Diabetic kidney disease in children and adolescents: an update

Lopez, L.N. et al | 2021 |  Diabetic kidney disease in children and adolescents: an update | Pediatric Nephrology | doi.org/10.1007/s00467-021-05347-7

The reviewers of this article review recent updates to the diagnosis and management of diabetic kidney disease (DKD) in children and adolescents.

The review makes the following key points:

  1. The incidence of diabetes, particularly type 2 diabetes, and its complications, are on the rise in children and adolescents, disproportionately affecting racial-ethnic minorities.
  2. The cornerstone in the prevention of diabetic kidney disease is optimal glycemic control, along with screening for and management of hypertension and albuminuria.
  3. GLP1 receptor agonists, in conjunction with metformin, have been shown to have a beneficial effect in reducing the incidence of adverse kidney outcomes, and are now approved for use in older children with type 2 diabetes.
  4. While many new therapies have been studied and approved for use in adults with diabetes and diabetic kidney disease, insufficient progress has been made in performing clinical trials in children and young adults.

Abstract

Diabetic kidney disease (DKD), previously encountered predominantly in adult patients, is rapidly gaining center stage as a childhood morbidity and one that pediatric nephrologists are likely to encounter with increasing frequency. This is in large part due to the obesity epidemic and the consequent rise in type 2 diabetes in children and adolescents, as well as the more aggressive diabetes phenotype in today’s youth with more rapid beta-cell decline and faster development and progression of diabetes-related complications along with lower responsiveness to the treatments used in adults. DKD, an end-organ complication of diabetes, is at the very least a marker of, and more likely a predisposing factor for, the development of adverse cardiovascular outcomes and premature mortality in children with diabetes. On an optimistic note, several new therapeutic approaches are now available for the management of diabetes in adults, such as GLP1 receptor agonists, SGLT2 inhibitors, and DPP4 inhibitors, that have also been shown to have a favorable impact on cardiorenal outcomes. Also promising is the success of very low-energy diets in inducing remission of diabetes in adults. However, the addition of these pharmacological and dietary approaches to the management toolbox of diabetes and DKD in children and adolescents awaits thorough assessment of their safety and efficacy in this population. This review outlines the scope of diabetes and DKD, and new developments that may favorably impact the management of children and young adults with diabetes and diabetic kidney disease.

The full article is available from Pediatric Nephrology 


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