well as between uNGAL and AER [AER (mg/24 h) = 8.7538 + 0.01032 × uNGAL (ng/ml); r = 0.51; p = 0.016]. No relationship between sNGAL and uNGAL, and GFR and HbA1c were found. Normal-range albuminuria does not exclude diabetic nephropathy defined as increased sNGAL and uNGAL concentration. NGAL measurement can be more sensitive than MA and may become a useful tool for evaluating renal involvement in diabetic children.

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Acknowledgement

We thank Mrs. Milena Kornaszewska for her linguistic assistance and Marek Niedziela M.D., Ph.D for his kind contribution to improvement of our discussion.

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Authors and Affiliations

  1. Department of Pediatric Nephrology, Poznan University of Medical Sciences, Szpitalna 27/33 str., 60-572, Poznan, Poland

    Jacek Zachwieja, Jolanta Soltysiak, Katarzyna Lipkowska & Maria Lewandowska-Stachowiak

  2. Department of Pediatric Endocrinology and Diabetes, Poznan University of Medical Sciences, Poznan, Poland

    Piotr Fichna, Witold Stankiewicz & Bogda Skowronska

  3. Department of Pediatric Urology, Poznan University of Medical Sciences, Poznan, Poland

    Pawel Kroll

Authors
  1. Jacek Zachwieja
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  2. Jolanta Soltysiak
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  5. Witold Stankiewicz
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Correspondence to Jacek Zachwieja.

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An erratum to this article can be found at http://dx.doi.org/10.1007/s00467-010-1527-9

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Zachwieja, J., Soltysiak, J., Fichna, P. et al. Normal-range albuminuria does not exclude nephropathy in diabetic children. Pediatr Nephrol 25, 1445–1451 (2010). https://doi.org/10.1007/s00467-010-1443-z

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  • DOI: https://doi.org/10.1007/s00467-010-1443-z

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