Abstract
The assessment of renal function is crucial in type 1 diabetes because nephropathy is one of the major complications. The measurement of urinary albumin excretion is the most widely used method for monitoring kidney involvement (1), although the use of other markers, such as enzymes or proteins derived from tubular cells (2), has also been proposed. 1H nuclear magnetic resonance (NMR) spectroscopic analysis of urine may provide useful information because it allows the analysis, in a single image, of several metabolites that reflect diverse renal functions, including intermediary metabolism as well as tubular and medullary cell function. In this study, we compared the 1H NMR spectra of urine samples from children and adolescents with type 1 diabetes, but without microalbuminuria or any other renal complication, with spectra of samples from healthy individuals matched for sex and age. The aim of this comparison was to obtain basic knowledge of possible differences in the urinary excretion or concentrations of a series of metabolites between patients with type 1 diabetes and nondiabetic individuals, with the prospect of evaluating the utility of diabetes-associated differences in the assessment of the patients’ metabolic control. 1H NMR spectra were registered at 25 °C, following a standardized protocol (3) and using a Gemini 300 apparatus (Varian) operating at 300 MHz. Metabolite quantification was performed using peak heights normalized in relation to the signal of creatinine. Thus, the values obtained for each metabolite are expressed as millimoles per mole of creatinine present in the sample. Spot urine samples were obtained from 25 patients with type 1 diabetes. Patients (15 girls and 10 boys; mean age, 13.9 years; range, 6.5–17.8 years) with normal serum and urinary creatinine and without any signs of microvascular complications were recruited into the study haphazardly among patients older than 6 years …
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