Pediatric Chronic Disease Research Articles

DOMINÓ Registry: study protocol on mineral and bone disease (DOença MINeral e Óssea) of chronic kidney disease in pediatrics in Brazil.

Pediatric patients with chronic kidney disease (CKD) develop mineral and bone disorders (MBD). We do not have Brazilian data that evaluate these outcomes, which can be obtained through epidemiological records. To present the DOMINÓ study, which aims to describe CKD-MBD characteristics in Brazilian pediatric patients. Retrospective and prospective, multicenter, observational cohort. The retrospective study will analyze data from prevalent patients in 2024, and the prospective study will analyze data from 2025 onwards. Demographic, clinical, laboratory, imaging, and bone biopsy data will be collected from pediatric patients with CKD-MBD < 18 years old with CKD stage 3-5D and kidney transplant recipients. The Ethics Committees of the participating centers approved the study. The DOMINÓ study will provide information on the incidence, prevalence, morbidity, treatment results, and mortality of this pediatric disease in Brazil. Future analyses will allow us to identify predictors of response to treatment and improve the care for these patients.

Chronic kidney disease in pediatrics: Closing the gap between knowledge and clinical practice.

Chronic kidney disease in pediatrics: Closing the gap between knowledge and clinical practice.

Engaging Students in a Dialysis Unit: A Pilot Study.

Seeking to provide early paediatric nephrology exposure to medical students in the United States, we implemented the Kids In Dialysis, Nephrology Exposure and Education (KIDNEE) club. This club served as an educational intervention in which preclinical medical students were paired with paediatric dialysis patients, as patient buddies. Students were recruited for involvement in the club through the medical school Paediatric Interest Group. For the 2022-2023 academic year, seven first-year students were paired with seven paediatric dialysis patients. Students met with their patient match weekly to play games, watch movies and to act as a friend. The evaluation aimed at assessing the feasibility and acceptability of this intervention as well as influence on student interest in paediatric chronic disease and paediatric nephrology. We developed and distributed surveys to patients, unit staff, and students after programme implementation. From October 2022 to April 2023, medical students collectively spent ~173 h in the dialysis unit. Staff and patients/families unanimously reported that they would recommend the KIDNEE club to other families. Students objectively reported an increased interest in paediatric nephrology and chronic disease and subjectively reported an increased understanding of the patient experience. The KIDNEE club pilot was both feasible and acceptable for patients/families, staff and students. It holds the potential to increase student interest in the field of paediatric nephrology. As our results are limited by small sample size given the pilot nature of the programme, future studies are needed to assess programme expansion and longitudinal influence on students' career paths.

Long-Term Management of Pediatric Chronic Diseases: Improving Quality of Life and Reducing Hospital Admissions in Children With Asthma, Cystic Fibrosis, Diabetes, and Epilepsy.

Children who suffer from long-term illnesses, including asthma, cystic fibrosis, diabetes, or epilepsy, sometimes struggle to manage their ailments, which affects their quality of life and how often they use healthcare services. This study aimed to explore comprehensive long-term management strategies for children with asthma, cystic fibrosis, diabetes, and epilepsy, with a focus on enhancing quality of life and reducing hospital admissions. A prospective cohort research was conducted involving 480 children, divided into four groups: 120 children with asthma, 120 children with cystic fibrosis, 120 children with diabetes, and 120 children with epilepsy. Participants were evaluated at baseline and at several follow-ups (3, 6, 12, and 24 months) across a 24-month period. Structured surveys, including questions on treatment adherence and quality of life metrics, as well as checks of medical records to monitor hospital admissions, were used to gather data. To investigate changes in hospital admission rates and quality of life scores over time, statistical analyses were performed, including paired t-tests. Statistical significance was defined as a p-value of less than 0.05. Quality of life scores improved significantly for all groups, with asthma patients demonstrating the most significant increase of 12.53 ± 3.51 points, rising from a baseline score of 62.54 ± 14.03 to 75.07 ± 10.52 (p < 0.001). Hospital admissions also declined substantially, particularly in the asthma group, which reduced from 4.51 ± 2.07 to 2.06 ± 1.37 (p < 0.001). High adherence rates were observed among patients, with 85 (70.83%) in asthma, 90 (75.00%) in cystic fibrosis, 95 (79.17%) in diabetes, and 92 (76.67%) in epilepsy. Additionally, patient satisfaction scores were notably high, averaging 78.02 ± 10.07 in asthma, 80.03 ± 9.52 in cystic fibrosis, 82.21 ± 8.05 in diabetes, and 79.15 ± 9.03 in epilepsy across the different disease categories. Children with chronic illnesses have a much higher quality of life and fewer hospital admissions when family engagement techniques and technology-driven monitoring are used.

