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Purpose of Review <p>Diabetic kidney disease (DKD) is a significant complication of youth‑onset diabetes with profound implications for long-term morbidity and mortality. Early structural changes precede the onset of albuminuria and functional decline, and are largely driven by a broader cardiometabolic risk milieu extending beyond suboptimal HbA1C targets. Management in paediatrics centres on early recognition and timely intervention targeting these modifiable factors.</p> Recent findings <p>Strict blood pressure, lipid, and weight control alongside encouraging physical activity and smoking cessation should be combined with intensive glycaemic regulation aiming for near-normoglycaemia with reduced variability. Renin–angiotensin system blockade is recommended for persistent albuminuria and/or hypertension. SGLT2 inhibitors and GLP‑1 agonists are established in adult DKD management and their renoprotective role in paediatrics is evolving as promising adjuncts when initiated for glycaemic and/or weight indications. Vigilance for atypical features suggesting non‑diabetic kidney injury is advised to ensure appropriate diagnosis and management. Emerging biomarkers aim to detect evidence of early structural kidney injury prior to overt functional decline although not yet adapted for clinical practice.</p> Summary <p>Embedding a multidisciplinary, nephrology‑engaged DKD prevention bundle including individualised risk stratification, active surveillance, and early renoprotective interventions into routine paediatric diabetes care is currently the most effective approach to offset DKD development and slow progression. </p>

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Paediatric Diabetic Kidney Disease: Screening, Signs, and Strategies

  • 期刊论文

  • 发表日期：

    2026年7月14日

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  • Asmaa A. Milyani,
  • Hadel AlSubaie,
  • Atessa Bahadori,
  • Rishil Patel,
  • Nithiakishna Selvathesan

摘要

Purpose of Review

Diabetic kidney disease (DKD) is a significant complication of youth‑onset diabetes with profound implications for long-term morbidity and mortality. Early structural changes precede the onset of albuminuria and functional decline, and are largely driven by a broader cardiometabolic risk milieu extending beyond suboptimal HbA1C targets. Management in paediatrics centres on early recognition and timely intervention targeting these modifiable factors.

Recent findings

Strict blood pressure, lipid, and weight control alongside encouraging physical activity and smoking cessation should be combined with intensive glycaemic regulation aiming for near-normoglycaemia with reduced variability. Renin–angiotensin system blockade is recommended for persistent albuminuria and/or hypertension. SGLT2 inhibitors and GLP‑1 agonists are established in adult DKD management and their renoprotective role in paediatrics is evolving as promising adjuncts when initiated for glycaemic and/or weight indications. Vigilance for atypical features suggesting non‑diabetic kidney injury is advised to ensure appropriate diagnosis and management. Emerging biomarkers aim to detect evidence of early structural kidney injury prior to overt functional decline although not yet adapted for clinical practice.

Summary

Embedding a multidisciplinary, nephrology‑engaged DKD prevention bundle including individualised risk stratification, active surveillance, and early renoprotective interventions into routine paediatric diabetes care is currently the most effective approach to offset DKD development and slow progression.