IS DIABETES MELLITUS A RISK FACTOR FOR CONGENITAL ANOMALIES OF THE KIDNEY AND URINARY TRACT (CAKUT)?

Abstract

Background: Congenital anomalies of kidney and urinary tract (CAKUT) are characterized by structural
and functional abnormalities of kidney, collecting system, bladder, and urethra [1]. In Egypt, CAKUT
comprised 46% of the underlying etiology in Egyptian CKD pediatric patients [2]. Evolving studies
postulating CAKUT and related risk factors addressed diabetes mellitus (DM) as one of preventable risk
factors. However more is needed to address the pattern of DM exposure during pregnancy in relation to
CAKUT occurrence.
Study Design: Retrospective case-control study from April 2018 –November 2020.
Setting & Participants: Children aged (0-5) diagnosed with CAKUT attending Minia University Hospitals
and their controls
Methodology: Questionnaire data were collected from mothers of 150 children with CAKUT and 150
healthy controls. Maternal risk factors investigated included maternal age, residence, history of obesity
during pregnancy and diabetes mellitus. Logistic regression analyses were performed to assess associations
between these potential risk factors and CAKUT occurrence.
Results: 150 case patients with CAKUT and 150 controls aged from 0 to 5 years were interviewed.
Maternal DM occurred in 33 (22%) of CAKUT cases and in 16 (10.7%) of controls (P=0.01) .Maternal pre
gestational DM (diagnosed before pregnancy type 1 or type 2 DM occurred in 7 cases (4.7%) of the
CAKUT group versus 5 cases (3.4%) controls (P=0.5), whereas gestational DM (diagnosed during
pregnancy) occurred in 26 (17.3%) of the CAKUT group and 11 (7.3%) controls (P=0.01). In multivariable
logistic regression model, gestational DM was associated with CAKUT (OR =2.8; 95% CI, 1.3-59),
whereas pre gestational DM was not (OR =1.6; 95% CI, 0.4-5.4).
Conclusions: This study suggests that gestational DM is associated with CAKUT in exposed infants.
Screening and intervention studies in women of childbearing age with DM are warranted to determine
whether the risk of chronic kidney disease in children can be modified.