Challenges and Recommendations on Digital Health Sources in Pediatric Chronic Suppurative Lung Diseases

In the context of digitalizing healthcare systems, digital health sources (DHSs) aim to enhance the efficiency, accessibility, and quality of healthcare services by leveraging technology. Multiple types of DHSs are increasingly established in healthcare, providing direct and wide communication between pediatric patients, parents, and healthcare professionals. Therefore, they are considered promising key tools to improve pediatric disease monitoring and management. At the same time, DHSs have been associated with several issues and risks, such as those related to data sharing, privacy, and the cultural readiness of the users. Yet, discussions in the literature have mostly focused on technical considerations and a user-friendly design. In contrast, the contribution of DHSs to treatment engagement in pediatric populations and data sharing has only partially been discussed. On this basis, we provide an overview of the available digital health technologies and their application in the pediatric population with chronic suppurative lung diseases; we describe the effectiveness in health-related outcomes, discuss possible challenges, and propose some recommendations that may overcome barriers in their everyday use.

Artificial intelligence in the care of children and adolescents with chronic diseases: a systematic review

The integration of artificial intelligence (AI) and machine learning (ML) has shown potential for various applications in the medical field, particularly for diagnosing and managing chronic diseases among children and adolescents. This systematic review aims to comprehensively analyze and synthesize research on the use of AI for monitoring, guiding, and assisting pediatric patients with chronic diseases. Five major electronic databases were searched (Medline, Scopus, PsycINFO, ACM, Web of Science), along with manual searches of gray literature, personal archives, and reference lists of relevant papers. All original studies as well as conference abstracts and proceedings, focusing on AI applications for pediatric chronic disease care were included. Thirty-one studies met the inclusion criteria. We extracted AI method used, study design, population, intervention, and main results. Two researchers independently extracted data and resolved discrepancies through discussion. AI applications are diverse, encompassing, e.g., disease classification, outcome prediction, or decision support. AI generally performed well, though most models were tested on retrospective data. AI-based tools have shown promise in mental health analysis, e.g., by using speech sampling or social media data to predict therapy outcomes for various chronic conditions. Conclusions: While AI holds potential in pediatric chronic disease care, most reviewed studies are small-scale research projects. Prospective clinical implementations are needed to validate its effectiveness in real-world scenarios. Ethical considerations, cultural influences, and stakeholder attitudes should be integrated into future research.What is known:• Artificial Intelligence (AI) will play a more dominant role in medicine and healthcare in the future and many applications are already being developed.What is new:• Our review provides an overview on how AI-driven systems might be able to support children and adolescents with chronic illnesses. • While many applications are being researched, few have been tested on real-world, prospective, clinical data.

Information Needs of State-Level Asthma Programs: Recommendations to Increase Accessibility.

Asthma is the most common pediatric chronic disease, affecting about 5 million U.S. children. Controlling asthma requires intervention at the individual, household, and community levels. State asthma programs offer activities to support asthma control. We profiled U.S. state asthma programs through a website survey (24 CDC-funded, 10 non-CDC-funded) and then interviewed program managers about their information needs to identify ways to support their work. While CDC-funded and non-CDC-funded programs report similar goals and activities, their levels of engagement differed. Most programs rely on federal agencies or national associations for education materials. Concerns about materials were the lack of accessibility due to readability (reading level above sixth grade) and the lack of translations for culturally and linguistically diverse populations. In addition to priority needs around accessibility of materials, programs requested research to enhance their work and to support asthma management for young adults and incarcerated individuals.

Chronic Pediatric Lung Diseases: Point-High-Resolution CT Is Superior to All Other Available Imaging Modalities for Detection of Early, Subtle, or Management-Altering Findings.

Chronic Pediatric Lung Diseases: Point-High-Resolution CT Is Superior to All Other Available Imaging Modalities for Detection of Early, Subtle, or Management-Altering Findings.

Chronic Pediatric Lung Diseases: Counterpoint-A Growing Role for MRI.

