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

Yıl 2020, , 218 - 222, 20.08.2020

Mehtap Çelakıl

https://doi.org/10.35440/hutfd.719246

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

Destekleyen Kurum

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Proje Numarası

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Teşekkür

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

Öz

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

Anahtar Kelimeler

Type 1 diabetes, Microalbuminuria, Diabetic nephropathy, Prognosis

Proje Numarası

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Kaynakça

• 1. Basiratnia M, Abadi SF, Amirhakimi GH, Karamizadeh Z, Karamifar H. Ambulatory blood pressure monitoring in children and adolescents with type-1 diabetes mellitus and its relation to diabetic control and microalbuminuria. Saudi J Kidney Dis Transpl. 2012 Mar;23(2):311-5.
• 2. Zabeen B, Nahar J, Islam N, Azad K, Donaghue K. Risk Factors Associated with Microalbuminuria in Children and Adolescents with Diabetes in Bangladesh. Indian J Endocrinol Metab. 2018 Jan-Feb;22(1):85-88. doi: 10.4103/ijem.IJEM_269_17
• 3. Mateo-Gavira I, Vílchez-López FJ, García-Palacios MV, Carral-San Laureano F, Jiménez-Carmona S, Aguilar-Diosdado M. Nocturnal blood pressure is associated with the progression of microvascular complications and hypertension in patients with type 1 diabetes mellitus. J Diabetes Complications. 2016 Sep-Oct;30(7):1326-32. doi: 10.1016/j.jdiacomp.2016.05.021. Epub 2016 May 29.
• 4. Lévy-Marchal C, Sahler C, Cahané M, Czernichow P; GECER Study Group. Risk factors for microalbuminuria in children and adolescents with type 1 diabetes. J Pediatr Endocrinol Metab. 2000 Jun;13(6):613-20.
• 5. Darcan S, Goksen D, Mir S, Serdaroglu E, Buyukinan M, Coker M et al. Alterations of blood pressure in type 1 diabetic children and adolescents. Pediatr Nephrol. 2006 May;21(5):672-6. Epub 2006 Mar 28.
• 6. Perrin NE, Torbjörnsdotter T, Jaremko GA, Berg UB. Risk markers of future microalbuminuria and hypertension based on clinical and morphological parameters in young type 1 diabetes patients. Pediatr Diabetes. 2010 Aug;11(5):305-13. doi: 10.1111/j.1399-5448.2009.00595.x.
• 7. Machnica L, Deja G, Jarosz-Chobot P. Hypertension and prehypertension in children and adolescents with diabetes type 1. Pediatr Endocrinol Diabetes Metab. 2008;14(4):215-9.
• 8. Lopes CA, Lerário AC, Mion D Jr, Koch V, Wajchenberg BL, Rosenbloom AL. Ambulatory blood pressure monitoring (ABPM) in normotensive adolescents with type 1 diabetes. Pediatr Diabetes. 2002 Mar;3(1):31-6.
• 9. Shikata K, Kodera R, Utsunomiya K, Koya D, Nishimura R, Miyamoto S et al.; JDCP study group. Prevalence of albuminuria and renal dysfunction, and related clinical factors in Japanese patients with diabetes: The Japan Diabetes Complication and its Prevention prospective study 5. J Diabetes Investig. 2020 Mar;11(2):325-332. doi: 10.1111/jdi.13116. Epub 2019 Sep 25.
• 10. Staiano AE, Morrell M, Hsia DS, Hu G, Katzmarzyk PT. The Burden of Obesity, Elevated Blood Pressure, and Diabetes in Uninsured and Underinsured Adolescents. Metab Syndr Relat Disord. 2016 Nov;14(9):437-441. Epub 2016 Jul 11.
• 11.Wan Nazaimoon WM, Letchuman R, Noraini N, Ropilah AR, Zainal M, Ismail IS et al. Systolic hypertension and duration of diabetes mellitus are important determinants of retinopathy and microalbuminuria in young diabetics. Diabetes Res Clin Pract. 1999 Dec;46(3):213-21.
• 12. Aggarwal HK, Jain D, Mor S, Yadav RK, Jain P. Prevalence and Clinical Correlates of Microalbuminuria in Patients with EssentialHypertension - A Tertiary Care Center Cross Sectional Study. J Assoc Physicians India. 2018 May;66(5):30-4.
• 13. Chiarelli F, Trotta D, Verrotti A, Mohn A. Treatment of hypertension and microalbuminuria in children and adolescents with type 1 diabetes mellitus. Pediatr Diabetes. 2002 Jun;3(2):113-24.
• 14. Hornung RJ, Reed PW, Mouat F, Jefferies C, Gunn AJ, Hofman PL. Angiotensin-converting enzyme-inhibitor therapy in adolescents with type 1 diabetes in a regional cohort: Auckland, New Zealand from 2006 to 2016. J Paediatr Child Health. 2018 May;54(5):493-498. doi: 10.1111/jpc.13814. Epub 2017 Dec 22.
• 15. Zheng XY, Luo SH, Wei XY, Ling P, Ai HY, Liu ZY et al. Related factors for microalbuminuria in adult type 1 diabetes patients of short disease duration. Zhonghua Yi Xue Za Zhi. 2020 Feb 18;100(6):419-423. doi: 10.3760/cma.j.issn.0376-2491.2020.06.005
• 16. Lind M, Pivodic A, Svensson AM, Ólafsdóttir AF, Wedel H, Ludvigsson J. HbA1c level as a risk factor for retinopathy and nephropathy in children and adults with type 1 diabetes: Swedish population based cohort study. BMJ. 2019 Aug 28;366:l4894. doi: 10.1136/bmj.l4894.
• 17. Fellinger P, Fuchs D, Wolf P, Heinze G, Luger A, Krebs M, Winhofer Y. Overweight and obesity in type 1 diabetes equal those of the general population. Wien Klin Wochenschr. 2019 Feb;131(3-4):55-60. doi: 10.1007/s00508-018-1434-9. Epub 2019 Jan 7.
• 18. Secrest AM, Costacou T, Gutelius B, Miller RG, Songer TJ, Orchard TJ. Association of socioeconomic status with mortality in type 1 diabetes: the Pittsburgh epidemiology of diabetes complications study. Ann Epidemiol. 2011 May;21(5):367-73. doi: 10.1016/j.annepidem.2011.02.011.
• 19 . Mühlhauser I, Overmann H, Bender R, Bott U, Jörgens V, Trautner C, Siegrist J, Berger M. Social status and the quality of care for adult people with type I (insulin-dependent) diabetes mellitus--a population-based study. Diabetologia. 1998 Oct;41(10):1139-50. 20. Sochett EB, Poon I, Balfe W, Daneman D. Ambulatory blood pressure monitoring in insulin-dependent diabetes mellitus adolescents with and without microalbuminuria. J Diabetes Complications. 1998 Jan-Feb;12(1):18-23.
• 21.Markuszewski L, Ruxer M, Szadkowska A, Bodalska J, Bissinger A. Evaluation of blood pressure changes by 24hours ambulatory blood pressure monitoring (ABPM) in young, normotensive patients with diabetes mellitus type I. Pol Merkur Lekarski. . 2006 Jan;20(115):32-5.