Pediatric aspects of diabetic kidney disease

Area of Science:

• Pediatric Nephrology
• Diabetology
• Public Health

Background:

• Type 1 diabetes mellitus (DM1) is common in childhood, with increasing rates of type 2 diabetes (DM2) also observed in pediatric populations.
• While kidney failure is rare in childhood, prolonged hyperglycemia from either diabetes type contributes to significant long-term renal complications.
• Early identification and management of diabetic kidney disease (DKD) are crucial for preventing progressive renal damage.

Purpose of the Study:

• To outline a screening strategy for diabetic kidney disease in children with DM1 and DM2.
• To emphasize the importance of early detection and management of renal complications in pediatric diabetes.
• To highlight current recommendations for screening glomerular filtration rate, blood pressure, and urine albumin excretion.

Main Methods:

• Screening for glomerular filtration rate, blood pressure, and urine albumin excretion is recommended for all children with diabetes.
• For DM1, screening should commence 5 years after diagnosis or at puberty.
• For DM2, screening should begin at the time of diagnosis.

Main Results:

• Atypical findings like proteinuria or active urine sediment may necessitate nephrology referral and evaluation, potentially including kidney biopsy.
• Optimal glycemic control is the primary treatment for both DM1 and DM2.
• Anti-angiotensin II drugs are recommended for patients with microalbuminuria or hypertension.

Conclusions:

• Establishing lower blood pressure goals, below the 90th percentile for age, height, and gender, is prudent for children with diabetes, mirroring adult recommendations.
• Continued longitudinal studies and development of novel screening tests are essential for earlier detection of children at risk for DKD.
• Proactive screening and management strategies can potentially prevent or delay the onset of diabetic kidney disease in pediatric populations.