Chronic Pediatric Lung Diseases: Counterpoint-A Growing Role for MRI.

Systematic review and meta-analysis of combined cognitive-behavioral therapy and physical activity and exercise interventions for pediatric chronic disease.

Cognitive-behavioral (CBT) interventions combined with either a physical activity (CBT+PA) or exercise intervention (CBT+Ex) are becoming more common in pediatric populations. Considering the independent effects of PA and exercise on health and psychological outcomes, it is unclear whether CBT alone differs from CBT+PA or CBT+Ex in efficacy. The main objective of this systematic review and meta-analysis of randomized clinical trials (RCTs) was to assess the efficacy of CBT+PA and CBT+Ex interventions in pediatric chronic disease. This review included RCTs in children (≤18 years) with a chronic condition, a CBT+Ex or CBT+PA intervention, and an objective measure of PA&Ex. Seven databases were searched using MeSH terms and key terms and included studies published before July 1, 2023. Abstracts were reviewed for inclusion by two independent reviewers, data was extracted by three independent reviewers. Risk of bias (RoB 2) and study quality were coded. Random effect meta-analyses of differences in between-group change in PA&Ex were conducted. Eligible studies (k = 5) reported outcomes for a combined 446 children. A small, nonsignificant overall effect was found (d = 0.10, 95% CI -0.16, 0.35) indicating intervention groups (CBT+PA or CBT+Ex) increased engagement in PA&Ex more than comparator groups (CBT). Additional analyses were inconclusive due to the small number of eligible studies. Additional RCTs are needed with integrated PA&Ex interventions targeting pediatric chronic disease. Future trials should report more detailed PA&Ex data. The full protocol for this analysis was prospectively registered in Open Science Framework (project ID: osf.io/m4wtc).

Klotho improves Der p1-induced bronchial epithelial cell damage by inhibiting endoplasmic reticulum stress to regulate mitochondrial function

Asthma is a prevalent chronic pediatric lung disease which is commonly perceived as a syndrome of airway inflammation characterized by cough and wheeze in clinic. Klotho is implicated in diverse cellular activities, including inflammation, oxidative stress and apoptosis. This paper aims to explore the of klotho in asthma and investigate the relevant molecular reaction mechanisms. To this end, we used Der p1 to induce an in vitro asthma model in BEAS-2B cells. Klotho expression was manipulated in Der p1-induced BEAS-2B cells with overexpression and its effects on Der p1-induced pathologies including apoptosis and inflammatory cytokine levels and the expressions of oxidative stress-related markers and major mediators in endoplasmic reticulum stress (ER stress) were investigated. Mitochondrial membrane potential (MMP) and mitochondrial permeability transition pore (mPTP) opening were also detected. Our data demonstrated that Der p1 stimulation decreased klotho expression and klotho overexpression inhibited the Der p1-induced inflammation, oxidative stress and apoptosis. Overexpressing klotho inhibited ER stress to modulate mitochondrial function. The inhibitory effects of klotho overexpression were reversed by ER stress agonist tunicamycin. This paper validated the role of klotho in asthma pathogenies and develop prospective therapeutic targets for asthma treatment.

The possible role of serum NGAL and MMP-9 in the assessment of kidney impairment and cardiovascular risk in children and adolescents with type 1 diabetes mellitus or obesity.

Type 1 diabetes mellitus (DM1) and obesity represent two chronic pediatric diseases characterized by increased risk for renal impairment and cardiovascular disease. The potential usefulness of neutrophil gelatinase-associated lipocalin (NGAL) and matrix metalloproteinase-9 (MMP-9), two novel biomarkers, for predicting early kidney injury or increased cardiovascular risk in children and adolescents with DM1 or obesity, was investigated in this cross-sectional study. Serum samples were obtained from children and adolescents aged 12.7 ± 3.8 years old with DM1 (n = 38) or obesity (n = 34) and normal renal function, as well as from healthy controls (n = 24). NGAL and MMP-9 concentrations were measured using commercially available sandwich ELISA kits (NGAL: DY1757-05, MMP-9: DMP900; R&D systems, Minneapolis, MN, USA). NGAL serum values were found significantly higher in patients with obesity but not in those with DM1. A positive correlation was found in patients with DM1 with diabetes duration, and in the total population with body mass index (BMI) z-score. Also, serum MMP-9 levels were significantly increased in patients with DM1 and in patients with obesity compared to controls. Circulating NGAL and MMP-9 levels may prove useful as surrogate biomarkers to creatinine, glomerular filtration rate (GFR), and albumin excretion rate for early detection of kidney injury and cardiovascular complications in children and adolescents with DM1 or obesity.

