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Comparative Proteomic Analysis of Whole Kidney, Medulla, and Cortical Tubules in Diabetic Pathogenesis of Kidney Injury in Mice
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Comparative Proteomic Analysis of Whole Kidney, Medulla, and Cortical Tubules in Diabetic Pathogenesis of Kidney Injury in Mice

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New trends in the treatment of diabetic nephropathy in children

Alberto Verrotti1, Daniela Trotta, Giovanna di Corcia

  • 1Department of Pediatrics, Ospedale Policlinico, Via dei Vestini, Chieti, Italy. chiarelli@unich.it

Expert Opinion on Pharmacotherapy
|August 2, 2002
PubMed

Insights

Diabetic nephropathy in children with Type 1 diabetes is concerning. Microalbuminuria during puberty may resolve, but hypertension worsens outcomes, necessitating careful reno-protective drug use discussions.

Area of Science:

  • Nephrology
  • Diabetology
  • Pediatrics

Background:

  • Diabetic nephropathy is a leading cause of morbidity and mortality in Type 1 diabetes patients.
  • Persistent microalbuminuria is a key risk marker in adults, while puberty presents a critical period for microvascular complications in children.
  • Hypertension exacerbates both micro and macrovascular complications.

Purpose of the Study:

  • To review controversial aspects of managing microalbuminuria in pediatric Type 1 diabetes.
  • To discuss the natural history of microalbuminuria during puberty and its implications for treatment.
  • To evaluate the role of reno-protective drugs in pediatric diabetic nephropathy.

Main Methods:

  • Review of existing literature on diabetic nephropathy in pediatric populations.
  • Analysis of the significance of microalbuminuria and hypertension during puberty.
  • Discussion of current and potential therapeutic strategies, including ACE inhibitors and ARBs.

Main Results:

  • Microalbuminuria in pediatric Type 1 diabetes during puberty may be transient, with up to 50% reverting to normoalbuminuria.
  • Hypertension is a significant risk factor accelerating complications.
  • Angiotensin-converting enzyme inhibitors are currently favored for treating diabetic nephropathy, with angiotensin II receptor antagonists as a potential future choice.

Conclusions:

  • There is a lack of consensus regarding the treatment and timing of reno-protective interventions in pediatric patients with microalbuminuria.
  • Further research is needed to clarify the natural history of microalbuminuria in this age group to guide therapeutic decisions.
  • Optimizing management strategies is crucial to prevent long-term renal damage in children with Type 1 diabetes.

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