Albumin excretion in adolescents with diabetes

Abstract

If you would like to express interest in reviewing or writing papers for the Journal of Renal Nursing, please contact the journal’s editor via email (natasha.devan@markallengroup.com) Albumin excretion in adolescents with diabetes O ver the last 20 years, two longitudinal studies—the Oxford Regional Prospective Study (ORPS) and Nephropathy Family Study (NFS), facilitated by UK research nurses—have improved our understanding of the natural history of microalbuminuria in young people with type 1 diabetes. Microalbuminuria, a marker of early-stage renal damage and an independent risk factor for nephropathy and cardiovascular disease, has been found in around 26% of adolescents with type 1 diabetes 10–20 years after diagnosis. Early increases in urinary albumin excretion predict progression to microalbuminuria and more severe renal disease. In adults with type 1 diabetes, such early increases in albumin excretion have also been associated with risk for cardiovascular disease, but data from adolescents with type 1 diabetes has been lacking. The Adolescent Type 1 Diabetes cardio-renal Intervention Trial (AdDIT), designed to explore the effects of lipid-lowering drugs (statins) and blood pressure lowering drugs (angiotensin-converting-enzyme (ACE) inhibitors) on risk for diabetic nephropathy and cardiovascular disease, has allowed exploration of the relationship between cardiovascular risk and urinary albumin excretion in adolescents with type 1 diabetes. Research nurses in the UK, Australia and Canada screened over 3000 people aged 10–16 years with type 1 diabetes to identify those with higher than average albumin excretion. Participants were found to have renal hyperfiltration and an increase in both risk markers and direct measures of cardiovascular disease. Around 850 participants have now been recruited to a clinical trial of ACE inhibitors and/or statins, which has the potential to change diabetes management during adolescence and improve the long-term prognosis of young patients with type 1 diabetes.