Abstract: TH-OR073
Trajectory from Glomerular Hyperfiltration to Rapid GFR Decline in Youth with Obesity and Type 2 Diabetes as They Transition to Young Adulthood
Session Information
- Precision Medicine in Diabetic Kidney Disease: Biomarkers, Combination Therapies, and Treatment Response Prediction
November 06, 2025 | Location: Room 372A, Convention Center
Abstract Time: 04:30 PM - 04:40 PM
Category: Diabetic Kidney Disease
- 702 Diabetic Kidney Disease: Clinical
Authors
- Narongkiatikhun, Phoom, Chiang Mai University, Chiang Mai, Thailand
- Carrasco, Diego, Lincoln Memorial University, Knoxville, Tennessee, United States
- Choi, Ye Ji, University of Washington, Seattle, Washington, United States
- Pinzon Cortes, Jairo Arturo, University of Washington, Seattle, Washington, United States
- Hampson, Hailey E, University of Washington, Seattle, Washington, United States
- Tommerdahl, Kalie L., University of Washington, Seattle, Washington, United States
- Pyle, Laura, University of Washington, Seattle, Washington, United States
- Bjornstad, Petter, University of Washington School of Medicine, Seattle, Washington, United States
Background
Youth with obesity and type 2 diabetes (T2D) increased risk for early kidney disease as they transition to young adulthood, often beginning with glomerular hyperfiltration and subclinical structural changes. Yet, longitudinal studies using gold-standard measures of glomerular filtration rate (GFR) and renal plasma flow (RPF) to track these changes remain limited.
Methods
We followed 22 youth with obesity and/or T2D (mean[±SD] age 17±2 years) from the Renal-HEIR study. Plasma clearance of iohexol and p-aminohippuric acid (PAH) were used to measure GFR and RPF. Kidney MRI was performed to evaluate total kidney volume (TKV). Urinary albumin-to-creatinine ratio (UACR) was calculated from early morning void.
Results
Over a mean follow-up of 3.3±1.3 years, GFR declined by 5.2% per year from 151±33 to 125±31 mL/min per 1.73m2 (p<0.01), and RPF decreased from 688±99 to 566±75 mL/min per 1.73m2. Prevalence of elevated albuminuria rose from 27% to 41%. Despite reductions in BMI and systolic blood pressure, height-adjusted TKV increased significantly (177±35 to 242±38 mL/m, p<0.01).
Conclusion
This study provides longitudinal evidence of a shift from glomerular hyperfiltration toward structural and functional kidney injury in youth with obesity and T2D. The increase in TKV and albuminuria, along with rapid decline of GFR and RPF, supports a model in which early compensatory hyperfiltration evolves into maladaptive remodeling. Integration of gold-standard clearance and MRI-based metrics offers a mechanistic framework for understanding the natural history of early kidney disease in young persons with obesity and T2D.