الفهرس 
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Abstract
I
n experimental models, maternal hyperglycemia is associated with reduced nephron number, raised blood pressure, microalbuminuria, and diminished glomerular filtration rate in offspring. In children whose mothers had diabetes, renal functional reserve was decreased suggesting a reduction in nephron number.
Altered urinary albumin creatinine ratio (UACR), a well-known marker of glomerular permeability, among infant of diabetic mothers might reflect abnormal renal development induced by hyperinsulinemia. The fractional excretion of sodium (FeNa) describes the fraction of the filtered load of Na that is excreted in the final urine and is a reflection of tubular function. Urinary alpha-1 microglobulin (A1M) provides a non-invasive and inexpensive diagnostic alternative for early detection of tubular disorders.
Kidney injury molecule-1 (KIM-1) is a transmembrane glycoprotein specifically over-expressed in damaged proximal tubules. Moreover, urinary KIM-1/Creatinine ratio is a sensitive, non-invasive diagnostic tool for kidney affection in type 2 diabetic Egyptian patients that seem to predict renal injury in early period independent of albuminuria.
Few studies investigated the influence of maternal hyperglycemia on renal functional and structural integrity of their infants. Therefore, the aim of study was to assess renal functional and structural integrity in infants of diabetic mothers using urinary biomarkers; UACR, FeNa, A1M and KIM-1 levels as sensitive markers for renal impairment. The secondary objective was to investigate the possible relation between levels of the studied urinary biomarkers and maternal and neonatal clinical and laboratory variables.
This study comprised 100 full term neonates (≥ 37 weeks) delivered at Obstetrics and Gynecology hospital, Ain Shams University; 58 infants were born to diabetic mothers and another 42 age- and sex-matched healthy infants were enrolled as controls.
All newborns were subjected to detailed medical history and thorough clinical examination. Maternal laboratory investigations included random blood glucose (RBG) and HbA1c. Neonatal laboratory analysis included RBG, serum and urinary creatinine, estimated glomerular filtration rate (eGFR), UACR and FeNa as well as urinary A1M and KIM-1 levels by ELISA.
Upon comparison between diabetic mothers and control group, a significant difference was found as regards obesity where the percentage of overweight and obese mothers was significantly higher among diabetic mothers compared with healthy mothers. RBG was found to be higher among diabetic mothers.
Upon comparison between infant of diabetic mothers and control group as regards clinical data, it was found that infants of diabetic mothers had higher birth weight than control group. Respiratory distress was the most frequent complication among infants of diabetic mothers followed by hypoglycemia.
Comparison of laboratory data among infants of diabetic mothers and control group showed that RBG, UACR, FeNa, urinary A1M, urinary KIM-1 as well as A1M/cr ratio and KIM-1/cr ratio were significantly higher while eGFR was significantly lower among infants of diabetic mothers.
Infants of overweight and obese diabetic mothers had significantly higher UACR, FeNa, A1M and KIM-1 levels compared with those born to diabetic mothers with normal weight.
There were significant positive correlations between maternal HbA1c and each of UACR, FeNa, A1M and KIM-1 levels. Moreover, FeNa was positively correlated to maternal weight gain as well as urinary albumin, A1M/cr and KIM-1/cr ratios while it was negatively correlated to urinary creatinine. Both A1M and KIM-1 were positively correlated.
Multivariable linear regression analysis showed that maternal HbA1c was a significant independent factor related to levels of the studied biomarkers among infants of diabetic mothers.