PERSISTENT MICROALBUMINURIA IN ADOLESCENTS WITH TYPE-I (INSULIN-DEPENDENT) DIABETES-MELLITUS IS ASSOCIATED TO EARLY RATHER THAN LATE PUBERTY - RESULTS OF A PROSPECTIVE LONGITUDINAL-STUDY

Microalbuminuria is generally accepted to be highly predictive of over t diabetic nephropathy which is the leading cause of endstage renal fa ilure and, consequently, of death in patients with type 1 (insulin-dep endent) diabetes mellitus (IDDM). Its early identification and therapy are exceedingly important. We studied prospectively the occurrence of microalbuminuria (MA) in relation to puberty and its pubertal stages in 164 children and adolescent patients (83 girls and 81 boys) with ID DM. Analysing 100 healthy subjects, normal values for albumin excretio n (range: 0-10.1 mu g/min/1.73 m(2)) according to sex and the differen t pubertal stages were defined. No significant difference between the groups were noted and, therefore, 20 mu g/min per 1.73 m(2) (3 SD abov e the mean) was generally defined as cutoff for MA. Of the patients wi th IDDM studied, 20% (20 females and 12 males) developed persistent MA (22.1-448.2 mu g/min/1.73 m(2)) during the study period of 8 years. T he first manifestation of persistent MA was in 69% (13 females and 9 m ales) during stages of early and midpuberty; and in 28% (6 females and 3 males) at a late pubertal stage or at the end of puberty. The only child who developed MA before the onset of puberty (range: 23.5-157.4 mu g/min/1.73 m(2)) was found to have dystopic kidney. Therefore, all patients with IDDM should be screened for MA regardless of diabetes du ration, sex and level of diabetes control beginning at the very first stage of puberty and neither earlier nor after puberty as suggested by the American Diabetes Association.