First Things First

Don’t look for rising blood pressure as a first indicator of impending kidney disease if the subject is a child.

Researchers in England who studied whether blood pressure rose in children with type 1 diabetes before microalbuminuria showed up found that it did not. Results were published in the March issue of Diabetes Care.

Microalbuminuria—microscopic amounts of protein in the urine—is the first sign that kidney disease may be developing. A buildup of creatinine, a waste product from muscle activity, is a sign that kidneys are losing function. In the study, children were considered to have developed microalbuminuria if their albumin-to-creatinine ratio was more than 3.5 mg/mmol in males and 4 mg/mmol in females.

When researchers compared the 63 children who developed microalbuminuria during one or more annual tests with other children the same gender and age at diagnosis, they found no significant difference in blood pressure between the groups before microalbuminuria developed. They did point out that the group that developed microalbuminuria had an average HbA1c of 1.1 percent points higher than the group that did not.

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