Role of Serum Autotaxin in Estimating Degree of Liver Fibrosis and Disease Severity in Pediatric and Adolescent Chronic Liver Diseases

Abstract Background Autotaxin (ATX) or ecto-nucleotide pyrophosphatase/ phosphodiesterase-2 is a secreted lysophospholipase D that hydrolyzes extracellular lysophospholipids into the lipid mediator lysophosphatidic acid, a ligand for specific G protein-coupled receptors. Lysophosphatidic acid stimulates the proliferation and contractility of hepatic stellate cells, a key player in liver fibrogenesis, and inhibits their apoptosis. Objective To determine serum ATX levels in pediatric and adolescent patients with chronic liver diseases of different etiologies and to compare it with the control group and to correlate between serum ATX level and disease severity, stage of fibrosis in liver biopsy in patients with chronic liver disease. Patients and Methods This was a cross sectional- case controlled study carried out in Ain Shams University pediatric Hospital, in the period between January 2023 and December 2023. To all patients and controls, serum sample was withdrawn to assess autotaxin level. For patients with chronic liver disease data was collected from hepatology clinic files including laboratory investigations and liver biopsy done within 1 year, to assess the degree of liver fibrosis and activity. Results Regarding serum autotaxin level, it was significantly higher in patients with chronic liver disease(868.8ng/dl) compared to control(30ng/dl, p = 0.000). Serum autotaxin level was higher in females (median 2582.5 ng/dl) than males (median 586) (p = 0.038). The study showed significant correlation in serum autotaxin level and etiology of chronic liver disease (p = 0.008). Also, there was a positive correlation with MELD score(r = 0.563) (p = 0.045), PELD score(r = 0.503) (p = 0.007) and severity of Child Pugh score (p = 0.000). Regarding Ishak fibrosis score there was a significant correlation with serum autotaxin level (r = 0.734) (p = 0.000), METAVIR fibrosis score (0.717) (p = 0.000). Roc analysis curve shows high sensitivity 100% and specificity of 100% of autotaxin to predict fibrosis in patients with chronic liver disease, the cut off value is 97.4ng/ml. Conclusion Developments of serum biomarkers have focused on the diagnosis of cirrhosis and the assessment of advanced fibrosis. Serum autotaxin as a biomarker for fibrosis in patients with chronic liver disease. Serum autotaxin level has shown a direct association with stage of fibrosis in patients with chronic liver disease. Also, serum autotaxin can be used to determine the severity of liver fibrosis and to evaluate the prognosis of liver cirrhosis.

Asthma and Participation: A Scoping Review.

Asthma is a widespread pediatric chronic disease, but there is limited understanding of its impact on participation (other than physical activity) and the conceptualization of participation. We conducted a scoping review to explore the evidence on the relationship between pediatric asthma and participation in several domains of occupation outlined in the Occupational Therapy Practice Framework 4th Edition. A structured literature search was implemented in PubMed/MEDLINE, Elsevier EMBASE, CINAHL, SCOPUS, Clarivate Web of Science Core Collection, and APA PsycINFO. Data were extracted by occupational domain and analyzed using a stoplight categorization. Of the 3444 identified articles, 10 met inclusion criteria, five of which were categorized as green (addressing specific occupational activities). No article explicitly defined participation. Asthma's influence on nonphysical activity occupations remains unclear. Future research must clarify both the meaning and measures that best capture participation, and further explore the relationship between asthma and participation.

Interferon γ Expressing Mucosal Cells in Pediatric Chronic Inflammatory Bowel Disease.

