FAMILIAL AND PERINATAL RISK-FACTORS FOR MICROALBUMINURIA AND MACROALBUMINURIA IN YOUNG IDDM PATIENTS

It has been suggested that hereditary risk for hypertension and cardio vascular disease (CVD) as well as intrauterine growth may be involved in the pathogenesis of diabetic nephropathy. In the present study, we investigated the influence of familial and perinatal risk factors on t he occurrence of micro- and macroalbuminuria in young IDDM patients. A cohort of 1,150 young patients with greater than or equal to 5 years' duration of IDDM was screened for microalbuminuria. Data on family hi story of hypertension, CVD, IDDM, and NIDDM; perinatal factors such as birth weight, gestational age, and duration of breastfeeding; and mat ernal education, smoking, hypertension, and proteinuria during pregnan cy were collected. We identified 75 patients with an albumin excretion rate greater than or equal to 15 mu g/min in more than two overnight urinary samples and compared them in a nested case-control study with three normoalbuminuric control subjects per patient from the same coho rt, matched for diabetes duration. Perinatal factors were analyzed in all patients born at term (+/- 2 weeks), 59 of the 75 patients and 155 of the 225 control subjects. In univariate analysis, hypertension in parents (odds ratio [OR] 4.21), CVD in parents and grandparents (OR 1. 26), maternal smoking during pregnancy (OR 3.21), and a low level of m aternal education (OR 2.33) were significantly associated with the dev elopment of micro- and macroalbuminuria. When adjusted for other famil ial and perinatal factors, current mean blood pressure, HbA(1c), smoki ng, BMI, sex, age, and postpubertal diabetes duration, using logistic regression analyses, only parental hypertension in all patients and ma ternal smoking during pregnancy and low level of maternal education in full-term patients were independent risk factors. When patients with poor glycemic control mere analyzed separately, familial CVD, poor met abolic control, parental hypertension, maternal smoking during pregnan cy, and level of maternal education were independent risk factors, wit h the adjusted OR markedly increased, compared with the matched subgro up with better HbA(1c). In conclusion, familial hypertension and CVD, maternal smoking during pregnancy, and low level of maternal education may independently increase the risk for incipient nephropathy in full -term offspring who later develop IDDM. Current poor glycemic control seemed to increase the effect of these risk factors.