الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: Type 1 diabetes occurs when there is the autoimmune destruction of pancreatic beta cells leading to insufficient insulin production and resulting hyperglycemia. With insulin replacement, type 1 diabetes is a chronic disease requiring intensive effort on the part of the person with diabetes and caregivers. There is an emphasis on reducing hyperglycemia while minimizing the risk of hypoglycemia. The complex balance of glucose is affected by food, insulin doses, body stresses, exercise, and dozens of other factors( American Diabetes Association, 2019). Diabetic nephropathy (DN) occurs in 20-40% of patients with diabetes and is a major cause of end-stage renal disease (ESRD). The impact on life quality is serious and the cost of treatment is high for patients with ESRD. chronic renal disease is also associated with premature mortality in patients with diabetes. Since most patients with type 1 diabetes (T1D) were diagnosed in childhood or adolescents, early detection and prevention of DN are necessary ( Huang et al,2017). Diffusion MRI can assess cellular density and cytoarchitecture based on the measurement of water diffusivity [6]. Diffusion abnormalities of water molecules, captured by DWI, can reflect changes of tissue organization and impediments in water molecule motion at a cellular level. The diffusion-sensitizing effects from the gradients are indicated by the b-value (s/mm), which represents the duration between gradient pulses that water molecules are allowed to diffuse before the distance is measured (Thoeny et al,2012). Aim of the work : The aim of this work is to assess role of magnetic resonance diffusion weighted imaging in diagnosis of nephropathy in diabetic patients in pediatric age. The secondary end point is to find cut off point to diagnose diabetic nephropathy by magnetic resonance diffusion weighted imaging. Materials and Methods: This study is a prospective observational case control study and was carried out in outpatient clinics at Mansoura University Children Hospital (MUCH) In the period between January 2019 and January 2020. The study involved 60 subject divided into 30 patients with type 1 diabetes mellitus (T1DM) with duration more than 3 years and 30 control healthy child with matched age and sex. The patient group subdivided into two groups diabetic patients with microalbuminuria and diabetic patients without microalbuminuria. All patients were subjected to detailed history taking and complete physical examination. Laboratory investigations included HbA1c, serum creatinine, 24 hour urinary albumin excretion and kidney magnetic resonance diffusion weighted imaging by Philips Enginea MRI device. All MR acquisitions were acquired on a Philips Enginea 1.5‐T machine scanner in the supine position utilizing a multichannel surface coil. No intravenous contrast was used. The sequences included in the imaging protocol were conventional SSFSE axial, coronal and sagittal scout images followed by T2-weighted (axial and coronal fast spin echo, TE = 100ms, TR = min and slice thickness of 3mm) breath hold images for anatomic details. Axial, breath-held diffusion weighted sequences were acquired with b-values of 50, 500 and 700 s/mm2. Results: This study demonstrates that there is a significant difference between patient and control groups and between normoalbuminuric and microalbuminuric patients regarding mean renal ADC. Also, there is statistically significant positive correlation between GFR and mean renal ADC. Whereas there is statistically significant negative correlation between mean ADC and albumin in urine. Conclusion: We concluded that there is a significant difference between patient and control groups and between normoalbuminuric and microalbuminuric patients regarding mean renal ADC. Also, there is statistically significant positive correlation between GFR and mean renal ADC. Whereas there is statistically significant negative correlation between mean ADC and albumin in urine.