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Renal Involvement in Children with Type 2 Diabetes Mellitus Onset: A Pilot Study

Pierluigi Marzuillo1, Anna Di Sessa1, Pier Luigi Palma1

  • 1Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 801138 Naples, Italy.

Children (Basel, Switzerland)
|August 27, 2021
PubMed

Insights

In children with new-onset Type 2 Diabetes Mellitus (T2DM), acute kidney injury (AKI) was not observed. However, renal tubular damage (RTD) was detected in three out of ten pediatric patients.

Area of Science:

  • Pediatric Nephrology
  • Endocrinology
  • Diabetology

Background:

  • Type 2 Diabetes Mellitus (T2DM) is a significant risk factor for chronic kidney disease (CKD) in adults.
  • The occurrence of acute kidney injury (AKI) and renal tubular damage (RTD) in children with T2DM remains understudied.
  • AKI can escalate the risk of developing CKD, while RTD may precede AKI.

Purpose of the Study:

  • To determine the prevalence of AKI and RTD in children newly diagnosed with T2DM.
  • To identify potential clinical features associated with AKI and RTD in this pediatric population.

Main Methods:

  • A prospective study enrolled 10 children (mean age 12.9 ± 2.3 years) with newly diagnosed T2DM.
  • AKI was diagnosed based on KDIGO criteria.
  • RTD was defined by elevated urinary beta-2-microglobulin, reduced tubular reabsorption of phosphate (TRP <85%), or increased fractional excretion of sodium (FeNa >2%).

Main Results:

  • No participants developed AKI.
  • Three out of ten children (30%) exhibited signs of RTD, characterized by high beta-2-microglobulin levels.
  • Among those with RTD, one patient also had decreased TRP, and two presented with proteinuria. Patients with RTD showed higher beta-2-microglobulin, creatinine ratios, and serum ketones.

Conclusions:

  • In this pilot study, pediatric T2DM onset was not associated with AKI.
  • A significant proportion of children with new-onset T2DM showed evidence of RTD.
  • RTD, indicated by elevated beta-2-microglobulin, may be an early renal complication in pediatric T2DM.

Keywords:
acute kidney injurychildrenrenal tubular damagetype 2 diabetes mellitus

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