Diabetic nephropathy in children with type 1 diabetes mellitus with vitamin D deficiency and dyslipidemia as associated risk factors

Background: Diabetic nephropathy (DN) is one of the most common and significant chronic complications associated with diabetes mellitus (DM). Vitamin D (VD) deficiency is linked to poor control of diabetes and its complications including the microvascular one such as DN. Dyslipidemia is believed to play a role in DN progression. Objective: The aim of this article is to estimate the prevalence of DN in children and adolescents with type 1 DM and its association with VD deficiency and dyslipidemia as risk factors. Materials and Methods: We conducted a cross-sectional study over a period of 6 months on 45 patients (children and adolescents) who attended the Pediatric Endocrinology Clinic of the National Diabetic Center/Al-Mustansiriyah University in Baghdad city, Iraq. The age of study participants ranged from 10 to 17 years, with the duration of type 1 DM of 5 years or more. Data including age, gender, duration of diabetes, daily insulin dose per kilogram body weight, growth measurements, and blood pressure (BP) were reported. A venous blood sample was collected for glycated hemoglobin (HbA1c), lipid profile, VD level, whereas a urine sample was collected for albumin-to-creatinine ratio. Two of the three specimens were obtained within a 3–6-month period due to variability in urinary albumin excretion. Results: The majority of diabetic children (71.1%) had DN. There were no significant differences in age, gender, duration of diabetes, body mass index (BMI), and BP between patients with diabetes and nephropathy and those with only diabetes. Both insulin dose and the HbA1c levels were significantly greater in diabetic patients with nephropathy (P-value 0.018 and 0.04, respectively) compared with diabetic patients without nephropathy. Insufficient and deficient VD levels were significantly higher among diabetic patients with nephropathy, whereas the sufficient level was higher among diabetic patients without nephropathy (P = 0.020). Diabetic patients with nephropathy had significantly higher levels of triglyceride, low-density lipoprotein (LDL), very LDL but lower high-density lipoprotein levels than diabetic patients without nephropathy (P-values 0.004, 0.047, 0.024, and 0.030 respectively). Conclusion: DN was not significantly associated with age, gender, disease duration, BMI, and BP of patients. Patients with DN need higher doses of insulin therapy and had higher HbA1c levels. VD deficiency is linked to a higher risk of DN. Patients with nephropathy had more significant dyslipidemia than patients without nephropathy