scholarly journals Diabetic nephropathy in type 1 diabetes and pregnancy. Modern view of the problem

2020 ◽  
Vol 23 (4) ◽  
pp. 340-348
Author(s):  
Ekaterina S. Shilova ◽  
Natalya V. Borovik ◽  
Maria I. Yarmolinskaya
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Nephropathy ◽  
Pregnancy Outcomes ◽  
Neonatal Morbidity ◽  
High Rate ◽  
Team Care ◽  
Patients With Diabetes ◽  
Blood Pressure Goals

Diabetic nephropathy (DN) is specific kidney damage in patients with diabetes mellitus. DN develops relatively often in pregestational diabetes patients (5,9-26%) and stills one of the main limitations for successful pregnancy in this patients’ group. Advanced DN increases risks of poor pregnancy outcomes for women and fetuses including chronic kidney disease (CKD) progression, high rate of preeclampsia, preterm deliveries, Cesarean sections, perinatal mortality and neonatal morbidity. At the same time there are more and more successful pregnancies with advanced DN in the wold.In our paper we systematize global experience of planning and management pregnancies with type 1 diabetes and DN in different stages of renal impairment. We discuss role of nephroprotective therapy in preconception care, achievement and maintaining blood pressure goals, multidisciplinary team care for improvement pregnancy outcomes in type 1 diabetic women with DN.

Role of magnetic resonance diffusion weighted imaging in diagnosis of diabetic nephropathy in children living with type 1 diabetes mellitus

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Eman Nabil Wahba ◽  
Ashraf Elsharkawy ◽  
Mohammad Hosny Awad ◽  
Ashraf Abdel Rahman ◽  
Amr Sarhan
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Nephropathy ◽  
Glomerular Filtration Rate ◽  
Magnetic Resonance ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Apparent Diffusion

Abstract Objectives Diabetic nephropathy is a serious and a common complication of diabetes that can lead to end stage renal disease among children living with type 1 diabetes, thus an early and accurate method of diagnosis that allows timely intervention is of high importance. This study aimed to evaluate the role of magnetic resonance diffusion weighted imaging in diagnosis of diabetic nephropathy in children with type 1 diabetes. Methods This prospective, observational, case control study included 30 children with type 1 diabetes and 30 matched healthy controls attending the outpatient clinics in Mansoura University Children’s Hospital. All were subjected to magnetic resonance DWI of the renal parenchyma and their glomerular filtration rate (GFR) was estimated, along with micro albumin in 24 h urine collection and HbA1c in patients with diabetes. Results Children with diabetes who were positive for microalbuminuria had significantly lower apparent diffusion coefficient value compared to Children with diabetes who were negative for microalbuminuria (p = 0.034) as well as controls (p = 0.001). Among children with type 1 diabetes, apparent diffusion coefficient had significant positive correlation with estimated glomerular filtration rate (r = 0.491, p = 0.006) and negative correlation with microalbuminuria (r = −0.437, p = 0.016). Conclusion Magnetic resonance DWI of the renal parenchyma is correlated with estimated glomerular filtration rate (eGFR) in children with type 1 diabetes and can detect GFR deterioration even in presence of normal albumin excretion.

scholarly journals Elevated urinary excretion of immunoglobulins in nonproteinuric patients with type 1 diabetes

2012 ◽  
Vol 303 (1) ◽  
pp. F157-F162 ◽  
Author(s):  
Tomohito Gohda ◽  
William H. Walker ◽  
Pawel Wolkow ◽  
Jung Eun Lee ◽  
James H. Warram ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Nephropathy ◽  
Healthy Subjects ◽  
Fractional Excretion ◽  
Study Groups ◽  
The Past ◽  
Urine Matrix ◽  
Early Diabetic Nephropathy

Increased albuminuria is a hallmark of early diabetic nephropathy, whereas the role of immunoglobulins (Igs), such as IgG (its 1–4 subtypes), IgA, and IgM, different in charge and size, has not been examined in early nephropathy in the past due to lack of a sensitive and reliable method. Our study group consisted of subjects with type 1 diabetes (T1D) and normoalbuminuria ( n = 78), microalbuminuria ( n = 78), and of 75 healthy subjects (HS). A Luminex-based immunoassay (1,000 time more sensitive than nephelometry-based method) was validated for the urine matrix and used for the measurements of IgG1–4, IgA, and IgM in our study groups. The Luminex-based assay detected Igs in 87% of HS subjects and in 100% of T1D subjects. Recovery of known amounts of Igs added to urine was 92–118%. In the normoalbuminuria group, urinary concentrations of albumin, IgG2, IgA, and IgM were significantly higher than in HS, whereas in the microalbuminuria, further elevation of IgG2, IgG4, and IgA was the most pronounced. In all three groups, fractional excretion of Igs was at least 100 times lower than that of albumin. Fractional excretion of IgG2 was the highest among all Igs. We validated a sensitive method for measuring Igs in urine using Luminex. We found that elevated concentrations of Igs, particularly in IgG2 and IgA, is present in subjects with T1D and no proteinuria. Elevation of those particular Ig subtypes suggests a contribution of novel mechanisms in early diabetic nephropathy, different from charge and size barrier impairment.

