الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
e in the incidence and
prevalence of diabetes ,World Health Organization (WHO) projecting that
there will be up to 285 million cases in the year 2025. Although this
increase is expected in type 2 diabetes ,a parallel increase in childhood
diabetes , including type 1& 2 diabetes , has been reported .
Diabetes mellitus is a chronic disease associated with serious long
term complications including macro vascular disease , retinopathy ,neuropathy
and nephropathy .
Diabetic nephropathy results from ongoing injury to the
microvasculature of the kidney from decades of disease, so the incidence is
uncommon in childhood. Poor glyceamic control is associated with worse vascular
injury, but the mechanism is still uncertain. Diabetic nephropathy is progressive
and will eventually lead to ESRD and the need for chronic dialysis or renal
transplant without intervention. The earliest marker of diabetic renal injury is
microalbuminuria, 30 to 300 mg/d.
Microalbuminuria has been identified in as many as 5% to10% of
adolescents with type 1 diabetes for 10 years, so annual screening of
microalbuminuria is now recommended by the American Diabetes Association for
children 10 years or older and with diabetes for 5 years or more.
Early identification of microalbuminuria allows early treatment with ACE
inhibitors, which has been shown to reverse microalbuminuria and retard the
progression of diabetic nephropathy. Blood pressure should also be screened
yearly, and if high, treated to maintain pressure at less than the 90th percentile for
age and height to prevent further renal injury.
This study is a cross sectional study that had been conducted in children with
type 1 DM who attended to Ismailia Health Insurance Hospital and Ismailia
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General Hospital , duration of diabetes <3 years and with exclusion of syndromes
associated with diabetes , patients receiving corticosteroids and other causes of
albuminuria & protienuria.
Our study aimed to detect microalbuminuria as an early sign of diabetic
nephropathy and finding the relation between metabolic control and development
of diabetic nephropathy.
The present study included 60 type 1 diabetic patients (31 females and 29
males) were evaluated. All of them were subjected to history taking, clinical
examination, and laboratory screening tests.
The mean age of the studied patients was 13.3 ± 2.59 years ranging
between 6 – 18 years and mean duration of diabetes 5.8 ± 3.13 years ranging
between 3- 14 year.
In our study, we found four patients (6.6%) had microalbuminuria; three of
them had hypertension (75%).
We found that poor glycaemic control is associated with the
development of diabetic nephropathy as all our patients with +ve MAU had poor
glycaemic control, indicated by the mean annual HbA1c concentrations.
Incidence of microalbuminuria increases with long duration of diabetes and
most cases occur after puberty (3 cases > 14 years).
There is highly significant correlation between both poor glycaemic control &
high blood pressure and development of micro-albuminuria.
There is also positive significant correlation between duration of diabetes,
BMI and development of micro-albuminuria while there is no significant
correlation between neither age nor gender and development of micro-albuminuria
in our study.
On the other hand, there is a highly significant negative relation between
regimen of insulin and albumin/ creatinine ratio which indicates that intensive
regimen is more efficient to control blood glucose level leading to good glycaemic
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control which appears to be an important factor in preventing diabetic