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First page of Acute kidney injury at the onset of type 1 diabetes mellitus: a balance between kidney stress and nephron mass

IIntroduction: Uromodulin reflects nephron mass, while urinary neutrophil gelatinase-associated lipocalin (NGAL) indicates kidney injury. We hypothesized that low urinary uromodulin at type 1 diabetes mellitus (T1DM) onset may be linked to acute kidney injury (AKI) and that a higher urinary uromodulin-to-NGAL ratio, reflecting the balance between nephron mass and kidney stress, may reduce the risk of AKI. Our aim was to test these hypotheses. Methods: In this prospective study, 75 children (mean age:8.64.3years) hospitalized for new-onset T1DM were enrolled. AKI was defined as a highest-to-basal serum creatinine ratio≥1.5. Urinary NGAL and uromodulin levels were measured at admission and upon kidney injury resolution. Results: Of 75 patients, 33(44%) had diabetic ketoacidosis (11 severe, 10 moderate, 12 mild) and 33 (44%) developed AKI. At T1DM onset, patients with AKI had similar urinary uromodulin levels but higher urinary NGAL levels, higher uromodulin-to-creatinine ratio, and lower urinary uromodulin-to-NGAL ratio than those without AKI. The uromodulin-to-NGAL ratio correlated inversely with the highest-to-basal creatinine ratio (r=–0.42;p<0.001), while NGAL correlated positively (r=0.36;p=0.001). Both urinary NGAL and the uromodulin-to-NGAL ratio at T1DM onset predicted the absence of AKI, with an areas under the receiver-operating characteristic curve of 0.66(95%Confidence Interval[CI]:0.54–0.79;p=0.01) and 0.75(95%CI:0.63–0.86;p<0.001), respectively. Conclusions: Our findings suggest a potential interplay between nephron mass and kidney stress in AKI development at T1DM onset. While uromodulin levels alone were not associated with AKI, a higher urinary uromodulin-to-NGAL ratio –possibly reflecting better-preserved nephron mass under stress– may be linked to a reduced risk of AKI. Further confirmation is needed.

Journal Section:
Brief Report
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S. Karger AG, Basel
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2025
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