Relationship Between Microalbuminuria and 24-hour Blood Pressure Monitoring in Patients with Type 1 Diabetes

Abstract

Background: Diabetic nephropathy is leading cause of mortality and morbidity of type 1 diabetes mellitus (DM). The most important indicators that determine the progression of nephropathy are microalbuminuria and hypertension. The aim of the study is to assess the role of blood pressure by ambulatory blood pressure monitoring (ABPM) in children and adults with type 1 DM and its correlation with microalbuminuria and assess the prognostic factors on nephropathy.
Materials and Methods: The files of 129 patients followed-up with the diagnosis of type 1 DM were reviewed retrospectively. 89 patients with a 24-hour blood pressure holter, a follow-up time>3 years, a diagnosis age of 7-18 and no chronic disease in addition to type 1 DM were included in the study. The patients were divided into two groups, with and without microalbuminuria. These patients were compared in terms of demographic (age, gender, age of diagnosis, duration of follow-up, sociocultural level) and clinical features(24-h ABPM, presence of retinopathy, eco findings, hemoglobin A1c levels, chronic kidney disease).
Results: 56 patients had microalbuminuria, while 33(37.1 %) patients din not have microalbuminuria. 12(21.4 %) patients with microalbuminuria had systolic, 4(7.1 %) had diastolic and 3(5.3 %) had both systolic and diastolic hypertension. 31(55.3 %) patients didn’t have systolic or diastolic hypertension.18 (58%) of these 31 patients were systolic non-dipper and 4(12.9 %) were diastolic non-dipper. 22(66.6 %) of 33 patients without microalbuminuria had non-dipping phenomenon. While the number of patients with at least one of the parents graduated from university was 3(5.3 %) in the microalbuminuric group, it was significantly higher in the non-microalbuminuric group (p<0.01).
Conclusion: In patients with type 1 DM, a 24-h ABPM may be necessary and important for early diagnosis in addition to microalbuminuria as a follow-up of diabetic nephropathy

Keywords

• Type 1 diabetes, Microalbuminuria, Diabetic nephropathy, Prognosis

Tip 1 Diyabetli Hastalarda Mikroalbuminüri ve 24 Saatlik Kan Basıncı Monitörizasyonu Arasındaki İlişkinin Değerlendirilmesi

Öz

Amaç: Diyabetik nefropati tip1 diyabetin(DM) önemli mortalite ve morbidite nedenlerindendir. Nefropatinin seyrini belirleyen en önemli göstergeler mikroalbuminüri ve hipertansiyondur. Bu çalışmanın amacı, tip 1 DM’li çocuklarda ve ergenlerde 24 saatlik ayaktan kan basıncı izleme(24sa holter) ile mikroalbuminüri korelasyonu ve nefropati üzerindeki prognostik faktörleri değerlendirmektir.
Materyal ve metod: Tip 1 DM tanısı ile takipli 129 hastanın dosyası retrospektif olarak tarandı. 24 saatlik kan basıncı holteri takılmış, takip süresi> 3yıl, tanı yaşı 7-18 olan, tip1 DM ye ek bir kronik hastalığı bulunmayan 89 hasta çalışmaya dahil edildi. Hastalar mikroalbuminürisi olan ve olmayan olmak üzere 2 gruba ayrıldı. Bu hastalar demografik (yaş, cinsiyet, tanı yaşı, takip süresi, sosyokültürel düzey) ve klinik özellikler(24 sa holter sonuçları, retinopati varlığı, ekokardiyografi bulguları, hemoglobin A1c düzeyleri, kronik böbrek hastalığı) açısından karşılaştırıldı.
Bulgular: Hastaların 56(%62,9)’sında mikroalbuminüri varken, 33(%37,1) hastada mikroalbuminüri yoktu. Mikroalbuminüri olan 12(%21,4) hastada sistolik, 4(%7,1)’ünde diastolik, 3(%5,3)’ünde sistolik ve diastolik hipertansiyon mevcuttu. 31(%55,3) hastanın sistolik ve/veya diastolik hipertansiyonu yoktu. Ancak bu 31 hastanın 18(%58)’i sistolik non-dipper, 4(%12,9)’ü diastolik non-dipperdı. Mikroalbuminüri olmayan 33 hastanın 22(%66,6)’sinin 24 saatlik tansiyon holteri ise non-dipper idi. Ebeveynlerden en az birinin üniversite mezunu olduğu hasta sayısı mikroalbuminürik grupta 3(%5,3) iken, mikroalbuminürik olmayan grupta anlamlı derecede yüksekti (p<0.01).
Sonuç: Tip 1 DM tanılı hastalarda diabetik nefropatinin takibi olarak mikroalbuminürinin yanında 24saatlik tansiyon holteri yapılması erken tanı için gerekli ve önemli olabilir

Anahtar Kelimeler

• tip 1 diyabet
• mikroalbuminüri
• diyabetik nefropati
• prognoz

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