Prevalence, clinical characteristics and genetic markers of incipient diabetic nephropathy in children and adolescents with type 1 diabetes in Western Australia

Patricia Herold Gallego

    Research output: ThesisDoctoral Thesis

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    Abstract

    [Truncated abstract] Diabetic nephropathy (DN) is an important cause of morbidity and mortality among subjects with type 1 diabetes mellitus (T1DM). Early elevation of albumin excretion rate (AER) and the presence of microalbuminuria (MA) are early signs of DN and predictors for the progression of diabetic nephropathy and the development of cardiovascular disease. The overall aim of this work was to define potential clinical and genetic markers for the appearance of persistent MA among children and adolescents with T1DM. The main hypothesis was that both environmental and genetic factors are contributors to the appearance of DN and that these factors can be identified at very early stages of T1DM in childhood. MA in children and adolescents with T1DM was examined in four different settings: 1) In the first study (Chapter 3), the natural history of incipient nephropathy was assessed in a population-based sample of 955 children and adolescents aged less than 16 years at diabetes onset who were followed longitudinally until the development of MA. The prevalence and the clinical factors that predicted the development of MA were studied. MA was prevalent in 13.4%. The major clinical contributors were glycaemic control as reflected by mean HbA1c; age at diagnosis of T1DM and the presence of puberty. HbA1c increased the risk for MA by 21% after adjusting for other covariates. Age at diagnosis increased the risk by 25% whereas puberty increased by 8-fold the risk for persistent MA. Furthermore, the contribution of diabetes duration for the appearance of persistent MA was not uniform over time with subjects diagnosed under the age of 5 years presenting a prolonged survival time without MA in comparison with those diagnosed between 5-11 and > 11 years. 2)
    Original languageEnglish
    QualificationDoctor of Philosophy
    Publication statusUnpublished - 2010

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