ISSN - 0973-0958

Pediatric Oncall Journal

Prevalence of Microalbuminuria in Children with Type 1 Diabetes Mellitus 01/09/2014 00:00:00

Prevalence of Microalbuminuria in Children with Type 1 Diabetes Mellitus

V Poovazhagi, Prabha Senguttuvan, Padmaraj R.
Diabetic clinic, Institute of Child Health and Hospital for Children, Egmore, Chennai, India.

Poovazhagi V, 8/11 manjolai street, Kalaimagal nagar, Ekkaduthangal, Chennai 600032, India.
Diabetic nephropathy, the leading cause of morbidity and mortality in adults with type 1 diabetes mellitus may have its roots since childhood. The occurrence of microalbuminuria in children with Type 1 Diabetes may provide an early opportunity to study the natural history and plan earlier interventions. This study was done in diabetic clinic and pediatric nephrology department of the Institute of Child Health and Hospital for Children, Egmore, Chennai to determine the prevalence of microalbuminuria in children with Type 1 Diabetes mellitus (DM). Prevalence of microalbuminuria in children with Type 1 DM in our study was 13.4%. Higher diabetic age and higher glycosylated hemoglobin (HBA1c) levels were found to be significantly associated with microalbuminuria.
Type 1 Diabetes Mellitus; microalbuminuria; children
Diabetic nephropathy (DN) is a leading cause of increased morbidity and mortality in patients with type 1 diabetes mellitus (DM). Microalbuminuria (MA) is an early predictor for diabetic nephropathy and is rarely detected before puberty. MA is predictive of future DN in adults with diabetes mellitus. This link between MA levels and DN allows patients to receive timely interventions. The predictive value of MA for DN in children with diabetes however is not well established. Diabetic nephropathy is rarely seen in childhood but the dreadful complication originates in the early years of disease when the child is still under pediatric care. The impact of early intervention on the future outcome needs to be studied.
Methods & Materials
All the type 1 DM children who are regularly followed up at the diabetic clinic of a tertiary care pediatric institute were recruited. Study period was between January 2008 and December 2010. Children with febrile illness, urinary tract infection, diabetic ketoacidosis (DKA), children with preexistent renal disease were excluded from the study. Children were subjected to 3 early morning spot urine examinations for microalbumin/creatinine ratio (ACR) done over a period of 12 months and if two of the three samples were positive they were considered to have persistent microalbuminuria. The urine microalbumin estimation was done using fully automated immunoturbidimetry method and creatinine by Jaffee method. ACR ratio < 30μg/gm of creatinine was defined as normoalbuminuria, between 30-300μg/mg of creatinine was defined as microalbuminuria and >300μg/g was defined as macroalbuminuria. Children had the glycosylated (HBA1c) levels evaluated once every 4 months. HBA1C was done by bidirectionally interfaced fully automated turbidometry by Roche. The mean HBA1c over the period of 12 months was considered for the diabetic control. Chronological age, duration of diabetes, age at the onset of diabetes, body mass index (BMI), insulin dose and level of diabetic control by HBA1c were compared between the group without microalbuminuria (Group 1) and the group with microalbuminuria (group2). Data were analyzed by Epi Info version 3.5.3, statistical soft ware. Chi-square test and Fisher exact test were used to calculate the difference among the two groups and the statistical significance was set at p <0 .05.
One hundred twenty seven children were recruited for the study. Male: female ratio was 5:8. Seventeen children (13.4%) showed persistent microalbuminuria with a mean age at microalbuminuria being 10.9 ± 2.3 years and range from 5 to 15.7 years. One child was under 5 years of age, 3 were between 5-9 years, 7 were between 10-12 years and 6 were more than 12 years of age. The diabetic duration at diagnosis of MA was 1 to 9 years with a mean of 4.2 ± 2.6 years. The diabetic duration was < 3 years in 5 children, between 4-6 years in 8 children and more than 7 years in 4 children at the time of diagnosis of microalbuminuria. None had hypertension. None had macroalbuminuria. The gender distribution, mean chronological age, mean diabetic age, BMI, HBA1c levels, serum cholesterol levels and insulin dose in both the groups are depicted in Table 1. Children in the microalbuminuria group were found to be at a higher diabetic age (p=0.01) and had a higher HBA1c levels (0.004).

Table - 1: Factors associated with microalbuminuria
Parameter Normoalbuminuria Microalbuminuria P value
Age at diagnosis (years) 6.5+3.1 6.2+2.7 0.75
Body mass index 21.1+4.3 20.1+5.8 0.47
Chronologic age (years) 11.2+2.9 12.5+3.2 0.08
Diabetic age (years) 4.7+2.3 6.3+2.8 0.01
Insulin dose (IU/kg) 1.3+0.4 1.3+0.4 0.69
Glycosylated hemoglobin (HBA1c) 9.2+1.6 10.9+2.3 0.004
Prevalence of microalbuminuria in Type 1 diabetes varies from 3-30 % in various studies. (1-3) Occurrence of microalbuminuria depends on many factors, including chronological age, duration of DM, glycemic control, gender, insulin dose, level of metabolic control, cholesterol and triglyceride level. (2,4-8) Longer duration of diabetes and higher HBA1c levels have been found to be consistently associated with microalbuminuria in most of the studies and has been demonstrated in this present study too. (2,4-8) Other study parameters like insulin dose, BMI, age at onset of diabetes did not show any statistically significant difference among the two groups.

