TY - JOUR
T1 - Aminoaciduria and metabolic dysregulation during diabetic ketoacidosis
T2 - Results from the diabetic kidney alarm (DKA) study
AU - Melena, Isabella
AU - Piani, Federica
AU - Tommerdahl, Kalie L.
AU - Severn, Cameron
AU - Chung, Linh T.
AU - MacDonald, Alexis
AU - Vinovskis, Carissa
AU - Cherney, David
AU - Pyle, Laura
AU - Roncal-Jimenez, Carlos A.
AU - Lanaspa, Miguel A.
AU - Rewers, Arleta
AU - van Raalte, Daniël H.
AU - Cara-Fuentes, Gabriel
AU - Parikh, Chirag R.
AU - Nelson, Robert G.
AU - Pavkov, Meda E.
AU - Nadeau, Kristen J.
AU - Johnson, Richard J.
AU - Bjornstad, Petter
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/6
Y1 - 2022/6
N2 - Objective: We examined changes in the excretion of various amino acids and in glycolysis and ketogenesis-related metabolites, during and after diabetic ketoacidosis (DKA) diagnosis, in youth with known or new onset type 1 diabetes (T1D). Methods: Urine samples were collected from 40 youth with DKA (52% boys, mean age 11 ± 4 years, venous pH 7.2 ± 0.1, blood glucose 451 ± 163 mg/dL) at 3 time points: 0–8 h and 12–24 h after starting an insulin infusion, and 3 months after hospital discharge. Mixed-effects models evaluated the changes in amino acids and other metabolites in the urine. Results: Concentrations of urine histidine, threonine, tryptophan, and leucine per creatinine were highest at 0–8 h (148.8 ± 23.5, 59.5 ± 12.3, 15.4 ± 1.4, and 24.5 ± 2.4% of urine creatinine, respectively), and significantly decreased over 3 months (p = 0.028, p = 0.027, p = 0.019, and p < 0.0001, respectively). Urine histidine, threonine, tryptophan, and leucine per urine creatinine decreased by 10.6 ± 19.2, 0.7 ± 0.9, 1.3 ± 0.9, and 0.5 ± 0.3-fold, respectively, between 0 and 8 h and 3 months. Conclusions: In our study, DKA was associated with profound aminoaciduria, suggestive of proximal tubular dysfunction analogous to Fanconi syndrome.
AB - Objective: We examined changes in the excretion of various amino acids and in glycolysis and ketogenesis-related metabolites, during and after diabetic ketoacidosis (DKA) diagnosis, in youth with known or new onset type 1 diabetes (T1D). Methods: Urine samples were collected from 40 youth with DKA (52% boys, mean age 11 ± 4 years, venous pH 7.2 ± 0.1, blood glucose 451 ± 163 mg/dL) at 3 time points: 0–8 h and 12–24 h after starting an insulin infusion, and 3 months after hospital discharge. Mixed-effects models evaluated the changes in amino acids and other metabolites in the urine. Results: Concentrations of urine histidine, threonine, tryptophan, and leucine per creatinine were highest at 0–8 h (148.8 ± 23.5, 59.5 ± 12.3, 15.4 ± 1.4, and 24.5 ± 2.4% of urine creatinine, respectively), and significantly decreased over 3 months (p = 0.028, p = 0.027, p = 0.019, and p < 0.0001, respectively). Urine histidine, threonine, tryptophan, and leucine per urine creatinine decreased by 10.6 ± 19.2, 0.7 ± 0.9, 1.3 ± 0.9, and 0.5 ± 0.3-fold, respectively, between 0 and 8 h and 3 months. Conclusions: In our study, DKA was associated with profound aminoaciduria, suggestive of proximal tubular dysfunction analogous to Fanconi syndrome.
KW - Aminoaciduria
KW - Diabetic ketoacidosis
KW - Diabetic nephropathy
KW - Pediatrics
KW - Type 1 diabetes
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U2 - 10.1016/j.jdiacomp.2022.108203
DO - 10.1016/j.jdiacomp.2022.108203
M3 - Article
C2 - 35523653
AN - SCOPUS:85129554744
SN - 1056-8727
VL - 36
JO - Journal of Diabetes and its Complications
JF - Journal of Diabetes and its Complications
IS - 6
M1 - 108203
ER -