[Microalbuminuria and tubular reabsorption of minerals in children with type 1 diabetes mellitus]. / Mikroalbuminúria a tubulárna reabsorpcia minerálov u detí s diabetes mellitus 1. typu.

BACKGROUND: The most severe late complication of microangiopathic changes in diabetes mellitus type I (IDDM) is the diabetic nephropathy. The fully developed picture of diabetic nephropathy usually does not occur in children, however, original signs of altered renal functions may be present already. OBJECTIVES: The study is aimed firstly at the detection of microalbuminuria and the relation between the amount of albumin urinary excretion and individual clinical indices such as age, degree of metabolic compensation, blood pressure. Secondly, the study's objective is to evaluate alterations in tubular reabsorption of minerals. MATERIAL AND METHODS: 1.) The occurrence of microalbuminuria has been detected on the basis of a four-year longitudinal clinical follow-up of 134 children (81 boys and 53 girls) with IDDM. Examinations which took place in regular twelve-month intervals were aimed at the investigation of the amount of albumin urinary excretion by means of radioimmunoanalysis in the collected twelve-hour night fraction of urine, simultaneous level of HbA1C and blood pressure values. The degree of the evaluated metabolic compensation during the first 5 years of diabetes occurrence was evaluated retrospectively and expressed as its mean value. 2.) 18 randomly selected patients and 12 controls were subdued to an examination of alterations in tubular reabsorption of minerals--sodium, calcium and phosphorus. RESULTS: 1.) On the basis of the amount of excreted albumin the children were divided into 3 groups. The first group (n = 105) consisted of children with normal albumin excretion, the second group (n = 13) represented children with transitory microalbuminuria, and the third group 16 (11.9%) were patients with persistent microalbuminuria. There was no significant difference observed in the degree of metabolic compensation between individual groups. At the end of investigation the diastolic blood pressure was significantly higher in the third group of children (76.1 +/- 0.9 and 75 +/- 1.9 or 82.8 +/- 1.8 mmHg, 0.001). A significant correlation was found between HbA1c, systolic and diastolic blood pressure and the amount of urinary excretion of albumin (p < 0.001). 2.) The investigation of tubular balance of minerals led to the detection of a significantly increased tubular reabsorption of sodium and calcium in children with IDDM (p < 0.001), whilst the urinary excretion of these ions did not increase. However, there were found significantly increased values of urinary phosphorus excretion (p < 0.001) with its value of tubular reabsorption remaining unaltered. CONCLUSIONS: The alterations of glomerular functions is present already in the commencing stages of IDDM. The significance of examination of the amount of albumin urinary excretion augments after the twelfth year of age, during which the metabolic compensation becomes markedly deteriorated and the blood pressure elevates. Bad metabolic compensation with hyperglycaemia and glycosuria significantly influence tubular functions. This can represent the cause of the disturbed glomerulo-tubular balance which manifests itself by increased losses of phosphorus in children with IDDM. This fact can disturb osteogenesis in these patients. (Tab. 2, Fig. 3, Ref. 27.)

[Early intensification of treatment in diabetes using a combination of insulin and nicotinamide--effect on C-peptide levels and the course of the disease]. / Vcasná intenzifikovaná liecba diabetu inzulínom v kombinácii s nikotínamidom--vplyv na hladiny C-peptidu a priebeh ochorenia.

Significantly higher C-peptide levels were found in a group of 49 juvenile diabetics treated with insulin in combination with nicotinamide compared to 33 diabetics treated with insulin only. There had been no significant differences in the initial values of C-peptide between the two groups. After six weeks the mean basal values of C-peptide in the blood of nicotinamide treated diabetics reached 1.21 +/- 0.79 ng/ml compared to 0.87 +/- 0.55 ng/ml determined in the group treated with insulin only (p less than 0.05). After one year of therapy the differences remained significant (p less than 0.01). The insulin requirement was significantly lower in the nicotinamide treated group after six weeks (p less than 0.001) and the difference remained significant also after two years of nicotinamide treatment (p less than 0.02). A longer period of partial remission was recorded in the group of diabetics who were administered nicotinamide. (Tab. 4, Fig. 2, Ref. 13.)

[The role of coxsackie virus infection in the development of type 1 diabetes mellitus and its effect on the postinitial course of the disease in childhood]. / Spoluúcast' infekcie vírusmi Coxsackie na vývoji diabetes mellitus typ 1 a vplyv na d'al'sí postiniciálny priebeh ochorenia v detskom veku.

The authors present the results of a three-year investigation of Coxsackie viruses in children diabetics. In paired serum samples of 66 newly diagnosed patients of virus neutralizing antibodies against eight types of Coxsackie viruses were estimated. Concurrently specific antibodies of class IgM were assessed and compared with a control group of 218 healthy children. Infection with Coxsackie viruses, in particular types B2, B4 and B5, were found in 38 diabetics (in 57.6%) as compared with 6% in healthy children. The findings indicate an evidence that diabetics with Coxsackie infection at the betics. The prospective three-year investigation provided evidence that diabetics with Coxsackie infection at the time of manifestation of the disease had a worse postinitial course. Their C-peptide levels were significantly lower (p less than 0.05). The frequency and intensity of partial remission were significantly worse in the group of diabetics who had just overcome a Coxsackie virus infection (p less than 0.02).