N-acetyl-beta-d glucosaminadase and retinol-binding protein versus albuminuria in insulin dependent diabetic children.

ABSTRACT

Markers of tubular dysfunction [N-acetyl-beta-D-glucosaminidase and retinol binding protein], markers of glomerular dysfunction [glomerular filtration rate, urinary albumin excretion, blood urea and serum creatinine]and blood pressure were estimated in 32 insulin dependent diabetic children [IDDM] [16 males and 16 females] aged from 7 to 15 years, who had negative reagent strip test for proteinuria and in 10 age and sex matched healthy control children [6 males and 4 females]. Ultrasonography of the kidneys and fundus examination for the detection of retinopathy were done for all cases. The results indicated that tubular dysfunction, as evidenced by RBP and NAG, is more sensitive and precedes glomerular dysfunction in insulin dependent diabetics. However, RBP is a convenient, more sensitive, specific and early diagnostic tool for the detection of tubular affection than NAC. Albuminuria and increased GFR are early markers of glomerular dysfunction preceding the elevations of blood urea and serum creatinine. A reduction in hyperfiltration or GFR with increased albumin excretion is a marker of progression of renal disease. Hypertension is a feature of diabetic nephropathy after the appearance of microalbuminuria. However, the role of dietary modification programs and blood pressure control in normalization of kidney function in IDDP remains to be evaluated