PANTHER Study: Puberty, Diabetes, and the Kidneys, When Eustress Becomes Distress
Petter Bjornstad
Summary
Early diabetic kidney disease (DKD) occurs in 50-70% of youth with type 2 diabetes (T2D) and confers high lifetime risk of dialysis and premature death. Youth-onset T2D typically manifests during or shortly after puberty in adolescents with obesity. Epidemiological data implicate puberty as an accelerator of kidney disease in youth with obesity and diabetes and the investigators posit that the link between puberty and T2D-onset may explain the high burden of DKD in youth-onset T2D. A better understanding of the impact of puberty on kidney health is needed to promote preservation of native kidney function, especially in youth with T2D.
Description
Puberty is a complex process of physiological changes, including neuroreproductive and growth hormone activation and rapid organ growth, that may predispose organs to injury. The kidneys may be especially susceptible because they are highly metabolically active and second only to the heart with respect to oxygen consumption per tissue mass. During puberty, the kidneys almost double in size, likely increasing the kidneys' already high energy expenditure. In parallel, puberty is associated with physiologic insulin resistance (IR), which is accentuated in obesity. Our central hypothesis is that o…
Eligibility
- Age range
- 8–14 years
- Sex
- All
- Healthy volunteers
- Yes
Inclusion Criteria: * HbA1c ≥6.0% for untreated high-risk group * BMI ≥ 85th %ile for high-risk group * Normal HbA1c ≤5.6% for control group * Type 1 diabetes (T1D) Antibody negative Exclusion Criteria: * History of Chronic kidney disease (CKD) or acute kidney injury (AKI) * Metabolic disorder prohibiting safe fasting * Iodine or penicillin allergy * Pregnancy * Thrombophilia * MRI contraindications * Hormone therapy
Interventions
- DrugAminohippurate Sodium Inj 20%
Diagnostic aid/agent used to measure effective renal plasma flow (ERPF)
- DrugIohexol Inj 300 MG/ML
Diagnostic aid/agent used to measure glomerular filtration rate (GFR)
- DrugDextran 40
Diagnostic aid/agent used to measure glomerular size and selectivity
Locations (2)
- Children's Hospital ColoradoAurora, Colorado
- Seattle Children's HospitalSeattle, Washington