DYNAMICS OF CLINICAL, BIOCHEMICAL AND THERAPEUTIC INDICATORS IN THE COURSE OF DIABETIC NEPHROPATHY IN A CHILD: CASE REPORT

Introduction. Diabetic nephropathy (DN) is a chronic microvascular complication of type 1 diabetes mellitus (T1DM). DN incidence has been gradually increased worldwide. Prevalence of the DN varies between age groups, patients’ cohorts, countries, and continents. Factors such as smoking, hypertension, hyperglycemia, hyperfiltration and late nephroprotective treatment are the major risk factors in the DN progression. Numerous diverse causes are associated with kidney function impairment in children with DN. The latter are uncompensated kidney failure and hypertensive nephrosclerosis, leading to the complications, i.e. hypertension, proteinuria, and progressive reduction in the kidney function. DN remains incompletely understood in pediatric practice, particularly requiring an understanding of the individual course, mechanisms of pathogenesis and progression of its early stages in children. Case presentation. We describe a 17-year-old female patient diagnosed type 1 diabetes followed by Diabetic nephropathy development. We conducted an analysis of the dynamics of clinical, biochemical and therapeutic indicators in the course of type 1 diabetes mellitus with the development of diabetic nephropathy in a child during 4 years. Conclusions. Diabetic nephropathy is a life-threatening progressive complication of type 1 diabetes. Course of the DN is accompanied by a range of biochemical and clinical deviations and disorders. In this study we show that diabetic nephropathy is accompanied by a wide range of biochemical and clinical disorders, i.e. hyperglycemia-related disorders, hypercholesterolemia, pro-inflammatory status, functional changes in ECG, compensatory hypertrophy of the kidneys, glomerular hyperfiltration and disorders of Vitamin D system. Monitoring of patients with diabetic nephropathy requires constant and timely assessment of both standard indicators of the course of type 1 diabetes (blood glucose, Hb1Ac, albuminuria, GFR, serum cholesterol, albumin/globulin ratio) and additional ones – vitamin D. Nephroprotective therapy should be started as soon as possible in diabetic nephropathy to guarantee that kidney damage markers return to normal. A crucial component of the treatment of diabetic nephropathy is correcting vitamin D insufficiency.