Pediatric Diabetic Kidney Disease: A Review

Concomitant with the increasing incidence of diabetes mellitus in recent decades, there has been a significant increase in the incidence of diabetic kidney disease (DKD). In children and adolescents, kidney disease associated with diabetes mellitus is represented by persistent albuminuria, arterial hypertension, progression in decline in estimated glomerular filtration rate, development of end-stage renal disease (ESRD), and increased cardiovascular and all-cause morbidity and mortality. In a recent issue of the World Journal of Diabetes, Carmen Muntean, MD, PhD, and colleagues provided an overview of diabetic kidney disease in pediatric patients [World J Diabetes. 2022;13(8):587-599].

The gold standard marker for the prediction and detection of diabetic kidney involvement in pediatric diabetes is microalbuminuria screening, regardless of low specificity to detect early stages of DKD. There are some limitations of albuminuria value as a predictive biomarker for DKD as some children with microalbuminuria or macroalbuminuria do not develop ESRD.

Because tubular damage occur prior to glomerular injury, tubular biomarkers are superior to glomerular markers. Tubular markers may provide early detection of DKD in patients with type 1 diabetes mellitus as well as those with type 2 diabetes mellitus.

Conventional and novel biomarkers to identify children and adolescents with diabetes who are at risk for renal complications at early stages and renoprotective strategies are needed to delay progression of kidney disease in the pediatric population. The review includes new biomarkers and therapeutic strategies for timely diagnosis and treatment for pediatric patients with diabetes.