Urine May Reveal Heart Risk in Young Diabetes Patients

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Kidney disease and heart problem risk in teens with type 1 diabetes detected with urine test

November 6, 2013 / Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

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(dailyRx News) For adults with diabetes, a urine test can spot those at risk for heart and kidney disease. The same test may also work for young people with type 1 diabetes.

A simple screening can measure the amount of a protein called albumin in the urine. Healthy kidneys prevent albumin — which is found in the blood — from passing into the urine. A high level of this protein in the urine is not only a sign of kidney damage, but it can indicate potential trouble for the heart as well.

Recent research showed that this type of screening may also help teens with type 1 diabetes determine their risk of getting heart and kidney disease.

"Ask your doctor about kidney function tests if you have diabetes."

David Dunger, PhD, a professor of pediatrics and clinical scientist at the University of Cambridge in England, collaborated with fellow researchers from the UK, Australia and Canada on this study.

These researchers measured albumin levels in the urine of 3,353 young people with type 1 diabetes. Participants ranged in age from 10 to 16.

The researchers studied patients for early signs of heart and kidney disease. These included impairment of kidney function, hardening of the arteries and abnormal lipid (blood fat) profiles.

Teens with albumin levels in the top 30 percent had more signs of early kidney and cardiovascular problems than those with lower protein levels in their urine, according to the study findings. The researchers pointed out that the albumin levels in the top 30 percent, however, are currently considered within the “normal” range.

Professor Dunger told dailyRx News, “This finding could help us identify teenagers who may benefit from lipid lowering or blood pressure lowering drugs — heart and kidney disease being the major cause of early death and morbidity in type 1 diabetes.”

"This study shows that by using a simple urine test with children ages 10-16 who have type 1 diabetes, we can better assess their risk for heart and kidney complications," Jessica McIntyre, MD, family medicine physician at Loyola University Health System, told dailyRx News.

"We already use this screening test with adults with diabetes and high blood pressure to assess for early kidney disease. The tricky part is that many of the medicines we give adults once we have the urine results are not well studied and used for children and young adolescents," said Dr. McIntyre, who was not involved in this study.

"For now, children at this age with type 1 diabetes should continue their current care with their physicians, and discuss how they can continue to best manage their sugar levels in order to prevent future complications," she said.

The researchers said that the next step will be to see if medications used to treat heart and kidney disease — such as statins and blood pressure lowering medications like ACE inhibitors — can help prevent kidney and heart complications in this young and possibly at-risk population.

Statins are cholesterol-lowering medications, such as atorvastatin (brand name Lipitor), fluvastatin (brand name Lescol), lovastatin (brand name Mevacor), pravastatin (brand name Pravachol) and Simvastatin (brand name Zocor).

ACE inhibitors block angiotensin-converting enzymes, causing blood vessels to relax. Some ACE inhibitors include benazepril (brand name Lotensin), enalapril (brand name Vasotec), lisinopril (brand names Prinivil and Zestril), moexipril (brand name Univasc), perindopril (brand name Aceon), quinapril (brand name Accupril), ramipril (brand name Altace) and trandolapril (brand name Mavik).

Worldwide, more than 490,000 young people ages 0 to 14 have type 1 diabetes, according to the International Diabetes Federation.

“By showing that people at high risk of these complications can be identified when they are children, this research offers the exciting prospect that in the future we might be able to offer treatment early to stop them from happening,” said Alasdair Rankin, MD, director of research for Diabetes UK, in a statement.

He added that this offers “... real hope of another way to help people with type 1 diabetes have the best possible chance of a long and healthy life.”

This study was published on November 6 in the journal Diabetes Care. Funding was provided by Diabetes UK, Juvenile Diabetes Research Foundation and British Heart Foundation. The study was also funded in Canada by the Canadian Diabetes Association and the Heart and Stroke Foundation Canada.