The role of endothelial dysfunction in kidney damage in children with type 1 diabetes mellitus

Diabetes mellitus is a disease accompanied by the development of various complications, one of which is diabetic nephropathy.

Objective: to determine the clinical and diagnostic value of endothelial dysfunction in children and adolescents with type 1 diabetes mellitus.

Material and methods. The study included 87 children with type 1 diabetes mellitus, the control group consisted of 21 conditionally healthy children. All patients with type 1 diabetes mellitus were divided into two groups depending on the presence or absence of signs of kidney damage. Special research methods included determining the concentration of endothelin 1 and nitric oxide (NO) in blood plasma.

Results. A statistically significant increase in the level of endothelin 1 and NO in plasma was revealed in children with type 1 diabetes mellitus compared to the control group (p<0.001). When analyzing the level of endothelin 1 in blood plasma, it should be noted that it increases as chronic kidney disease progresses (p<0.001). In the group of children with type 1 diabetes without kidney damage, a statistically significant increase in NO levels was noted, followed by a decrease as chronic kidney disease progressed (p<0.001). In children with hyperfiltration, endothelin 1 and NO levels were statistically significantly higher compared to children with type 1 diabetes without kidney damage (p<0.001). Dyslipidemia plays an important role in the development of vascular complications of diabetes. In children with type 1 diabetes and dyslipidemia, the endothelin 1 level was significantly higher compared to children with type 1 diabetes without dyslipidemia (p=0.046). A prognostic model was developed to determine the probability of kidney damage in children with type 1 diabetes depending on the concentration of low-density lipoprotein in the blood.

Conclusions. The study of endothelial dysfunction markers (endothelin 1 and NO) in the blood has diagnostic significance in the formation and progression of chronic kidney disease in children with type 1 diabetes. Hyperfiltration is an early predictor of diabetic nephropathy formation at the preclinical stage of the disease.

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