Abstract
BackgroundThe aim of this study was to evaluate the association between blood pressure (BP) and urinary angiotensinogen excretion (uAGT) and renal sodium excretion (uNa) in children with type 1 diabetes mellitus (DM1).MethodsThe study group consisted of 52 children with DM1 (28 males and 24 females) with albumin/creatinine ratio (ACR) below 30 mg/g and glomerular filtration rate (eGFR) above 90 ml/min/1.73 m2. BP was assessed by 24-h ambulatory blood pressure monitoring (ABPM).ResultsThe patients showed significantly increased uAGT values with respect to controls (median 0.00 and range 1.76 vs. 0.00 and 0.00 ng/mg, respectively). The significant increase of uAGT was observed even in prehypertensive patients. uAGT concentrations showed positive correlation with systolic and diastolic 24-h BP and with mean arterial pressure (MAP) (r = 0.594). uNa values were negatively correlated with BP parameters, uAGT, ACR and eGFR.ConclusionsAn increase in uAGT precedes hypertension (HTN) in normoalbuminuric children with DM1 and may be considered as a new marker of HTN. Decreased sodium excretion seems to be involved in the development of HTN and early renal injury. Both uAGT and uNa are associated with BP in normoalbuminuric diabetic children.
Highlights
Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease, with a high risk of end-stage renal disease [1, 2]
albumin/creatinine ratio (ACR), estimated glomerular filtration rate (eGFR) and urinary sodium excretion (uNa) levels did not differ between the study groups
The comparison of children with normal blood pressure (BP), Prehypertensive children (preHTN) and HTN revealed a significant increase of urinary angiotensinogen excretion (uAGT) in preHTN patients, as well as in HTN, when compared to controls (Table 2, Fig. 1)
Summary
Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease, with a high risk of end-stage renal disease [1, 2]. In clinical and experimental trials, it has been shown that activation of the intrarenal renin-angiotensin system (RAS) has a potential role in the mechanism and progression of DKD [8,9,10]. The excretion of urinary angiotensinogen could be a potential biomarker of intrarenal RAS status in clinical and experimental type 1 diabetes [11,12,13]. Disruption of the filtration barrier in a transgenic mouse model increased both tubular and urinary AGT without any increase in renal renin activity. The aim of this study was to evaluate the association between blood pressure (BP) and urinary angiotensinogen excretion (uAGT) and renal sodium excretion (uNa) in children with type 1 diabetes mellitus (DM1). The significant increase of uAGT was observed even in prehypertensive patients. uAGT concentrations showed positive correlation with systolic and diastolic 24-h BP and with mean arterial pressure (MAP) (r=0.594). uNa values were negatively correlated with BP parameters, uAGT, ACR and eGFR
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