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World J Diabetes. Aug 15, 2022; 13(8): 587-599
Published online Aug 15, 2022. doi: 10.4239/wjd.v13.i8.587
Diabetic kidney disease in pediatric patients: A current review
Carmen Muntean, Iuliana Magdalena Starcea, Claudia Banescu
Carmen Muntean, Department of Pediatrics I, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, Târgu Mures 540142, Romania
Iuliana Magdalena Starcea, Department of IVth Pediatrics, University of Medicine and Pharmacy “Grigore T. Popa”, Iasi 700115, Romania
Claudia Banescu, Center for Advanced Medical and Pharmaceutical Research, University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Mureș, Târgu Mures 540142, Romania
Author contributions: All authors contributed equally to this work; Muntean C and Banescu C contributed to conception and design of the work, interpreting the relevant literature and drafting the manuscript; Muntean C, Banescu C and Starcea IM performed the research of the literature; Muntean C and Starcea IM made critical revisions of the manuscript; all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Carmen Muntean, MD, PhD, Associate Professor, Department of Pediatrics I, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, Gheorghe Marinescu No. 38, Târgu Mures 540142, Romania. duicucarmen@yahoo.com
Received: March 27, 2022
Peer-review started: March 27, 2022
First decision: May 30, 2022
Revised: June 13, 2022
Accepted: July 11, 2022
Article in press: July 11, 2022
Published online: August 15, 2022
Processing time: 137 Days and 22.9 Hours
Abstract

In the last decades, a significant increase in the incidence of diabetic kidney disease (DKD) was observed concomitant with rising diabetes mellitus (DM) incidence. Kidney disease associated with DM in children and adolescents is represented by persistent albuminuria, arterial hypertension, progressive decline in estimated glomerular filtration rate to end-stage renal disease and increased cardiovascular and all-cause morbidity and mortality of these conditions. In medical practice, the common and still the “gold standard” marker for prediction and detection of diabetic kidney involvement in pediatric diabetes is represented by microalbuminuria screening even if it has low specificity to detect early stages of DKD. There are some known limitations in albuminuria value as a predictor biomarker for DKD, as not all diabetic children with microalbuminuria or macroalbuminuria will develop end-stage renal disease. As tubular damage occurs before the glomerular injury, tubular biomarkers are superior to the glomerular ones. Therefore, they may serve for early detection of DKD in both type 1 DM and type 2 DM. Conventional and new biomarkers to identify diabetic children and adolescents at risk of renal complications at an early stage as well as renoprotective strategies are necessary to delay the progression of kidney disease to end-stage kidney disease. New biomarkers and therapeutic strategies are discussed as timely diagnosis and therapy are critical in the pediatric diabetic population.

Keywords: Diabetes; Kidney disease; Biomarkers; Microalbuminuria; Therapy; Children

Core Tip: Several reviews in the literature contributed to the pathophysiology, diagnostics and therapeutic options for diabetic kidney disease in pediatric patients. In this review, we reported the latest data regarding novel biomarkers and methods to identify diabetic children and adolescents at risk of renal complications at an early stage as well as renoprotective strategies to delay the progression of kidney disease to end-stage kidney disease.