الفهرس 
DIABETES MELLITUS
Hyperglycemic Hyperosmolar StateOnly 14 pages are availabe for public view
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Abstract
Diabetic nephropathy is one of the most important complications of type1 diabetes which causes many morbidity and mortality cases in children and adolescents with type 1 diabetes (Donaghue et al., 2009).
Many factors may affect the occurrence or the progression of this complication as:- Glycemic control, gender, duration of diabetes, hypertension, dyslipidemia, puberty, genetic factors and smoking (ADA, 2007).
Microalbuminuria is the recognized method of detection of early diabetic renal affection (Zemanovitz et al., 2009).
But as the microalbuminuria is the sign of glomerular affection, and as it is affected by other diseases and factors as urinary tract infections and exercise so many studies have been done to search another earlier predictor of diabetic renal affection (Caramori et al., 2000; Zachwija et al., 2010).
This is very important because of the great role of early treatment in reversing the renal changes of diabetes.
This treatment consists of treatment of the risk factors like hypertension, hyperglycemia, hyperlipidimia and smoking and also the use of drug therapy like angiotensin converting enzyme inhibitors (ACEI).In the microalbuminuric group the mean age was 14.28+2.94 years and the mean duration of diabetes was 7.47+3.30 years while in the normoalbuminuric group the mean age was 13.57+2.91 years and the mean duration of diabetes was 5.87+3.41 years.
There was no significant difference between the groups as regards sex, age, BMI, weight, and height.
There was a significant difference between the normoalbuminuric and microalbuminuric groups as regards systolic blood pressure which was higher in the microalbuminuric group and a significant difference between the control group and the microalbuminuric group as regards the diastolic blood pressure which was also higher in the microalbuminuric group. There was a difference between normoalbuminuric and microalbuminuric groups as regards duration of diabetes which was higher in the microalbuminuric patients but not to the significant level.
There was a highly significant difference between the 3groups as regards HbA1c which was higher in the microalbuminuric than the normoalbuminuric group and both groups were significantly higher than the control one.
Also the Cystatin C and the A/C ratio were found to be significantly higher in the microalbuminuric group than the normoalbuminuric and also than the control group.The cholesterol and the LDL were found to be significantly higher in the microalbuminuric group than the other groups while the triglycerides was found to be significantly higher in the microalbuminuric group than the normoalbuminuric one, it was found to be higher in the microalbuminuric group than the control group but not to the significant level, Also the liver enzymes were found to be significantly higher in the microalbuminuric group than the other two groups
The serum creatinine was found to be lower in the microalbuminuric and normoalbuminuric groups than the control group but not be the significant level.
There was a significant difference in the family history of diabetes between the microalbuminuric groups which was higher than the normoalbuminuric one.
Twenty nine patients of the 30 microalbuminuric (96.67%) had high urinary Cystatin C excretion (>90.4 according to roc curve done).
In addition to a 12 patients of the 30 normoalbuminuric (40%) had significantly increased urinary Cystatin C.
We compared these 2 groups{ a group with high urinary Cystatin C and another group with low urinary Cystatin C excretion,, the first one included 41 patients (29 with microalbuminuria and 12 with normoalbuminuria) and the second included 19 patients (one with microalbuminuria and 18 with normoalbuminuria)} as regards different epidemiologic and laboratory factors.
There was no significant difference between these groups as regards different epidemiological factors Age, Sex, weight, height also in many investigations as serum lipids, liver and renal functions, also the duration of diabetes did not differ between those with high and low urinary Cystatin C excretion (3:16 and 3:15 years respectively), but there was a difference in systolic and diastolic blood pressures and glycosylated hemoglobin which were all higher in the high urinary Cystatin C group but not to the significant level and a statistical difference in urinary A/C ratio and urinary microalbuminuria which was also higher in the same group.