Biomarkers for Early Detection of Diabetic Kidney Disease in Pediatric and Adolescent Populations: A Narrative Review

Diabetic nephropathy is among the most critical long-term complications linked to diabetes, substantially influencing both morbidity and mortality. Although it was once largely associated with adults, diabetic kidney disease (DKD) has now become a leading source of kidney complications among children worldwide. Acting as both an indicator and predictor of cardiovascular complications and end-stage kidney disease (ESKD), DKD in pediatric diabetic patients is of increasing concern.

This study was conducted as a narrative review of the literature focusing on emerging biomarkers for the early detection of diabetic kidney disease in pediatric and adolescent populations.

Traditionally, microalbuminuria assessed through spot urine samples remains the standard method for identifying early kidney involvement in patients with diabetes. However, growing evidence suggests that renal tubular injury often precedes overt glomerular damage, particularly in pediatric and adolescent populations. This highlights the potential value of tubular biomarkers, such as neutrophil gelatinase‑associated lipocalin (NGAL) and kidney injury molecule‑1 (KIM‑1), which may detect subclinical kidney injury before the onset of persistent albuminuria. Emerging biomarkers, including cystatin C, liver‑type fatty acid‑binding protein (L‑FABP), inflammatory mediators, and metabolic markers, may further improve the early identification and risk stratification of diabetic kidney disease, enabling timely intervention and personalized monitoring strategies in children and adolescents with diabetes.

Identifying new biomarkers for early-stage kidney involvement in diabetic youth could significantly enhance timely diagnosis and treatment strategies.