New test could predict risk of kidney failure in kids with type 1 diabetes
Staff Writer |
Researchers have successfully tested a new method for the early diagnosis in children and teenagers of diabetic nephropathy, a serious complication of diabetes that can increase risk of death.
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This new method, unveiled at the 68th AACC Annual Scientific Meeting & Clinical Lab Expo, would help pediatric patients get necessary treatment in a more timely manner.
Diabetic nephropathy affects 20–40% of type 1 and 2 diabetic patients. In type 1 diabetic patients who have progressed to the final stages of nephropathy, kidney failure eventually develops in 50% of individuals within 10 years after the onset of overt nephropathy and in >75% by the 20 year mark.
Currently, this condition is diagnosed through the detection of increased urinary albumin excretion, but a growing body of evidence suggests that the risk for developing diabetic nephropathy starts when urinary albumin excretion levels are still within the normal range.
If the onset of nephropathy could be detected before urinary albumin rises, patients could potentially be placed on treatment to prevent its development.
A team of researchers led by Ioannis Papassotiriou, PhD, of Aghia Sophia Children's Hospital in Athens, Greece, has determined that two proteins—growth differentiation factor-15 (GDF-15) and chitinase-3-like protein 1 (YKL-40)—could be used to detect diabetic nephropathy early.
In 56 type 1 diabetes patients ages 9–15 and 49 healthy controls ages 6–19, the researchers tested for GDF-15 and YKL-40 at time of enrollment in the study and after 12–15 months.
Also at these two time points, they evaluated subjects' kidney function by measuring cystatin C to determine estimated glomerular filtration rate (eGFR) and measuring neutrophil gelatinase associated lipocalin (NGAL).
After 12–15 months, the researchers found that GDF-15 levels in diabetes patients were significantly higher (366.7 pg/mL) than in healthy controls (278.6 pg/mL).
Initially, no significant difference in YKL-40 measurements was observed between diabetes patients and controls at time of enrollment, but over the course of the study, mean YKL-40 levels in diabetes patients proceeded to increase (from 17.4 ng/mL to 20.5 ng/mL).
GDF-15 levels also correlated negatively with eGFR values, while YKL-40 levels correlated positively with NGAL and GDF-15, indicating that rises in both proteins reflect a decline in kidney function.
"This is the first study to demonstrate a predictive role for serum GDF-15 and YKL-40 as early markers of diabetic nephropathy in children and adolescents with [type 1 diabetes] before severe overt nephropathy occurs," said Papassotiriou.
"Defining new predictors as supplementary tests to urinary albumin excretion for the early diagnosis of diabetic nephropathy could accelerate effective management and treatment approaches needed to minimize the rates of severe renal morbidity and mortality in young patients with [type 1 diabetes]." ■