Abstract
Diabetic kidney disease belongs to the major complications of diabetes mellitus. Here, hyperglycaemia is a key metabolic factor that causes endothelial dysfunction and vascular changes within the renal glomerulus. The aim of the present study was to assess the function of the vascular endothelium in children with type 1 diabetes mellitus (type 1 diabetes) by measuring selected endothelial lesion markers in blood serum. The selected markers of endothelial lesions (sVCAM-1, sICAM-1, sE-SELECTIN, PAI-1, ADMA and RAGE) were assayed by the immunoenzymatic ELISA method. The study involved 66 patients (age: 5–18 years) with type 1 diabetes and 21 healthy controls (age: 5–16 years). In the type 1 diabetes patients, significantly higher concentrations of all of the assayed markers were observed compared to the healthy controls (p < 0.001). All of the evaluated markers positively correlated with the disease duration, the age, and BMI of the patients, while only PAI-1 and sE-SELECTIN were characteristic of linear correlations with the estimated glomerular filtration rate (eGFR). It can be concluded that endothelial inflammatory disease occurs in the early stages of type 1 diabetes mellitus in children. The correlations between PAI-1, sE-SELECTIN, and eGFR suggest an advantage of these markers over other markers of endothelial dysfunction as prognostic factors for kidney dysfunction in children with type 1 diabetes.
Highlights
Diabetes is a significant health problem in children, including children who are very young
Pathomorphologic changes in the renal structure may be present at the time of diabetes diagnosis, resulting in initial hypertrophy and hyperfunction at the early stages and throughout albuminuria, eventually leading to end-stage renal failure
For all of the studied biomarkers, the minimal values in the DM1 group were higher than the maximal values in the control group: the sICAM-1 ranged from 102.55 to 117.8 in control group vs. from 162.41 to 425.35; sVCAM-1 ranged from 313.86 to 357.27 in the control group vs. from 400.20 to 762.65; sE-SELECTIN ranged from 29.12 to 35.38 in the control group vs. from 41.94 to 79.95; asymmetric dimethylarginine (ADMA) ranged from 68.49 to 75.81 in the control group vs. from 104.71 to 693.67; plasminogen activator inhibitor 1 (PAI-1) ranged from 6.02 to 6.82 in the control group vs. from 12.82 to 19.38; and RAGE ranged from 80.10 to 88.12 in the control group vs. from 114.47 to 796.66
Summary
Diabetes is a significant health problem in children, including children who are very young. Chronic hyperglycaemia results in the enhanced production of toxic oxygen derivatives that, together with their impaired elimination by the antioxidative systems of the body, cause a specific status to emerge called “oxidative stress” [2,3,4]. This entails modifications in the structures of proteins, lipids, carbohydrates, or nucleic acids, resulting in degenerative changes to tissues, mainly those in the vascular area. Pathomorphologic changes in the renal structure may be present at the time of diabetes diagnosis, resulting in initial hypertrophy and hyperfunction at the early stages and throughout albuminuria, eventually leading to end-stage renal failure
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