ROLE OF PROINFLAMMATORY CYTOKINES IN PATHOGENESIS OF ARTHROPATHIES IN PATIENTS WITH DIABETES MELLITUS

2020 ◽  
Vol 73 (11) ◽  
pp. 2476-2481
Author(s):  
Valeriya L. Orlenko ◽  
Maria H. Kravchuk
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Proinflammatory Cytokines ◽  
Joint Damage ◽  
Tnf Α ◽  
Patients With Diabetes

The aim: Of our work was to study the level of proinflammatory cytokines in patients with diabetic arthropathy and to investigate their possible effect on the development of this complication. Materials and methods: 118 patients were examined, which were divided into groups by type of diabetes, the presence and severity of diabetic arthropathy. The content of IL-1, TNF-α, IL-6 and receptors to S IL-6-R in serum was determined by immunoassay. Results: In patients with diabetic arthropathy, levels of TNF-α (with type 1 diabetes 44.5%, type 2 diabetes 42.9%) and IL-6 (with type 1 diabetes 52.1%, with diabetes 2 types by 64.4%) significantly increased. There is a direct correlation between the severity of joint damage and the level of TNF-α and IL-6. For IL -1, receptors for S IL-6-R have not been detected. Conclusions: The chances of detecting arthropathy with type 1 diabetes with increasing TNF levels increase by 1.7 times, with an increase in IL-6 by 1.5 times. For type 2 diabetes, it is 1.8 and 1.3 times, respectively. Thus, TNF-α and IL-6 may be markers of the presence and progression of arthropathy in patients with diabetes mellitus

scholarly journals Kidneys cytomembranes stability in pregnant women with type 1 diabetes and pregnancy outcomes depending on the method of insulin delivery

2012 ◽  
Vol 15 (4) ◽  
pp. 69-73
Author(s):  
Zulfiya Raisovna Alimetova ◽  
Farida Vadutovna Valeeva
Keyword(s):  
Type 1 Diabetes ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Insulin Pump ◽  
Control Group ◽  
Albumin Excretion ◽  
Patients With Diabetes ◽  
The Status ◽  
Daily Urine

Objective. To evaluate of kidney cytomembranes stability during pregnancy and its outcomes in patients with diabetes mellitus type on type 1 with different stages of diabetic nephropathy (DN) according to the route of insulin administration. Materials and Methods. We study 100 pregnant women with type 1 diabetes with the introduction of insulin in the mode of multiple subcutaneous injections (MSII) and with portable dispenser with a continuous subcutaneous insulin infusion (CSII). DN stage determined by the level of albumin in the daily urine. Cytomembranes stability assessment conducted on daily excretion of ethanolamine and phospholipids with urine in each trimester. Pregnancy outcomes were analyzed in 52 patients with type 1 diabetes. In the group of pregnant women with delivery at term 38-40 weeks we also analyzed the status of newborns. Results. Indicators of cytomembranes stability of kidneys in pregnant women on CSII consistent with those in healthy pregnant women (p>0.05) the whole pregnancy, regardless of the level of daily urinary albumin excretion. There were no differences in cytomembrana stability of kidneys between the group of patients on MSII with normal albumin excretion (NAU) and the control group regardless to the gestational age (p>0.05). With the introduction of insulin in the mode of MSII on the stage of microalbuminuria (MAU) in the 3rd trimester we found the increase of ethanolamine excretion as compared to control groupy (U=8,00, p=0.012) and the group on CSII with a similar stage of nephropathy (U=2.00, p=0.033). In patients with proteinuria (PU) in the group on the MSII in the third trimester phospholipids excretion is increased with a daily urine (U=27,5, p=0.03 and U=22,00, p=0.07 for patients MSII and CSII, respectively). The use of an insulin pump allowed to prolong gestational period, even in severe proteinuric stage of nephropathy. Manifestations of diabetic fetopathy as macrosomia, hypoglycemia in the fetus at birth time mothers using CSII mode were less common than with MSII (p=0.01 and p=0.04, respectively). In the CSII group no resuscitation was needed, as opposed to 20% of children whose mothers used the MSII. Conclusion. The administration of insulin using portable dispenser the of mode CSII during pregnancy in patients with type 1 diabetes, even at the initial stage of the DN the cytomembranes stability is saved, pregnancy outcomes are improved.

The Role of Secrecy and Disclosure in Type 1 Diabetes Adherence and Glycemic Control

2013 ◽  
Author(s):  
P. Osborn ◽  
C. A. Berg ◽  
A. E. Hughes ◽  
P. Pham ◽  
D. J. Wiebe
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control

A Case of Diabetic Nephropathy in a Child with Type 1 Diabetes

2008 ◽  
Vol 12 (2) ◽  
pp. 250 ◽  
Author(s):  
Hwan-Hee Jung ◽  
Sung-Sin Park ◽  
Sung-Do Kim ◽  
Byoung-Soo Cho
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Nephropathy
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