Advances in clinical and metabolic profiling in children with type 1 diabetes and diabetic nephropathy.
Aim: To stratify children with T1D according to their risk of developing and progressing DN using cluster analysis of clinical and laboratory indicators.
Materials and Methods: Cluster analysis was performed in a cohort of 60 children (mean age 13 } 3 years; 17 [28,3%] boys and 43 [71,7%] girls) with T1D, with (n = 30) or without (n = 30) early-stage DN, based on parameters such as T1D duration, estimated glomerular filtration rate, microalbuminuria (MAU), urinary kidney injury molecule-1 (KIM-1), and episodes of diabetic ketoacidosis (DKA).
Results: Three clusters with distinct renal risk profiles were identified in children with T1D with or without DN. The risk group for DN development in T1D children showed moderate T1D duration, random MAU and DKA episodes, and slightly increased KIM-1 levels. The risk group for further DN progression in children with early DN was characterized by prolonged T1D duration, pronounced MAU, frequent DKA, hyperfiltration, and markedly elevated urinary KIM-1.
Conclusions: Cluster analysis allows early identification of the risk group for DN in children with T1D and the risk group for DN progression in children with early DN. Urinary KIM-1 may be implemented as a biomarker of tubular injury, providing opportunities for earlier intervention before clinical nephropathy develops.
Materials and Methods: Cluster analysis was performed in a cohort of 60 children (mean age 13 } 3 years; 17 [28,3%] boys and 43 [71,7%] girls) with T1D, with (n = 30) or without (n = 30) early-stage DN, based on parameters such as T1D duration, estimated glomerular filtration rate, microalbuminuria (MAU), urinary kidney injury molecule-1 (KIM-1), and episodes of diabetic ketoacidosis (DKA).
Results: Three clusters with distinct renal risk profiles were identified in children with T1D with or without DN. The risk group for DN development in T1D children showed moderate T1D duration, random MAU and DKA episodes, and slightly increased KIM-1 levels. The risk group for further DN progression in children with early DN was characterized by prolonged T1D duration, pronounced MAU, frequent DKA, hyperfiltration, and markedly elevated urinary KIM-1.
Conclusions: Cluster analysis allows early identification of the risk group for DN in children with T1D and the risk group for DN progression in children with early DN. Urinary KIM-1 may be implemented as a biomarker of tubular injury, providing opportunities for earlier intervention before clinical nephropathy develops.
Authors
Burlaka Burlaka, Kovalchuk Kovalchuk, Mityuryayeva-Kornijko Mityuryayeva-Kornijko
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