The pathogenesis of Crohn's disease (CD) and ulcerative colitis (UC) is multifactorial and includes aberrations in the composition of gastrointestinal mucosal inflammatory cells. Accurate identification of CD and UC is important as treatment and prognosis differs; however, CD and UC may be difficult to differentiate. Interferon γ (IFNγ) expression appears to be increased in ileal mucosa from CD patients, implying that IFNγ could be a diagnostically useful marker to differentiate CD from UC. This study uses automated assessment of IFNγ immunohistochemical expression in archival GI mucosal biopsies from stomach, duodenum, terminal ileum, and colon in a pediatric population to address this possibility. IFNγ positive mucosal cells are increased in the colon in both CD and UC compared to normal colon and in the ileum of CD compared to normal and UC. The abundance of IFNγ positive cells is not correlated with the presence of active inflammation, indicating that active inflammation is not responsible for the variance in abundance of IFNγ positive cells between cohorts and sites. Overlap between CD, UC, and normal suggests that IFNγ immunohistochemistry may only be clinically useful in select situations such as undetermined inflammatory bowel disease and additional study in these areas is warranted.

New noninvasive modalities in long-term pediatric ventilation: a scoping review.

Long-term noninvasive ventilation modalities for the pediatric population have undergone a continuous evolution. Hybrid noninvasive ventilation modalities have been recently introduced in clinical practice. Combining the advantages of conventional ventilation, hybrid modes use algorithms that automatically adjust the ventilator's settings to achieve a predefined ventilation target. Most of the recommendations on the use and settings of hybrid noninvasive ventilation modalities in children are derived from adult experience. Therefore, there is a lack of evidence on its implementation in pediatric chronic respiratory diseases. This scoping review aims to map the existing information regarding the use of hybrid ventilation modalities in the pediatric population and identify knowledge or research gaps. We performed a literature search using MEDLINE and Pubmed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We included 13 studies (ten studies on average volume-assured pressure-support ventilation; two studies on intelligent volume-assured pressure-support ventilation; and one study on adaptive servoventilation). The use of new noninvasive ventilation modes in the pediatric population has been applied for the treatment of neuromuscular and hypoventilation syndromes as an alternative therapeutic option in the case of the failure of conventional noninvasive ventilation. Their widespread use has been hampered by the limited evidence available. Longitudinal studies on a larger number of patients are needed to confirm their effectiveness and evaluate their long-term clinical and functional outcomes.

Systematic review and meta analysis of psychological interventions to prevent or treat pediatric chronic disease in rural communities.

The purpose of this systematic review and meta-analysis was to examine the effectiveness of psychological interventions at improving physical or mental health outcomes for youth living in rural communities who have, or are at-risk for, any chronic medical condition in comparison to control interventions conducted in rural communities. Following prospective registration (OSF.IO/7TDQJ), 7 databases were searched through July 1, 2023. Studies were included if they were a randomized control trial of a psychological intervention conducted with youth living in a rural area who had, or were at-risk for, a chronic medical condition. Risk of bias was assessed with the Cochrane risk of bias version 2 tool. A qualitative synthesis and meta-analysis were conducted. 15 studies met inclusion criteria. Obesity studies (n = 13) primarily focused on body mass index metrics, with limited significant findings across studies. Asthma treatment interventions (n = 2) showed no impact on hospitalizations. 3 studies evaluated mental health outcomes with no significant group differences observed. We meta-analytically analyzed 9 studies that evaluated body mass index z-scores and identified an overall null effect (Hedge's g = 0.01, 95% CI [-0.07, 0.09], p = .85). Most included studies focused on pediatric obesity, and there was a limited range of health outcomes reported. Compared to controls, minimal significant improvements in health outcomes were identified for psychological interventions for youth living in rural communities. Future efforts may benefit from situating this work more systematically within a health disparities framework with a focus on understanding mechanisms of disparities and translating this work into interventions and policy changes.

Endoscopic Powered Intracapsular Tonsillectomy and Adenoidectomy in Pediatric Obstructive Sleep Apnea With High-Risk Comorbid Disease Conditions: A Case Series.

Pediatric obstructive sleep apnea (OSA) caused by adenoids or an enlarged palatine tonsil has a negative impact on physical and mental growth. Surgical removal of the tissue is effective but entails a life-threatening risk of postoperative bleeding, which is up to 30 times higher in chronic pediatric disease cases. However, endoscopes and resection devices provide safe, reliable surgical methods. Here, we report the efficacy and safety of endoscopic powered intracapsular tonsillectomy and adenoidectomy (PITA) for pediatric OSA in patients with high-risk comorbidities. This retrospective case series included pediatric patients with OSA who underwent PITA at a single tertiary medical center between April 2017 and May 2023. Ten patients (three males and seven females; mean age 6.4 years, range 2-12 years) were included; all met the Japanese criteria for complex chronic pediatric conditions. The average operative time was 61 min; a microdebrider was used in eight cases and a coblator in two cases. Although there was no postoperative bleeding, one case experienced regrowth. Our data show that an endoscopic PITA approach could reduce the risk of severe bleeding and relieve the sleeping conditions of pediatric patients with complex chronic OSA.

