الفهرس 
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Abstract
Diabetes mellitus is the most common endocrine –metabolic disorder in childhood and adolescence. Type 1 diabetes (IDDM) accounts for 5-10% of those with diabetes while type 2 diabetes accounts for 90-95% of those with diabetes.
Long term complications of DM occur at least 7 years after the onset of diabetes and they include diabetic retinopathy, neuropathy, nephropathy, atherosclerosis and ischemic heart disease. Pediatricians have become interested in diabetic complications only during the last decade when recent techniques permitted the detection of minor abnormalities in early asymptomatic cases.
Diabetic nephropathy occurs in 20-40% of the patients with type 1 DM. Microalbuminuria is the earliest indicator of nephropathy. It was defined as an albumin/creatinine ratio between 30-300mg/24hr. whereas macroalbuminuria is defined as elevated albumin/creatinine ratio >300mg/24hr. The occurrences of microalbuminuria in patients with type 1 DM is clearly indicative of increased risk of nephropathy and other microvascular and macrovascular complications. Progression of microalbuminuria can be modified by early intervention in children and young adult.
The present study aimed to assess the relationship between the state of glycemic control (glycosylated hemoglobin) and albumin/creatinine ratio in urine. Forty diabetic children of at least 3 years duration of diabetes were included in the study. In addition, twenty healthy children of matched age and sex were included as a control group.
Children included in the study were subjected to full history taking, thorough clinical examination, and anthropometric measurement. Laboratory investigations included were urine analysis, random blood sugar level, glycosylated haemoglobin and albumin/creatinine ratio.
The present study showed that 31 out of 40 diabetic children (77.5%) had early nephropathy (increased albumin/creatinin ratio) which is higher than the average reported by the ADA which states that diabetic nephropathy occurs in 20-40% of the diabetic children.(47) This may be due to poor glycemic control which is fairly common in our sample as 67.5% of the diabetic children had poor glycemic control. The degree of glycemic control as judged by HbA1c varies significantly between microalbuminuric and nonmicroalbuminuric group.
Also there was no demonstrable link between blood pressure and microalbuminuria. The total duration of diabetes did not reveal significant difference between microalbuminuria.
In addition there was no significant relationship between the age of the cases and the duration of diabetes and the glycemic control. Moreover, there was no significant relationship between the age, sex of the cases and the duration of diabetes and nephropathy. Also there was no demonstrable link between anthropometeric measurement and microalbuminuria.