Increased vascular endothelial growth factor serum concentrations may helpto identify patients with onset of type 1 diabetes during childhood at risk for developing persistent microalbuminuria

This study was designed to evaluate whether vascular endothelial growth fac tor serum concentrations may identify adolescents with onset of type I diab etes during childhood at greater risk to develop persistent microalbuminuri a and incipient diabetic nephropathy. In January 1989, vascular endothelial growth factor serum levels were measured in 101 normoalbuminuric diabetic children and adolescents (aged 7-14.9 yr; onset of diabetes before age IS y r; duration of diabetes >7 yr). Participants were clinically examined at ba seline and annually thereafter. Vascular endothelial growth factor serum co ncentrations were measured every year during the 8-yr follow-up period. Ove r 8 yr, 11 of 101 patients (10.9%) developed persistent microalbuminuria; n o patient developed overt nephropathy. The risk of developing microalbuminu ria was higher in children with increased vascular endothelial growth facto r serum levels (using 160 pg/ml as the arbitrary cut-off point; group 1) co mpared with those with normal vascular endothelial growth factor serum leve ls at the beginning of the study (group 2; 19.2 vs. 2.0%; P < 0.01; sensiti vity, 90.9%; specificity, 53.3%). The odds ratio for the occurrence of micr oalbuminuria after adjustment for confounding variables (albumin excretion rate, sex, hemoglobin A(1c), mean blood pressure, cholesterol, and triglyce rides) in type 1 diabetic adolescents with elevated vascular endothelial gr owth factor serum levels was 4.1 (95% confidence interval, 2.0-10.9). These results suggest that vascular endothelial growth factor serum concent rations may be one of the predictors and risk factors for microalbuminuria and incipient diabetic nephropathy in adolescents and young adults with ons et of diabetes during childhood. Persistently increased vascular endothelia l growth factor serum levels may help to identify normotensive, normoalbumi nuric patients with type 1 diabetes who are predisposed to develop persiste nt microalbuminuria later in life.