Bronchiolite obliterante post-infettiva (PIBO), chi è costei?

The paper presents the case of a 14-month-old child with a persistent respiratory distress with wheezing and diffuse crackles on chest auscultation. Symptoms appeared after a viral pneumonia caused by Adenovirus. The recent history, the clinical manifestations and the lung CT (Computed Tomography) scans, which showed a diffuse mosaic pattern, with air trapping, bronchiectasis and peribronchial inflammation, led to the diagnosis of Post-infectious Bronchiolitis Obliterans (PIBO). PIBO is a rare chronic paediatric pulmonary disease characterized by irreversible fibrotic narrowing of the small airways. It can present with a broad severity spectrum, and the evolution of this condition is not predictable in the single patient. Adenovirus is by far the most common cause of this lung pathology, and during the post Covid-19 pandemic an unprecedented rise in PIBO cases triggered by Adenovirus lower respiratory infections was observed. The treatment of PIBO is empirical, and a defined protocol does not exist yet. Therapeutic approaches range from nil to methylprednisolone pulse therapy, which would seem effective especially if performed early and if peribronchitis is found on imaging. Some studies evaluated the administration of intravenous immunoglobulins, while in more advanced cases showing fibrotic transformation of the parenchyma, the use of antifibrotic drugs (hydroxychloroquine, nintedanib) may be tried

#2307 Serum NGAL, MMP-9 and suPAR in the assessment of kidney impairment and cardiovascular risk in children and adolescents with type 1 diabetes or obesity

Abstract Background and Aims Type 1 diabetes mellitus (DM1) and obesity represent two chronic paediatric diseases with worryingly rising incidence, characterized by chronic inflammation, endothelial dysfunction and increased risk for kidney impairment and cardiovascular disease. The aim of this cross-sectional study was to explore the potential usefulness of serum Neutrophil Gelatinase-Associated Lipocalin (NGAL), Matrix Metalloproteinase-9 (MMP-9) and Soluble Urokinase Plasminogen Activator Receptor (suPAR) for predicting early kidney injury or increased cardiovascular risk in children and adolescents with DM1 or obesity. Method Serum samples were obtained from children and adolescents aged &amp;lt;18 years old with DM1 (n=35) or obesity (n=38) and normal renal function with no history of albuminuria, as well as from healthy controls (n=23). Serum NGAL, MMP-9 and suPAR concentrations were measured using commercially available sandwich ELISA kits (NGAL: (DY1757-05), MMP-9: (DMP900); suPAR: (DUP00); R&amp;D systems). All patients were evaluated for anthropometric indices (weight, height, BMI) while for different degrees of weight status we used the body mass index (BMI) z-score adjusted for age and sex. Estimated glomerular filtration rate (eGFR) was calculated according to the revised bedside Schwartz formula. Results Serum NGAL values were found significantly higher in patients with obesity but not in those with DM1. A positive correlation was found in patients with T1DM with diabetes duration (Spearman rho 0.364, p=0.044), and in all study participants with BMI z-score (Spearman rho 0.401, p=0.004). Furthermore, serum MMP-9 levels were significantly increased in patients with T1DM and in patients with obesity compared to controls. Mean serum suPAR levels were significantly higher in patients with obesity compared to patients with T1DM and controls, while children with T1DM had similar suPAR levels to controls (Table 1). Finally, serum suPAR levels showed a negative correlation with age (Spearman rho −0.359, p&amp;lt;0.001) and creatinine levels (Spearman rho −0.334, p=0.005), and a positive correlation with BMI z-score (Spearman rho 0.354, p=0.009). Conclusion Circulating NGAL, MMP-9 levels may prove useful as surrogate biomarkers to creatinine, GFR and albumin excretion rate for early detection of kidney injury, inflammation or endothelial dysfunction and cardiovascular complications in children and adolescents with T1DM or obesity. Children with obesity may have impaired inflammation status, kidney and endothelial function to a higher degree compared to children with T1DM, which may suggest that obesity may impose a greater health burden than T1DM, at least during childhood or the first years after T1DM diagnosis.