Impact--оf Urinary Growth Norifonё/Insplin-Like Growth Factor-I on The Development of Nephropathy in Early-Onset and Long-Term Diabetic Children

Abstract

Background: Growth hormone' (Gil), insuImn-1mke growth factor-I (1G1'-1), 1GF-binding protein (GHJIGF/ IGFBP) axis has been suggested bothţо'maintain.normal renal function and to play an important role in the development of diabetic nephropathy (DN), in patients with type I diabetes (TI D). Nephromegaly (NM) and microalbuminuria (МА) are early markers of DN.Objective: Study the role of urinary concentrations of GH and IGF-I in the development of DN, in children and adolescents suffering T ID.Study design: A total of 50 children and adolescents with TI D of 6-14 years old were recruited from the Pediatric Diabetes Clinic at King Abdulaziz University Hospital, 23 were males and 27 were females. Subjects were divided into two groups; 20 with early-onset diabetes and 30 with long-term diabetes. Both groups were subjected to history-taking, clinical examination including body mass index (BM1), pubertal staging according to the rating of Tannег , assessment of glycemic control, measurement of kidney volume (KV), as a marker of glomerular hypertrophy, by ultrasonography (U/S).Results: The overall rate of МА and NM accounted for 20% (10/50) and 26% (13/50), respectively, being more detected in long-term diabetics than that in patients with early-onset diabetes, with significant difference. Long-term diabetics had significantly higher albumin excretion rate (AER) and urinary GH and IGF-1 concentrations than that in early-onset diabetics. The mean BMI, pubertal duration, urinary GH and urinary IGF-1 were significantly higher among diabetics positive for MA than that among diabetics negative for hМА.Conclusion: Our data, which reflect increased mean urinary GH/IGF-1 production, strengthen the evidence of an association between GH, МА, NM and also implicate urinary G1l/IGF-I in DN, particularly in children and adolescents with long-term diabetes, increased pubertal duration and poor glycemic control.