Is hyperfiltration associated with the future risk of developing diabetic nephropathy? A meta-analysis.

Aims/hypothesis Glomerular hyperfiltration is a well established phenomenon occurring early in some patients with type 1 diabetes. However, there is no consistent answer regarding whether hyperfiltration predicts later development of nephropathy. We performed a systematic review and meta-analysis of observational studies that compared the risk of developing diabetic nephropathy in patients with and without glomerular hyperfiltration and also explored the impact of baseline GFR.

Methods A systematic review and meta-analysis was carried out. Cohort studies in type 1 diabetic participants were included if they contained data on the development of incipient or overt nephropathy with baseline measurement
of GFR and presence or absence of hyperfiltration.

Results We included ten cohort studies following 780 patients. After a study median follow-up of 11.2 years, 130 patients had developed nephropathy. Using a random effects model, the pooled odds of progression to a minimum
of microalbuminuria in patients with hyperfiltration was 2.71 (95% CI 1.20–6.11) times that of patients with normofiltration. There was moderate heterogeneity (heterogeneity test p=0.05, measure of degree of inconsistency=48%) and some evidence of funnel plot asymmetry, possibly due to publication bias. The pooled weighted mean difference in baseline GFR was 13.8 ml min-1 1.73 m-2 (95% CI 5.0–22.7) greater in the group progressing to nephropathy than in those not progressing (heterogeneity test p<0.01).

Conclusions/interpretation In published studies, individuals with glomerular hyperfiltration were at increased risk of progression to diabetic nephropathy using study level data. Further larger studies are required to explore this relationship and the role of potential confounding variables.

Imaging the future: theatre and change within the child protection system

The use of social pedagogy as a paradigm for critically appraising developments within child and family social work has been largely neglected. This paper outlines the work of Augusto Boal and his adoption of social pedagogy as a method for empowering oppres-sed social groups in Brazil. It is argued that Boal’s approach can be adapted by using action research techniques to analyse and effect change in situations where child care professionals face daily contradictions in their attempts to both protect children and support families. To demonstrate its relevance to child care practice, a description is provided of how the approach was used with two groups of social work students – one undertaking qualifying training, the other post-qualifying training. The results of this application suggest a new theoretical framework for practice which aims to establish communicative consensus around the needs of children and a mutual appreciation of roles and responsibilities.