This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.Diabetic kidney disease, or diabetic nephropathy (DN), develops in approximately 40 percent of patients with type 1 (insulin-dependent, childhood-onset) diabetes (DM). An early marker of DN is 'microalbuminuria' (MA)--the presence of small amounts of albumin in the urine. Early detection of MA is important because individuals with diabetes who have MA may be treated with medications called angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs) to prevent or delay the development of DN. However, recent studies have suggested that MA may not be a very reliable marker of risk for DN. Many people with type 1 DM and MA do not progress to DN and many who develop DN are not previously identified with MA. These studies have demonstrated the need for earlier and more reliable markers of risk for DN.A test for urine nephrin has been developed at the University of Michigan. Nephrin is a protein found in kidney cells called 'glomerular podocytes' that play an important role in the kidney's ability to filter urine. Our hypothesis is that the loss of cells with nephrin in the urine is an early marker of DN and can be detected before the onset of MA. If this hypothesis is true, there may be a role for treating individuals with type 1 DM who have nephrin in the urine with an ACEI or ARB to slow or prevent progression to DN.We will recruit 364 individuals who are 15 years of age or older and have type 1 DM. They will allow their medical records to be reviewed, complete a questionnaire, and submit up to six urine specimens at different times over 12 to 18 months. We will analyze the urine specimens by dipstick and for microalbumin, creatinine and nephrin. The data collected will be analyzed to describe:1. The relationship between nephrin, MA levels, and risk factors such as age, sex, race, duration of diabetes, blood pressure, and glycemic control2. The changes in levels of urinary nephrin and MA levels that occur in the same individual over time3. The relationship between nephrin, MA levels, and risk factors over timeWe will maintain the data containing participants' study and personal information in a password protected computer file in order to protect their identities.'
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