ESPE Abstracts

Aim: The work was initiated to assess functional condition of the kidneys and to study interrelation between ACE gene I/D polymorphism and stage of chronic kidney disease in children and adolescents with type 1 diabetes mellitus (DM) in compliance with K/DOQI recommendations (2002).

Materials and methods: We examined 120 children and adolescents with type 1 DM, 53 (44.2%) males and 67 (55.8%) females among them (mean age 13.8±0.24 years; 95% CI: 13.3–14.3). Glomerular filtration rate (GFR) was used to classify stages of chronic kidney disease in compliance with K/DOQI recommendations. DNA was isolated by Higuchi H.Erlich method (1989) with dry kit of Diatom DNAPrep 200. 49 (40.8%), 28 (23.4%) and 43 (35.8%) examinees with type 1 DM were carriers of II, I/D and DD genotype respectively.

Results: Renal disorder with normal and high GFR (I stage) was found in 69 (57.5%) children and adolescents with type 1 DM, mean GFR being 168.9±7.03/min/1.73 m² (95% CI: 155.1–18.7). Insignificant GFR reduction (CKD II stage) was found in 21 (17.5%) examinees, mean GFR being 77.8±2.05 ml/min/1.73 m² (95% CI: 73.8–81/9). Moderate GFR reduction (III stage) was registered in 12 (10.0%) patients, mean value being 39.3±2.05 ml/min/1.73 m² (95% CI: 35.3–43.3). CKD IV stage was observed in 18 (15.0%) examinees, mean GFR being 23.9±0.90 ml/min/1.73 m² (95% CI: 22.1–25.6). No CKD V stage was registered in the group examined. II genotype was found prevalent in the examinees with CKD I stage (n=46, 66.7%), ID genotype being found in 23 (33.3%) and no DD genotype being found. With progression of CKD stage frequency of persons with II genotype was found decreasing, DD genotype cases being increased. ID genotype was found at III and IV stages CKD (n=4, 19%) and n=1, 8.3% respectively). No cases of II genotype was found at III and IV stages CKD, while DD genotype 1ncidence was very high (n=11, 91.7% and n=18, 100% respectively. DD genotype correlated with CKD severity (r=0.66; P<0.05) and presence of diabetic nephropathy (DN) (r=0.32; P<0.05).

Conclusions: In compliance with (K/DOQI 2002) recommendations in most children and adolescents with type 1 DM (75.0%) CKD I and II stages were classified. With CKD progression upon DN in children and adolescents with type 1 DM DD genotype incidence was found increased, II genotype occurring more frequently with DN absent. The latter seems to be a protector from CKD progression, while DD genotype confers high risk of renal pathology in type 1 DM in children.