Risk factors for early onset of diabetic nephropathy in pediatric type 1 diabetes.

AIM: Diabetic nephropathy (DN) is a frequent complication in patients with long-standing type 1 diabetes mellitus (DM1). The objective of this study was to assess the prevalence of DN in DM1 patients diagnosed during childhood and its association with clinical and metabolic variables, such as age at diagnosis of DM1, glucose control, dyslipidemia, hypertension and the occurrence of diabetic retinopathy (DR). METHODS: The medical records of 205 patients admitted to the Pediatric Endocrinology Division at the Hospital das Clinicas da Universidade Federal de Minas Gerais, in Belo Horizonte, Brazil, were analyzed. For the analysis of survival and prognostic factors, the Kaplan-Meyer method and the COX regression model were used. RESULTS: The mean disease duration was 11.32 +/- 4.02 years and the mean age at diagnosis was 6.10 +/- 3.54 years. Microalbuminuria was present in 11.2% of them, proteinuria in 6.8% and end-stage renal disease (ESRD) in 2.9%. There was a significant association between the occurrence of microalbuminuria or proteinuria and poor glucose control (p=0.025 and p=0.005, respectively), higher LDL cholesterol levels (p=0.006 and p=0.004, respectively) and age greater than 6 years at diagnosis (p=0.049 and p=0.05, respectively). Proteinuria was also associated to the occurrence of DR (p=0.016). CONCLUSION: Our data showed that the prevalence of DN was higher than expected in this young population studied, especially considering the most severe forms. Clinical and laboratory factors associated to ND were: poor long-term glucose control, higher levels of LDL-C, higher age at diagnosis and the occurrence of DR.

Abordagem da nefropatia diabética em pediatria: [revisão] / Management of diabetic nephropathy in pediatric patients: [review]

A nefropatia diabética é uma complicação comum em pacientes portadores de diabetes mellitus tipo 1. Sua evolução para insuficiência renal crônica implica aumento na mortalidade, aumento dos gastos com o tratamento e queda na qualidade de vida dos pacientes. Esses aspectos justificam a busca de um melhor entendimento dos fatores associados ao aparecimento e à evolução desta complicação. Faz-se, através deste artigo, uma revisão sobre a abordagem da nefropatia diabética em pediatria. Além disso, serão abordadas questões como fatores de risco e diagnóstico laboratorial dessa patologia.

Diabetic nephropathy is a common complication found in patients with diabetes mellitus type 1. The progression of diabetic nephropathy to chronic renal failure results in an increased mortality and a worse quality of life, demanding more expensive and sophisticated treatment approaches. Those features indicate that a better understanding of the causing factors and a thorough elucidation of the evolutional mechanisms of this disease are needed. A survey on the management of pediatric patients with diabetic nephropathy is made. Other issues discussed are: risk factors, diagnostic tools and prognosis.

Elevated serum parathormone after Roux-en-Y gastric bypass.

BACKGROUND: Abnormalities in calcium and vitamin D metabolism are observed early after gastric bypass, whereas clinical or biochemical evidence of metabolic bone disease might not be detected until many years after the procedure. The aim of the present study was to evaluate the impact of bariatric surgery on bone metabolism determined on the basis of postoperative laboratory changes in calcium, phosphorus, magnesium, alkaline phosphatase and parathormone (PTH) levels. METHODS: 110 patients submitted to Roux-en-Y gastric bypass (RYGBP) were followed after surgery, and the following parameters were determined: intact PTH molecule (PTHi; chemiluminescence), alkaline phosphatase (colorimetric method), ionic calcium (selective electrode), phosphorus and magnesium (colorimetric method). RESULTS: Elevated serum PTHi levels were observed in 29% of the patients and hypocalcemia in 0.9% from the 3rd postoperative month and afterwards (3 to 80 months after surgery). CONCLUSION: There is a need for careful evaluation of bone metabolism and for routine calcium replacement after RYGBP.

