Diabetic kidney disease in children and adolescents

Abstract

Diabetes, more frequently type 1 but increasingly also type 2, commonly occurs in childhood. While more advanced diabetic kidney disease (DKD), e.g. loss of glomerular filtration rate (GFR), does not occur until adulthood, kidney biopsies show DKD structural changes as early as 1.5–5 years after the onset of type 1 diabetes. Earliest clinical sign of DKD, e.g. increased urine albumin excretion, commonly appears during childhood and adolescence and presents an important opportunity to detect and intervene on early DKD, perhaps more successfully than later in the disease course. Longitudinal studies of type 1 diabetes have enriched our understanding of the DKD natural history and modifiable risk factors for DKD progression. These studies have also shown that presence of DKD marks a subset of people with diabetes who are at the highest risk of early mortality, supporting an enhanced focus on DKD detection, prevention, and treatment. Early studies suggest that youth-onset type 2 diabetes is associated with a higher prevalence of comorbidities and risk factors and follows a more aggressive natural history. A deeper understanding of the natural history, risk factors, underlying mechanisms and therapeutic options for DKD in young-onset type 2 diabetes awaits further studies.

Zalecenia Sekcji Pediatrycznej Polskiego Towarzystwa Nadciśnienia Tętniczego dotyczące postępowania diagnostycznego i terapeutycznego w nadciśnieniu tętniczym u dzieci i młodzieży

“…Although AH most often affects patients with T2DM, its prevalence in children and adolescents with T1DM becomes increasingly common clinical problem [97,98]. AH is one of the main risk factors for the development of microand macrovascular complications, cardiovascular disease, and diabetic kidney disease which are the main causes of morbidity and mortality in patients with T1DM and T2DM [99,100].…”

“…The metabolic disorders resulting from chronic hyperglycaemia leading to atherosclerosis and increased arterial stiffness are also involved in the development of hypertension in diabetic patients [106][107][108][109]. Although, renal failure in diabetic kidney disease usually occurs after many years of disease, the early stages of diabetic kidney disease characterized by increased albuminuria are observed also in the paediatric population [110][111][112][113]. In adolescents kidney damage in T1DM is directly related to elevated BP values, and effective antihypertensive treatment slows the progression of kidney damage [114].…”

Osteopontin as a marker of vasculopathy in pediatric patients with type 1 diabetes mellitus: Relation to vascular structure

“…Earliest clinical sign of DKD is increased urine albumin excretion and this commonly appears during childhood and adolescence. It presents an important opportunity to detect and intervene on early DKD, perhaps more successfully than later in the disease course …”

“…It presents an important opportunity to detect and intervene on early DKD, perhaps more successfully than later in the disease course. 5 Osteopontin (OPN) is phosphorylated sialic acid-rich noncollagenous bone matrix protein which was named for its function as a bridge between cells and minerals. 6 OPN is a multifunctional molecule highly expressed in chronic inflammatory and autoimmune diseases, and it is specifically localized in and around inflammatory cells.…”

Effects of Socio-Demographic Factors on Parental Monitoring, and Regimen Adherence Among Adolescents with Type 1 Diabetes: A Moderation Analysis

“…Adolescents with type 1 diabetes are more likely to be engaged in mismanagement behaviors (e.g., diet, missing blood tests, or missing insulin shots); in turn they are more likely to have poorer metabolic control than either their younger or older counterparts (Delamater, Albrecht, Postellon, & Gutai, 1991; Johnson, Silverstein, Rosenbloom, Carter, & Cunningham, 1986; Weissberg-benchell et al, 1995). Poorer metabolic control among adolescents results in risk for severe complications, including retinopathy, kidney failure, and heart disease (Afkarian, 2015; Clement et al, 2004). Therefore, understanding factors that can predict poor adolescent regimen adherence is critical.…”