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Microvascular Disorders: Vitamin D3 status and disease progression in children with Diabetic Nephropathy

BurlakaIe A, Maidannyk VG

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin (Type 1 diabetes, T1D) or when the body cannot effectively use the insulin it produces (Type A diabetes, T2D). Insulin is a hormone that regulates blood sugar. Type 1 diabetes is mainly a disease of children and young adults. The onset of disease is associated with three classical symptoms - polydipsia, polyphagia, and polyuria. Hyperglycemia is a main and primary metabolic disorder in T1D.

In 2014, 8.5% of adults aged 18 years and older had diabetes. In 2016, diabetes was the direct cause of 1.6 million deaths and in 2012 - 2.2 million deaths. An increasing incidence of diabetes complications, particularly overt nephropathy and proliferative retinopathy, has been reported in the type 1 diabetes population around the world over the past 15–20 years. Metabolic control including self-monitoring of blood glucose and HbA1c (A1C) testing, blood pressure management are main factors in prevention of the diabetic complications development. Vascular endothelial cells play a major role in maintaining cardiovascular homeostasis. In addition to providing a physical barrier between the vessel wall and lumen, the endothelium secretes a number of mediators that regulate platelet aggregation, coagulation, fibrinolysis, and vascular tone. Vascular disorders, i.e. hypertension are one of the most important causes of end-stage renal disease and death in patients with T1D. However, it is not clear whether hypertension also contributes to the gradual loss of kidney function. Moreover, it is unclear how these to disorders inter-related in their development and progression do. There are data about the role of Vitamin D in T1Dand it’s complications in adults. However, this issue remains to be open in pediatric practice. It is un-known whether Vitamin D and other players i.e. Endothelin-1 (ET-1) are inter-related in vascular disorders development in diabetic children.