Fisiopatologia da nefropatia diabética / Physiopathology of diabetic nephropathy

A nefropatia diabética é uma complicação comum em pacientes com diabetes mellitus tipo 1. O diabetes mellitus do tipo 1, normalmente, inicia-se na infância e, após cinco a quinze anos de doença, podem ocorrer as complicações, sobretudo a nefropatia diabética. Muitos fatores relacionam-se ao desenvolvimento do dano renal, tais como controle glicêmico, mediadores humorais, perfil genético e fatores de crescimento. Sua evolução para insuficiência renal crônica implica aumento na mortalidade, aumento dos gastos com o tratamento e queda na qualidade de vida dos pacientes. Esses aspectos justificam a busca de um melhor entendimento dos fatores associados ao aparecimento e à evolução dessa complicação. Este artigo consiste de uma revisão sobre a fisiopatologia da nefropatia diabética.

Diabetic nephropathy is a common complication found in type 1 diabetes patients. This normally starts in childhood and, after five to fifteen years of the disease, the complications, mainly nephropathy, may be present. Several factors may explain the development of renal involvement such as: glycemia control, humoral mediators, genetic profile, and growth factors. The progression of diabetic nephropathy to chronic renal failure results in an increased mortality and a worse quality of life, demanding more expensive and sophisticated approaches to treatment. These features indicate that a better understanding of the causative factors and a thorough elucidation of the evolutionary mechanisms of this disease are needed. A revision of the physiopathology of diabetic nephropathy is made.

Diabetes mellitus e cirurgia bariátrica: efeito da redução do peso no controle glicêmico / Diabetes mellitus and bariatric surgery: the effect of weight reduction on glicemic control

Fez-se uma análise prospectiva de 219 pacientes com obesidade mórbida, submetidos à cirurgia bariátrica entre 1996 e 2001, para estudar a prevalência e evolução do diabetes mellitus (DM). Trinta e nove pacientes (17,8%) do grupo eram diabéticos. O seguimento pós-operatório mostrou: melhor controle metabólico (glicemia em jejum e glicohemoglobina): 37 pacientes (94,8%) passaram a ser controlados somente com dieta: em um paciente (2,56%), a insulina pôde ser substituída por antidiabético oral e, em um paciente (2,56%), manteve-se o uso de insulina, porém em menor dosagem. O melhor controle do diabetes ocorreu entre 15 dias e 12 meses após a cirurgia (média de 3,4 meses). Naquele momento, o índice de massa corporal, a porcentagem de perda de peso e a porcentagem de perda de excesso de peso corporal demonstravam respectivamente: 43,5kg/m2 ± 7,15 (28,1-61,5); 16,8% (5,0-30,2%) e 30,6% (8,0-60,6%). Conclusões: 1) A prevalência de DM neste estudo foi de 17,8%; 2) A perda de peso melhorou o controle metabólico; 3) A redução média de 16,8% do peso corporal foi suficiente para melhorar o controle metabólico.

A prospective analysis of 219 patients with morbid obesity submitted to bariatric surgery between 1996 and 2001 was made to study the prevalence and evolution of the diabetes mellitus (DM). Thirty-nine patients (17.8%) met the criteria for type 2 DM. The follow-up showed better metabolic control (fasting plasma glucose and glycohemoglobin): 37 patients (94.8%) with diet alone, 1 patient (2.56%) changed insulin for oral drug and 1 patient (2.56%) continued with a lower dose of insulin. Treatment was modified between 15 days and 12 months after surgery (3.4 months). At that time: BMI 43.5 kg/m2± 7.15 (28.1-61.5), % loss body weight 16.8% (5-30.2), % loss excess body weight 30.6% (8- 60.6). Conclusion: 1) The prevalence of DM was 17.8%. 2) The weight loss improved metabolic control. 3) Reduction of 16.8% of body weight was sufficient to improve metabolic control.