الفهرس 
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Abstract
In the present study, we suggest that serum NGAL represents a novel biomarker for kidney disease activity in pediatric diabetic patients and a novel biomarker for severity of renal involvement as obvious from its correlation with protein excretion and BUN and we aimed to assess whether Doppler ultrasonography could be used to detect early changes in renal RI in children with type 1 diabetes and the possible correlations between these markers and metabolic parameters
The present study included 35 children and adolescents with type 1 diabetes mellitus. They divided into two groups:
Group 1: included 20 children with type 1 diabetes mellitus: with normoalbuminuria
Group 2: included 15 children and adolescents with type 1 diabetes mellitus with microalbuminuria
Another group of 20 healthy subjects of comparable age and sex were included as control group.
from the course of this study we found that:
- Urinary uNGAL was increased in group 1 and group 2 compared to controls.
-Mean RI was increased in group 1 and group 2 compared to controls.
This was found in the children with type 1diabetes mellitus, all having normal renal function. Increased RI correlates positively with microalbuminurea, and creatinine level. Increased RI correlates positively with duration of diabetes, No correlation between uNGAL and RI was found in the control groups. The significant positive association between uNGAL and Doppler RI in children with diabetes suggests that precocious abnormality in uNGAL production and action occurring early in the course of the disease may have contributed to the loss of maintaining the normal state of vascular tone and, thus, to the higher starting RI values.
In conclusion, this study demonstrates that in children with type 1diabetes mellitus, chronic hyperglycemia may act through a mechanism that involves increased uNGAL production and/or action and contributes to generating intrarenal hemodynamic abnormalities, detectable by Doppler ultrasonography even in early diabetic nephropathy before microalbuminuria appears.
Although our data have to be confirmed in further longitudinal studies, they suggest that evaluation of uNGAL excretion and Doppler intrarenal RI may be a useful complementary test in the evaluation of early stages of diabetic nephropathy. Longitudinal monitoring of a panel of laboratory markers may better define their relevance in progressive kidney disease and provide greater insight into the mechanisms underlying this process.