Macroalbuminuria and Renal Pathology in First Nation Youth with Type 2 Diabetes Mellitus

Abstract

Objective: to determine the prevalence of macroalbuminuria and to describe the clinical and renal pathological changes associated with macroalbuminuria in a population of Canadian First Nation children and adolescents with type 2 diabetes.

Research Design and Methods: We conducted a retrospective chart review at a single, tertiary care pediatric diabetes centre and a case series was constructed. We collected data on micro (≥ 3mg/mmol creatinine [26.5 mg/g]) and macroalbuminuria (≥ 28 mg/mmol creatinine [247.5 mg/g]), eGFR, renal pathology, aggravating risk factors (poor glycemic control, obesity, hypertension, glomerular hyperfiltration, hypercholesterolemia, smoking, exposure to diabetes in utero) were extracted from the charts.

Results: We reviewed 90 charts of children and adolescents with type 2 diabetes. 53% had at least one random urine albumin: creatinine ratio (ACR) ≥ 3 mg/mmol (26.5 mg/g). 14/90 (16%) had persistent macroalbuminuria at, or within 8 years of diagnosis of diabetes. Of these 14 subjects, one had orthostatic albuminuria and 3 had spontaneous resolution of albuminuria. 10 had renal biopsies performed. 9/10 exhibited immune complex disease or glomerulosclerosis and none had classic diabetic nephropathy.

Conclusions: this study suggests that the diagnosis of renal disease in children with type 2 diabetes cannot be reliably determined by clinical and laboratory findings alone. Renal biopsy is necessary for accurate diagnosis of renal disease in children and adolescents with type 2 diabetes and macroalbuminuria. The additional burden of non-diabetic kidney disease may explain the high rate of progression to end-stage kidney failure in this population.