Twenty percent of patients with juvenil diabetes mellitus (JDM)

Abstract

Will develop renal failure within 30 years. The interval between the first clinical signs of nephropathy and terminal renal failure averages 3 years. To find early predictors of diabetic nephropathy, renal functional studies are being carried out in the 250 children followed in the diabetic section of this hospital. Glomerular filtration rate (GFR) and the clearance of Beta-2-microglobulin and albumin are determined. Results are presently available from BO children and show that GFR is increased already shortly after the onset of JDM (149 ±20 ml/1.73 m2/min as compared to 110±12 in controls). GFR remains on a high level during the first 10 years after the onset. 10-15 years after the onset, GFR is no longer sign. different from that in controls. 15 years after the onset, subnormal GFR values are recorded in some patients. 0-2 years after the onset there is a positive correlation between GFR on one hand and average blood sugar and HbA1C on the other hand. 2-6 years after the onset there is no correlation between GFR and HbA1C. 6-10 years after the onset there is a negative correlation between GFR and HbA1C. Fractional excretion of Beta-2-microglobulin is normal in all patients suggesting that the changes in diabetic nephropathy are primarily glomerular. The different correlations between GFR and metabolic control recorded early after the onset and during the later course of the disease suggest that the changes in GFR in JDM are due both to functional adaptation to the altered metabolism and to progressive structural changes.