Probe • Vol LXII • No. 4 • Sep–Dec 2023 • 27 Nephrology Acute Kidney Injury and Diabetic Kidney Disease in ChildrenWith Acute Complications of Diabetes Diabetic ketoacidosis (DKA) and hyperglycemia without ketoacidosis are common acute complications of diabetes. Their association with acute kidney injury (AKI) and diabetic kidney disease (DKD) was analyzed in this study. The study group consisted of 197 children with type 1 diabetes mellitus with an average diabetes duration of 8.08 ± 2.32 years. The medical history of the patients was retrospectively reviewed. The number of children with severe hyperglycemia, DKA, and AKI was assessed. The association with the risk of chronic kidney disease (CKD) was analyzed. AKI was found in 14% of the patients hospitalized for DKA and 8% of the patients hospitalized for hyperglycemia. Patients with AKI showed a significantly increased corrected sodium level. Patients with AKI in DKA showed a significant increase in WBCs. Follow-up analysis after a minimum of 5 years of diabetes revealed that a single episode of DKA was found in 63 patients and a single episode of AKI in 18 patients. Two or more episodes of DKA were found in 18 patients, and 9 patients were complicated by AKI. These patients showed a significant increase in urinary albumin excretion (44.20 ± 64.21 mg/24 h), the highest values of eGFR, and the worst glycemic control. Diabetic children can develop AKI in the course of DKA and hyperglycemia without ketoacidosis, which is associated with volume depletion and reflected by corrected sodium concentration. AKI in DKA seems to be complicated by stress and inflammation activation. AKI and poor glycemic control with repeated DKA episodes can magnify the risk of progression to DKD. Source: Soltysiak J, et al. Pediatr Nephrol. 2023;38(5):1643–1652. C3c Deposition PredictsWorse Renal Outcomes in Patients With BiopsyProven Diabetic Kidney Disease in Type 2 Diabetes Mellitus Although extensive efforts have been put to identify reliable predictors of renal outcomes in patients with diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM), only a limited number of predictive factors of DKD progression are known. Whether renal complement depositions are associated with renal outcomes of DKD in T2DM or not is of interest. A total of 213 biopsy-proven DKD patients with T2DM were retrospectively recruited. Clinical and pathological data of the patients were analyzed. Kaplan–Meier analysis and Cox regression analysis were performed to explore the predictors of endstage renal disease (ESRD). During a median follow-up for 23 (12, 39) months, 100/213 (46.9%) patients progressed to ESRD. C3c and C1q depositions were observed in 133/213 (62.4%) and 45/213 (21.1%) patients, respectively. The Kaplan–Meier analysis revealed that patients with C3c or C1q deposition had significantly worse renal outcomes compared with those without C3c or C1q deposition. Univariate and multivariate Cox regression analyses demonstrated proteinuria (per 1 g/24 h increase; HR, 1.134; 95% CI, 1.079–1.191; P < .001), interstitial fibrosis and tubular atrophy score (score 2 and 3 vs 0 and 1; HR, 3.925; 95% CI, 1.855–8.304; P < .001), and C3c deposition (per 1+ increase; HR, 1.299; 95% CI, 1.073–1.573; P = .007) to be independent predictors of ESRD in DKD patients with T2DM. C3c deposition in the kidney was associated with worse renal outcomes and was an independent predictor of ESRD in DKD patients with T2DM. Source: Li MR, et al. J Diabetes. 2022;14(4):291–297. Abstracts From Literature
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