ESPE Abstracts

Background: Biomarkers other than microalbuminuria are needed to detect early kidney injury in adolescents with type 1 diabetes.

Objective and hypotheses: We aimed to determine diabetic nephropathy in normoalbuminuric and normotensive diabetic adolescents with biomarkers related different segments of the glomeruli (podocalyxin, nephrin and liver type fatty acid binding protein (L-FABP)), and to assess the relationship among these biomarkers and glomerular filtration rate (GFR).

Method: 109 diabetic adolescents and 30 healthy controls were enrolled in the study. Diabetics were divided into subgroups according to long-term mean HbA1c levels, diabetes duration as 1–5 years, 5–10 years and ≧10 years, allowing further assessment of association of biomarkers with study variables.

Results: Urinary podocalyxin, nephrin, L-FABP levels and GFR were higher in subjects with diabetes compared with nondiabetics. Urinary podocalyxin was found to be correlated with diabetes duration (r=0.752, P<0.001). Urinary nephrin and L-FABP levels were found to be correlated with HbA1c levels (r=0.45, P=<0.001 vs r=0.69, P=<0.001). Urinary nephrin, podocalyxin and L-FABP levels were found higher in normoalbuminuric diabetic patients with than healthy subjects and in diabetics with microalbuminuria than normoalbuminuric diabetics (P values, respectively 0.002, <0.001 vs <0.001).

Conclusion: The present study demonstrates that elevated urinary podocalyxin, nephrin and L-FABP excretion may determine early kidney injury before microalbuminuria occurs. Besides, these biochemical markers may be useful for staging kidney injury, predicting kidney injury progression. Closer monitoring of diabetic patients with elevated urinary podocalyxin, nephrin, L-FABP levels and protective measures may prevent chronic kidney disease development.