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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2015  |  Volume : 26  |  Issue : 2  |  Page : 373-374
Occurrence of microalbuminuria among children and adolescents with insulin-dependent diabetes mellitus


Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq

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Date of Web Publication3-Mar-2015
 

How to cite this article:
Al-Mendalawi MD. Occurrence of microalbuminuria among children and adolescents with insulin-dependent diabetes mellitus. Saudi J Kidney Dis Transpl 2015;26:373-4

How to cite this URL:
Al-Mendalawi MD. Occurrence of microalbuminuria among children and adolescents with insulin-dependent diabetes mellitus. Saudi J Kidney Dis Transpl [serial online] 2015 [cited 2019 Nov 17];26:373-4. Available from: http://www.sjkdt.org/text.asp?2015/26/2/373/152540
To the Editor,

Among many factors, Al-Agha et al [1] assessed in their interesting study the contribution of hypertension (HTN) to microalbuminuria (MA) in a population of diabetic children and adolescents. The studied cohort consisted of 409 children and adolescents aged 1-19 years. Blood pressure (BP) was measured by the conventional method on three or more separate occasions and the readings were plotted on the CDC age- and gender-specific BP charts. Al-Agha et al [1] addressed that MA was present in 16.7% of those with HTN, but only in 8.5% among those with normal BP (P <0.05). Accordingly, they concluded that HTN was a significant contributing factor for the progression of MA in their studied diabetic cohort. I presume that such a conclusion ought to be considered cautiously. This is based on the following two points: (1) although Al-Agha et al [1] did not mention the frequency distribution of the studied cohort according to their age groups, I presume that children constituted a substantial proportion of the total studied patients. It is well known that the definition of HTN in children, in contrast to adults, is based on distribution criteria and normalcy tables that provide BP percentiles for each measurement method (office, ambulatory and home) according to the individual's age, gender and population. To the best of my knowledge, no Saudi age- and gender-specific BP charts are yet present. (2) Owing to the presence of white coat and masked HTN phenomena, particularly in children, [2] ambulatory blood pressure monitoring (ABPM) is proven to be indispensable for the diagnosis of HTN. [3],[4] With the use of ABPM, two critical BP profiles were found to be prevailing in diabetic patients. The physiological nocturnal fall in BP has been noticed to be blunted or absent in individuals with T1DM who are completely normotensive by the conventional method. Also, patients with T1DM and MA have higher nocturnal BP than either patients with T1DM and normal albumin excretion or age-matched controls. [5],[6],[7] I realize that the application of ABPM to precisely detect the BP profile was not feasible in Al-Agha et al's [1] cross-sectional study due to technical difficulties. Despite the already mentioned concerns, regular monitoring of BP and MA should be part of routine follow-up of T1DM patients.

Conflict of interest: None

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   References Top

1.
Al-Agha AE, Ocheltree A, Hakeem A. Occurrence of microalbuminuria among children and adolescents with insulin-dependent diabetes mellitus. Saudi J Kidney Dis Transpl 2013;24: 1180-8.  Back to cited text no. 1
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2.
Suláková T, Janda J, Cerná J, et al. Arterial HTN in children with T1DM--frequent and not easy to diagnose. Pediatr Diabetes 2009;10: 441-8.  Back to cited text no. 2
    
3.
Karpettas N, Kollias A, Vazeou A, Stergiou GS. Office, ambulatory and home blood pressure measurement in children and adolescents. Expert Rev Cardiovasc Ther 2010;8:1567-78.  Back to cited text no. 3
    
4.
Karpettas N, Nasothimiou E, Kollias A, Vazeou A, Stergiou GS. Ambulatory and home blood pressure monitoring in children and adolescents: Diagnosis of hypertension and assessment of target-organ damage. Hypertens Res 2013;36:285-92.  Back to cited text no. 4
    
5.
Hogan D, Lurbe E, Salabat MR, Redon J, Batlle D. Circadian changes in blood pressure and their relationships to the development of microalbuminuria in type 1 diabetic patients. Curr Diab Rep 2002;2:539-44.  Back to cited text no. 5
    
6.
Pańkowska E, Golicka D. Changes in blood pressure and methods of blood pressure monitoring in patients with type-1 diabetes. Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw 2005;11:33-7.  Back to cited text no. 6
    
7.
Cuspidi C, Vaccarella A, Leonetti G, Sala C. Ambulatory blood pressure and diabetes: Targeting nondipping. Curr Diabetes Rev 2010;6:111-5.  Back to cited text no. 7
    

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Correspondence Address:
Prof. Mahmood Dhahir Al-Mendalawi
Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad
Iraq
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DOI: 10.4103/1319-2442.152540

PMID: 25758895

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