From the United Kingdom:
My son was diagnosed with Type 1 diabetes in May 1992 [about 4 1/2 years ago]. He is generally well controlled with Hb1ac results in the normal range and no signs of hypertension. I understand the first signs of diabetic nephropathy may exhibit from the 5th year after diagnosis. Would you recommend routine use of microalbuminuria testing after the 5th year? Would your recommendations and treatment options be different for a child than an adult?
You don't give the age of your son. The link between microalbuminuria and nephropathy in children is still unproven and the former is unusual in children. Currently a UK wide study is being set up to answer some of the outstanding questions. Age seems to be important as well as duration of diabetes. To be entirely pragmatic about it - I would be perfectly happy not to start routine screening until a patient is over 12 years old and has had diabetes for 4 years. Many centres will test first morning urine specimens on an annual or more frequent basis without asking for a formal timed overnight urine collection. Discuss this with your local diabetes team.
As far as management is concerned - there have been remarkably few studies but, in proven microalbuminuria, there would appear to be the same beneficial effects from the ACE inhibitor drugs as in adults but much more work is required.
Original posting 28 Dec 96
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Last Updated: Tuesday April 06, 2010 15:08:52
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