Background: There are international guidelines on screening for Microalbuminuria (MA) in children with Type1 Diabetes Mellitus (T1DM). But the National Paediatric Diabetic Audit, UK suggests that screening is missed in over 50% of cases. Further, there is little data on the management and natural course of MA in children by frontline units.
Objective and hypotheses: To describe the prevalence, management and natural course of MA in children and adolescents with T1DM.
Method: All patients with T1DM noted to have MA between April 2013 and April 2015 were included in the study. Data on demographic factors and laboratory results at onset of MA and during the study period was collected retrospectively from electronic records and databases. MA was diagnosed by ACR >3 mg/mol on a random urine sample.
Results: 18 out of 185(9.3%) children with T1DM were noted to have MA during the study period. Median age of presentation with MA was13.6 years (5.018.0). Mean duration from diagnosis of TIDM to MA was 5.9years (0.815.6) with nine patients (50%) presenting within 5 years.39% of the patients presented with MA under the age of 12 years. Mean duration of follow up of MA was 3.6 years. ACR normalised in 9 (50%) at a mean follow up of 4.3 years, was intermittent in 3 (16.7%) and persisted in 5 (27.8%). Frequency of retesting varied between 4 months to 3 years. The mean HbA1C was 81 mmol/mol (32.2171), but one third achieved an HbA1C <58.5 mmol/mol. No one developed macroalbuminuria, or required treatment. The one child referred to the nephrologist was diagnosed to have orthostatic proteinuria.
Conclusion: A significant proportion of patients presented with MA outside recommended screening criteria (>12 years and >5 years duration). A significant proportion also had good glycaemic control. MA either resolved or was non-progressive in the vast majority of patients.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology