Acute kidney injury and renal tubular damage in children with type 1 diabetes mellitus onset.

Acute kidney injury(AKI) and renal tubular damage(RTD), especially if complicated by acute tubular necrosis (ATN), could increase the risk of later chronic kidney disease. No prospective studies on AKI and RTD in children with type1diabetes mellitus(T1DM) onset are evaluate the AKI and RTD prevalence, and their rate and timing of recovery in children with T1DM onset.prospective study.Settings and patients: 185children were followed up after 14days from T1DM onset. The patients who did not recover from AKI/RTD were followed-up 30 and 60days later.AKI was defined according to the KDIGO criteria. RTD was defined by abnormal urinary beta-2-microglobulin and/or neutrophil gelatinase-associated lipocalin and/or tubular reabsorption of phosphate<85% and/or fractional excretion of Na(FENa)>2%. ATN was defined by RTD+AKI, prerenal-(P-)AKI by AKI+FENa<1% while acute tubular damage(ATD) by RTD without AKI.Prevalence of diabetic ketoacidosis(DKA) and AKI were 51.4% and 43.8% respectively. Prevalence of AKI in T1DM patients with and without DKA was 65.2% and 21.1%. 33.3% reached AKI stage2 and 66.7% of patients reached AKI stage1. RTD was evident in 136/185(73.5%) patients (32.4% showed ATN; 11.4% P-AKI; 29.7% ATD). All patients with DKA or AKI presented with RTD.The physiological and biochemical parameters of AKI and RTD were normal again in all patients. The former within 14days and the latter within 2months, respectively.Most patients with T1DM onset may develop AKI and/or RTD, especially if presenting with DKA. Over time the physiological and biochemical parameters of AKI/RTD normalize in all patients.

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Authors: Pierluigi Marzuillo, Dario Iafusco, Angela Zanfardino, Stefano Guarino, Alessia Piscopo, Francesca Casaburo, Daniela Capalbo, Maria Ventre, Maria Rosaria Arienzo, Grazia Cirillo, Carla De Luca Picione, Tiziana Esposito, Paolo Montaldo, Anna Di Sessa, Emanuele Miraglia Del Giudice