Retrospective evaluation of the frequency of nephropathy in children with type 1 diabetes mellitus

Introduction and Aim: In this study, it was aimed to determine the frequency of nephropathy in pediatric and adolescent patients followed up with T1DM. Material and Method In this study, 131 children and adolescents who were diagnosed with T1DM in the DUTF Pediatric Endocrinology Polyclinic between January 01, 2017 and December 01, 2022 and who were included in the study were examined retrospectively.. Results: A total of 131 cases were included in the study, with 66 being female (50.4%) and 65 being male (49.6%). The cases with microalbuminuria were classified as Group 1 (69 cases, 52.7%), while the cases without microalbuminuria were classified as Group 2 (62 cases, 47.3%). The mean age of diagnosis was calculated as 8.62±2.32 years for Group 1 and 9.35±3.75 years for Group 2, and no significant difference was observed between the two groups (p=0.71). The mean follow-up duration was 5.94±1.86 years for Group 1 and 4.93±2.72 years for Group 2, with a statistically significant difference (p<0.001). The mean HbA1c levels for Group 1 and Group 2 were 10.62±1.77 and 10.11±1.43, respectively, with no statistically significant difference (p=0.073). The mean total cholesterol levels were 169.64±35.90 mg/dl for Group 1 and 174.05±47.22 mg/dl for Group 2, the median triglyceride levels were 90 (62.30-112) mg/dl for Group 1 and 90.5 (66.75-154.25) mg/dl for Group 2, the median HDL values were 62.20 (49.10-64) mg/dl for Group 1 and 50.05 (44.50-66.07) mg/dl for Group 2, and the mean LDL levels were 94.12±28.95 mg/dl for Group 1 and 98.22±28.37 mg/dl for Group 2, with no statistically significant difference between the two groups (p>0.05). The mean systolic blood pressure was 113.40±17.43 mmHg for Group 1 and 102.68±11.53 mmHg for Group 2, with Group 1 showing a statistically significant higher value compared to Group 2 (p=0.025). The mean diastolic blood pressure for Group 1 and Group 2 was 67.86±9.17 mmHg and 66.75±8.88 mmHg, respectively, with no significant difference between the two groups (p=0.66). The median total protein in 24-hour urine was 140 (96-205) mg/day for Group 1 and 21 (14.75-26.55) mg/day for Group 2. Group 1 had a significantly higher value (p=<0.001). There was no significant relationship between the presence of proteinuria and gender, puberty, coeliac disease, and Hashimoto's disease in the included cases (p>0.05). Pearson correlation analysis between proteinuria and age of diagnosis, mean HbA1c level, total cholesterol level, triglyceride level, HDL level, LDL level, GFR, spot urine albumin/creatinine ratio, and diastolic blood pressure did not reveal any statistically significant differences (p<0.05). It was observed that proteinuria showed a negative correlation with T1DM follow-up duration (r= -0.351, p=<0.001) and a positive correlation with systolic blood pressure (r=-0.268, p=0.025). Conclusion: In conclusion, diabetes has been increasing in recent years and has become a significant problem in childhood. If not properly monitored and treated, it can lead to life-threatening and quality of life-reducing complications, particularly diabetic nephropathy (DN), in later years. Our study has shown that the frequency of DN increases with longer duration of diabetes and higher systolic blood pressure. Although there was no significant difference in average HbA1C levels between the group with proteinuria and the group without proteinuria, it was higher in the proteinuric patient group. Therefore, achieving good glycemic control and regularly monitoring blood pressure and proteinuria are of great importance in preventing chronic complications of diabetes, especially DN. When necessary precautions are taken and regular screenings are conducted, end-stage renal failure caused by DN can be prevented. Keywords: Microalbuminuria, Diabetic Nephropathy, Diabetes Mellitus