Low birth weight (BWT) may contribute to kidney disease and could explain some of the variance in the development of early diabetic kidney disease. This hypothesis was tested in the multicenter SEARCH study (3,714 youth with diabetes <20 years of age). A morning spot urine sample, laboratory and anthropometric data, and a medical history were obtained. Elevated albumin to creatinine ratio (ACR) was defined as > or =30 mcg albumin/mg creatinine, and BWT was categorized as low (<2,500 g), reference (2,500-4,000 g), or high (>4,000 g). The relationship of BWT to elevated ACR was analyzed using multiple logistic regression. In youth with diabetes, the prevalence of elevated ACR was 12.6% in those with low BWT, 9.7% in those with reference BWT, and 8.9% in those with high BWT. BWT category was not significantly associated with elevated ACR (p = 0.23). Those with diabetes duration >18 months (2,032) had the following association of BWT category with elevated ACR [odds ratio (OR) = 1.64, 95% confidence interval (CI) 1.00-2.69, p = 0.0503] for low BWT compared with reference BWT. Whereas low BWT may be a factor in kidney disease, little evidence was found of a relationship between low BWT and elevated ACR in this study population of youth with diabetes.
[Show abstract][Hide abstract] ABSTRACT: The significance of albumin in the urine of apparently healthy children is still the subject of much discussion. Most of these cases are accidentally discovered in the routine examination of urine in schools, orphan asylums and dispensaries. Bright,1 in 1827, regarded albumin in the urine as definite evidence of kidney disease. This view was held until Ultzmann,2 in 1870, suggested the possibility of this urinary finding without an accompanying nephritis, and Leube,3 in 1877, proved that albumin is found in the urine of many apparently healthy people. Various theories have been advanced to account for this benign albuminuria. Hooker4 reviews the voluminous literature up to 1910. Post and Thomas5 and Lauener6 have summarized it up to 1923.The frequency of the condition in children varies in the reports from different observers. Capitan7 reported the condition in 40 per cent of healthy children, Langstein
Journal of the American Medical Association 01/2009; 86(24):1821-1824. DOI:10.1001/jama.1926.02670500009004
[Show abstract][Hide abstract] ABSTRACT: Albuminuria is a marker of present and future cardiovascular and renal morbidity, and mortality, in adults. Because the roots of these diseases extend back into childhood, assessment of albuminuria has become relevant to child and adolescent clinical care.
Normal levels of albumin excretion in children are well below the cut-off for microalbuminuria. In healthy children, albuminuria relates to fasting insulin, but not blood pressure, BMI, lipid levels, fasting glucose, or insulin resistance. In obese children, albuminuria relates to multiple measures of insulin resistance. In children with type 1 diabetes, hemoglobin A1c seems to be the most consistent clinical predictor of microalbuminuria although multiple mechanisms seem to be involved, including genetic polymorphisms. Children with type 2 diabetes and hypertension already exhibit microalbuminuria.
When considering the population as a whole, children make ideal subjects in which to study the natural history of albuminuria given their relative lack of multiple morbidities commonly seen in adults. The unfortunate rise in 'adult' diseases in the pediatric age group makes this especially relevant. There is a need for longitudinal studies examining predictors of elevated urinary albumin levels as well as potential treatment strategies.
Current opinion in nephrology and hypertension 04/2009; 18(3):246-51. DOI:10.1097/MNH.0b013e3283294b98 · 3.96 Impact Factor
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