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In an effort to establish a reliable programme for the clincial monitoring of renal involvement in patients with type-I diabetes mellitus, we quantified the urinary excretion of immunoglobulin G (IgG), transferrin (Tf), albumin (Alb), α1-microglobulin (α1MG), N-acetyl-β-D-glucosaminidase (NAG), and total protein in 130 dipstick negative children and young adults with type-I diabetes. Eighty-five sex-and age-matched healthy persons served as a control group for the definition of the upper reference limits (95th centiles; μg min-1 1.73 m2): transferrin 1.4; albumin 16.6; total protein 27.1; NAG: 2.0 mU min-1 1.73 m2. Sex-related differences were detected for IgG (men: 3.8; women: 1.7) and α1MG (men: 6.0; women: 4.0 μg min-1 1.73 m2). The urinary excretion of IgG, Tf, α1MG, NAG, and total protein was significantly higher in subjects with diabetes when compared to healthy controls (p < 0.01). Furthermore, 20 patients (15%) showed an elevated excretion of tubular markers (α1MG and NAG), and 3 patients (2%) of at least two glomerular markers (Alb and/or Tf and/or IgG). Additionally, 18 individuals (14%) presented a mixed excretion pattern of both tubular and glomerular markers. These data suggest that the quantitation of both glomerular and tubular proteinuria provides a sensitive and cost-effective instrument for the non-invasive screening for renal involvement in patients with diabetes mellitus.

GH-tests in 55 children with short stature were compared: 24 hour (q2hr), sleep induced (6hr, q 30 min), Arginin(A)- (0.5 g/kg BW), Insulin(I)- (0.05 µ/kg BW) and GHRH- (1 µg/kg BW GHRH 1-44) stimulated GH-secretion and baseline SMC (U/ml). 20 patients had been diagnosed as growth hormone deficient (GHD; 10 off treatment > 1 year, 10 newly diagnosed) and 35 classified as Non GHD (NGHD) according to a normal spontaneous GH-secretion. Clinically, both groups were similar (CA, BA, growth velocity), GH-levels differed significantly (p < 0.01).In GHD ail tests correlated significantly (p<0.001), in NGHD no correlation was detected. 28 NGHD-patients were verified as constitutional delay (CD) (normal Arg/Ins, normal GHRH and SMC). In 7 NGHD-patients formerly included among CD, additional information was gained by GHRH and SMC results. 3 had pituitary dysfunction (low Arg/Ins and GHRH, normal SMC), 3 had partial GHRH deficiency (low SMC and GHRH, normal Arg/Ins) and 1 had SMC resistance (high Arg/Ins, high SMC and high GHRH).

15N-T and IGF 1-GT were studied by correlating shortterm effects to subsequent growth velocity (GV) during therapy.Methods: Nitrogen excretion Using the stable isotope 15N and IGF 1 were measured before and after 2 IU rHGH/m2BW s.c. on 3 consecutive days in patients with complete growth hormone deficiency (cGHD, n=17). partial GHD (pGHD, n=16) and normal variant short stature (NVSS, n = 18). Only cGHD and pGHD patients were treated for 1 year with rHGH (12 IU/m2xwk). Before treatment there were no significant differences in auxological data between the 3 groups; 15N-T, IGF 1-GT and growth velocity (GV) were compared with GV in the subsequent year either with rHGH-therapy (cGHD and pGHD) or without (NVSS). 15N-excretion was measured by isotope masspectrometry. IGF 1 was determined by a RIA after extraction.Results: The effect of rHGH-administration on the 15N-T differed significantly between the 3 groups. The best response (143±6.9% 15N-retentlon) was seen in the cGHD group, while 130.1±16,4% (P<0.001) in the pGHD and 108.9±6,4% (p<0,001)ln the NVSS group were reached. The IGF 1-GT did not show any differences between the three groups of patients. After 1 year of rHGH therapy GV was 11,3±3 cm/a in the cGHD and 7.6±2,2 cm/a in the pHGH group. The GV in the untreated NVSS patients was significantly lower (4,2±1,7 cm/a) compared to the cGHD (p<0,001) and the pGHD (p<0.001) patients. The 15N-T can discriminate between patients with complete and partial GHD and patients with short stature after only 3 injections of rHGH. A correlation between 15N-T and GV after 1 year of rHGH treatment was seen in the pGHD group (r=0,87). IGF 1-GT as well GV before treatment were not suitable to predict growth hormone response in any group.Conclusions: In this study the 15N-T was reliable in differentiating the 3 groups of patients and in predicting the response to growth hormone treatment in patients with pGHD.