Microalbuminuria occurring in older children is found to be clinically significant while the same in younger children may reflect functional, reversible renal changes. (9) Evaluation of urine for microalbuminuria is recommended after 5 years of diabetes in prepubertal children and after 2 years of diabetes in post pubertal children. (10) Our study has demonstrated urine microalbuminuria in children with less than 2 years of diabetes duration and in prepubertal children too. Currently, ISPAD 2009 recommends screening from age 11 years with 2 years diabetes duration and from 9 years with 5 years duration to capture most evolving microalbuminuria in children and adolescents. (11) Based on the above criteria for screening, 5 children would have not been diagnosed with microalbuminuria in this study group. The occurrence of persistent microalbuminuria in children within one year of diagnosis or at a younger age as in our study may warrant annual evaluation of Type 1 diabetic children for urine microalbuminuria much earlier than the current recommendations.

Microalbuminuria confers a 60-85% risk of the development of overt proteinuria within 6 - 14 years. Without intervention approximately 80% of Type 1 diabetic patients with persistent microalbuminuria develop overt nephropathy after 10 - 15 years. Eventually 50% of these develop end stage renal failure within 10 years and 75% by 20 years. (8) The levels of microalbuminuria vary within patients and may totally regress to normal over time with or without treatment. (6,12,13) Persistent microalbuminuria predicts progression to macroalbuminuria while transient does not. Hence the natural history of persistent microalbuminuria needs to be evaluated among children with Type 1 diabetes.

The intervention to be planned in such children is not clear. Current recommendations favor tight metabolic control, hypertension control and use of angiotensin converting enzyme (ACE) inhibitors for prevention of progression of urine microalbuminuria among diabetic children with risk factors. (14) Longitudinal studies following up children with microalbuminuria may show a clear picture of their clinical relevance in predicting their progression to diabetic nephropathy as adults.
Compliance with Ethical Standards
Funding None
Conflict of Interest None
  1. Schultz CJ, Neil HA, Dalton RN, Konopelska Bahu T, Dunger DB; Oxford Regional Prospective Study Group. Blood pressure does not rise before the onset of microalbuminuria in children followed from diagnosis of type 1 diabetes. Oxford Regional Prospective Study Group. Diabetes Care 2001; 24: 555-560.  [CrossRef]
  2. Moayeri H, Dalili H. Prevalence of Microalbuminuria in Children and Adolescents with Diabetes Mellitus Type I. Acta Medica Iranica 2006; 44: 105-110.  [PubMed]
  3. Viswanathan V, Snehalatha C, Shina K, Ramachandran A. Persistent microalbuminuria in type 1 diabetic subjects in South India. J Assoc Physicians India. 2002; 50: 1259-1261.  [PubMed]
  4. Rossing P, Huguard P, Parring H. Progression of microalbuminuria in type 1 diabetes. Kidney Int. 2005; 68: 1446-1450.  [CrossRef]
  5. Cizmecioglu FM, Noyes K, Bath L, Kelnar C. Audit of microalbumin excretion in children with type I diabetes. J Clin Res Pediatr Endocrinol 2009; 1: 136-143.  [CrossRef]
  6. Rademacher ER, Sinaiko AR. Albuminuria in children. Curr Opin Nephrol Hypertens. 2009; 18: 246-251.  [CrossRef]
  7. Stone ML, Craig ME, Chan AK, Lee JW, Verge CF, Donaghue KC. Natural history and risk factors for microalbuminuria in adolescents with type 1 diabetes: a longitudinal study. Diabetes Care. 2006; 29: 2072-2077.  [CrossRef]
  8. Razavi Z, Momtaz HE, Sahari S. Frequency of Microalbuminuria in Type 1 Diabetic Children. Iran J Pediatr 2009; 19: 404-408.
  9. Alleyn CR, Volkening LK, Wolfson J, Rodriguez-Ventura A, Wood JR, Laffel LM. Occurrence of microalbuminuria in young people with Type 1 diabetes: importance of age and diabetes duration. Diabet Med 2010; 27: 532-537.  [CrossRef]
  10. Derakhshan A, Akhavan M, Karamifar H. Evaluation of Microalbuminuria 4 to 6 Years Following Type 1 Diabetes and its Correlation to Glycemic Control in Children. Iran J Pediatr 2007; 17: 252-256.
  11. Donaghue KC, Chiarelli F, Trotta D, Allgrove J, Dahl-Jorgensen K. Microvascular and macrovascular complications associated with diabetes in children and adolescents. Pediatr Diabetes. 2009; 10 Suppl: 195-203.  [CrossRef]
  12. Salardi S, Balsamo C, Zucchini S, Maltoni G, Scipione M, Rollo A, et al. High rate of regression from micro-macroalbuminuria to normoalbuminuria in children and adolescents with type 1 diabetes treated or not with enalapril: the influence of HDL cholesterol. Diabetes Care. 2011; 34: 424-429.  [CrossRef]
  13. Amin R, Widmer B, Prevost AT, Schwarze P, Cooper J, Edge J, et al. Risk of microalbuminuria and progression to macroalbuminuria in a cohort with childhood onset type 1 diabetes: prospective observational study. BMJ 2008; 336: 697-701.  [CrossRef]
  14. Hasan MA, Diabetic Nephropathy in childhood and adolescence. Saudi J Kidney Dis Transpl 2002; 13: 155-162.  [PubMed]


Cite this article as:
Poovazhagi V, R P, Senguttuvan P. PREVALENCE OF MICROALBUMINURIA IN CHILDREN WITH TYPE 1 DIABETES MELLITUS. Pediatr Oncall J. 2012;9: 66-67. doi: 10.7199/ped.oncall.2012.43
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
Disclaimer: The information given by is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0