الفهرس 
DIABETIC KETOACIDOSISOnly 14 pages are availabe for public view
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Abstract
T
he current prospective longitudinal study was conducted on forty children with T1DM presented with moderate and severe DKA aged between (6-15) years, over one year. All patients were recruited from Emergency room, Pediatrics and Adolescent Diabetes Unit (PADU) and consultation was done by Pediatric Dialysis and Nephrology Unit (PDNU) Children’s Hospital, faculty of medicine Ain shams university Hospitals. This study aimed primarily to determine the level of urinary TIMP-2 and IGFBP7 as markers of AKI in children with T1DM during and after the resolution of DKA.
The age of the studied children and adolescents with T1DM was ranged from 6-15 years old with mean 10.59, female constituted 90%. The mean of BMI was 1.28, with mean duration of DM was 3 years (range 1.5 -4).
Regarding the severity of DKA, 20 patients had moderate DKA (50%), and 20 patients had severe DKA (50%), meanwhile all patients were polyureic at presentation.
According to eGFR, children with T1DM presented with moderate and severe DKA at presentation were classified as those with AKI (18 patients)45% and those without AKI (22 patients)55%, then at day 3& 14 all patients had full recovery of AKI. At presentation, children had a low eGFR 94.49 ml/min/1.73 m2 (56.8 – 172.10 ml/min/1.73 m2), which improved at day 3 129.92 (93.5 196.2), and normalized at day 14.
The mean of urinary TIMP-2 in children with T1DM presented with moderate and severe DKA was significantly high at presentation (median 68.34 ng/ml, range 13.76 - 190.1), which improved and decreased at day 3 (median 41.31 ng/ml, range 1.25 - 94.25 ng/ml), then it insignificant in day 14 after resolution of DKA with mean 0.82 ng/ml (0.43 - 2.34 ng/ml) (p <0.001).
TIMP-2 were significantly higher in children with severe DKA, rather than those with moderate DKA at presentation (p <0.001). Meanwhile the percentage change decreased from presentation to day 14, higher in children with severe DKA with mean -86.81 (-92.49 -81.42) rather than moderate DKA with mean-71.66 (-83.81 -59.96) (p=0.002).
A negative correlation with blood PH at presentation of DKA and TIMP-2 in children with AKI was higher than those without AKI at presentation (p <0.001), meanwhile it showed negative correlation with eGFR (p=0.029, r=-0.370).
On the other hand, the mean of IGFBP7 in children with T1DM presented with moderate and severe DKA at presentation was high and decreased at day 3, and 14 after resolution of DKA.
Urinary IGFBP7 shows significantly higher values in children with severe DKA rather than moderate DKA at presentation (p=0.003), and the percentage change decreased between presentation and day 14 in children with severe DKA rather than moderate (p=0.027).
IGFBP7 showed a negative correlation with blood PH at presentation, where it was significantly higher in children with AKI rather than those with no AKI at presentation with negative correlation with eGFR (p=0.036, r=-0.314).
Renal duplex revealed higher mean RI in our studied patients at presentation, which decreased at day 3, and 14 after resolution of DKA. Also, the RI was highly elevated in those patients with AKI than those with no AKI, with significant percentage change. The PI by renal duplex revealed a higher value in our studies patients at presentation, that was decreased but insignificant at day 14, meanwhile the PI was significantly elevated in children with AKI than those with no AKI at presentation.