Nephropathy in Youth and Young Adults with Type 2 Diabetes

Abstract

The occurrence and progression of nephropathy associated with early onset type 2 diabetes is a consequence of the ongoing epidemic of childhood obesity. Minimal evidence regarding treatment effectiveness of renovascular comorbidities in youth with early onset T2D is available, due to the relatively recent emergence of T2D in youth and young adults. Extrapolation of adult therapy guidelines is not an ideal approach to making therapeutic decisions in this population. Evolving management and intervention strategies are based on accumulating longitudinal data from cohorts of well characterized youth and young adults with T2D. The degree of similarity in histologic findings and disease specific characteristics of kidney disease in patients with early onset T2D and albuminuria compared to affected adults is not well characterized. Early aggressive therapies to minimize the impact of nephropathy are indicated as the evidence for best therapies in youth with T2D are further explored.

Diabetes mellitus, a complex and heterogeneous disease, and the role of insulin resistance as a determinant of diabetic kidney disease

“…Historically T2DM has been a disease in older adults but there is an emerging epidemic of T2DM in paediatric subjects and young adults that reflects increasing rates of obesity. Data from the USA on new-onset diabetes in adolescents shows a dramatic rise in the incidence of T2DM over the last [20][21][22][23][24][25][26][27][28][29][30] years from 3 to 45% of all cases with a significant percentage of subjects from ethnic minority groups [6]. These patients are at enhanced risk of early onset of albuminuria and display accelerated progression of albuminuria when compared with T1DM subjects of similar age and adult T2DM patients with similar duration of diabetes [6].…”

“…Data from the USA on new-onset diabetes in adolescents shows a dramatic rise in the incidence of T2DM over the last [20][21][22][23][24][25][26][27][28][29][30] years from 3 to 45% of all cases with a significant percentage of subjects from ethnic minority groups [6]. These patients are at enhanced risk of early onset of albuminuria and display accelerated progression of albuminuria when compared with T1DM subjects of similar age and adult T2DM patients with similar duration of diabetes [6]. Pima Indians with youngonset T2DM have high prevalence rates of hypertension (18%) and microalbuminuria (22%) at diagnosis with estimated prevalence rates of microalbuminuria of 60% and proteinuria of 17% before the age of 30 [6].…”

“…These patients are at enhanced risk of early onset of albuminuria and display accelerated progression of albuminuria when compared with T1DM subjects of similar age and adult T2DM patients with similar duration of diabetes [6]. Pima Indians with youngonset T2DM have high prevalence rates of hypertension (18%) and microalbuminuria (22%) at diagnosis with estimated prevalence rates of microalbuminuria of 60% and proteinuria of 17% before the age of 30 [6].…”

“…Although the exact mechanisms for this enhanced renal risk are yet to be elucidated, increased insulin resistance may be one of the factors involved [6].…”

RAAS inhibitors directly reduce diabetes‐induced renal fibrosis via growth factor inhibition

“…Current treatment strategies may hinder kidney injury, but are unable to stop the progression into CKD (Solis‐Herrera et al . ). Therefore, a better understanding of the molecular mechanisms involved in the pathophysiology of DKD is needed in the research for novel therapeutic concepts.…”