Pediatric Nephrology

, Volume 5, Issue 3, pp 359–363 | Cite as

The role of the pediatric nephrologist in the care of children with diabetes mellitus

  • Pascale Lane
  • Michael Steffes
  • S. Michael Mauer
Occasional Survey

Abstract

The pediatric nephrologist has traditionally not been involved in the care of the diabetic child since diabetic nephropathy presents in adulthood. Recent studies suggest that diabetic kidney disease develops silently during childhood. Measurement of urinary albumin excretion (UAE) allows earlier detection of patients at risk of nephropathy, often in adolescence. In addition to diabetic nephropathy, diabetic children are at risk of urinary tract infections, renal papillary necrosis, and various forms of glomerulonephritis. The role of the pediatric nephrologist in the care of the child with diabetes might include advising on the administration and interpretation of screening for UAE and the measurement and interpretation of glomerular filtration rate, and blood pressure. Children with evidence of renal dysfunction should be evaluated and treated by the pediatric nephrologist. Frequently, renal biopsy will be necessary in these patients. Future research may allow the detection of diabetic kidney disease earlier in childhood, further expanding the role of the pediatric nephrologist. In particular, early renal biopsy may eventually be used to select those patients at risk of diabetic nephropathy for specific treatment alterations.

Key words

Diabetes mellitus Nephropathy Renal biopsy Urinary albumin excretion Blood pressure 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Rao TKS, Hirsh, S, Avram MM, Friedman EA (1980) Prevalence of diabetic nephropathy in Brooklyn. In: Friedman EA, L'Esperance FA Jr (eds) Diabetic renal-retinal syndrome. Grune and Stratton, New York, pp 205–207Google Scholar
  2. 2.
    Christiansen JS, Anderson AR, Koch Anderson J, Deckert T (1985) The natural history of diabetic nephropathy Diabetic Nephropathy 4:104Google Scholar
  3. 3.
    Christiansen JS, Gammelgaard J, Svendsen PA, Tronier B, Parving H-H (1982) Kidney function and size in diabetic before and during initial insulin treatment. Kidney Int 21:683–688PubMedGoogle Scholar
  4. 4.
    Mogensen CE, Andersen NJF (1973) Increased kidney size and glomerular filtration rate in early juvenile diabetes. Diabetes 22:706–712PubMedGoogle Scholar
  5. 5.
    Mogensen CE, Andersen MJF (1975) Increased kidney size and glomerular filtration rate in untreated juvenile diabetes: normalization by insulin treatment. Diabetologia 11:221–224PubMedGoogle Scholar
  6. 6.
    Parving H-H, Oxenbøll B, Svendsen PA, Christiansen JS, Andersen AR (1982) Early detection of patients at risk of developing diabetic nephropathy. A longitudinal study of urinary albumin excretion. Acta Endocrinol (Copenh) 100:550–555Google Scholar
  7. 7.
    Viberti GC, Jarrett RJ, Mahmud U, Hill RD, Argyropoulos A, Keen H (1982) Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet II:1430–1432Google Scholar
  8. 8.
    Mogensen CE, Christensen CK (1984) Predicting diabetic nephropathy in insulin-dependent patients. N Engl J Med 311:89–93PubMedGoogle Scholar
  9. 9.
    Mathiesen ER, Oxenbøll B, Johansen K., Svendsen PA, Deckert T (1984) Incipient nephropathy in type I (insulin-dependent) diabetes. Diabetologia 26:406–410PubMedGoogle Scholar
  10. 10.
    Mogensen CE, Christensen CK, Vittinghus E (1983) The stages in diabetic renal disease. Diabetes 32 [Suppl 2]: 64–78PubMedGoogle Scholar
  11. 11.
    Viberti G, Mackintosh D, Biloas RW, Pickup JC, Keen H (1982) The proteinuria of diabetes mellitus. The role of spontaneous and experimental variation of glycaemia. Kidney Int 21:714–720PubMedGoogle Scholar
  12. 12.
    Mogensen CE (1982) Long-term antihypertensive treatment inhibiting progression of diabetic nephropathy. Br Med J 285:685–688Google Scholar
  13. 13.
    Parving H-H, andersen AR, Smidt UM, Christiansen JS, Oxenbøll B, Svendsen PA (1983) Diabetic nephropathy and arterial hypertension: the effect of antihypertensive treatment. Diabetes 32 [Suppl 2]: 83–87PubMedGoogle Scholar
  14. 14.
    Parving H-H, Andersen AR, Smidt UM, Svendsen PA (1983) Early aggressive antihypertensive treatment reduces rate of decline in kidney function in diabetic nephropathy. Lancet I:1175–1179Google Scholar
  15. 15.
    Parving H-H, Andersen AR, Smidt UM, Hommel E, Mathiesen ER, Svendsen PA (1987) Effect of antihypertensive treatment on kidney function in diabetic nephropathy. Br Med J 294:1443–1447Google Scholar
  16. 16.
    Mogensen CE (1988) Management of diabetic renal involvement and disease. Lancet I:867–870Google Scholar
  17. 17.
    Kunin CM (1971) Epidemiology and natural history of urinary tract infection in school age children. Pediatr Clin North Am 18:509–527PubMedGoogle Scholar
  18. 18.
    Wheat LJ (1980) Infection and diabetes mellitus. Diabetes Care 3: 187–197PubMedGoogle Scholar
  19. 19.
    Edmondson HA, Martin HE, Evans N (1947) Necrosis of renal papillae and acute pyelonephritis in diabetes mellitus. Arch Intern Med 79:148–175Google Scholar
  20. 20.
    Mujais SK (1984) Renal Papillary necrosis in diabetes mellitus. Semin Nephrol 4:40–47Google Scholar
  21. 21.
    Groop L, Laasonen L, Edgren J (1989) Renal papillary necrosis in patients with IDDM. Diabetes Care 12:198–202PubMedGoogle Scholar
  22. 22.
    Robinson GC, McConnell D (1961) Simultaneous onset of diabetes mellitus and the nephrotic syndrome. Can Med Assoc J 85:80–81PubMedGoogle Scholar
  23. 23.
    Urizar RE, Schwartz A, Top F, Vernier RL (1969) The nephrotic syndrome in children with diabetes mellitus of recent onset. N Engl J Med 281:173–181PubMedGoogle Scholar
  24. 24.
    Bortolussi R, Aterman K (1980) Proptosis, hematuria and proteinuria in a 10-year-old girl. Can Med Assoc J 122:1250–1258PubMedGoogle Scholar
  25. 25.
    Epstein SE, Becker EL (1961) Acute glomerulonephritis in an adult with longstanding diabetes mellitus. Ann Intern Med 54:97–103PubMedGoogle Scholar
  26. 26.
    Warms PC, Rosenbaum BJ, Michelis MF, Haas JE (1973) Idiopathic membranous glomerulonephritis occurring with diabetes mellitus. Arch Intern Med 132:735–738PubMedGoogle Scholar
  27. 27.
    Sharma HM, Yum MN, Kleit S (1974) Acute glomerulonephritis with diabetes mellitus. Arch Pathol 97:152–154PubMedGoogle Scholar
  28. 28.
    Olivero J, Suki WN (1977) Acute glomerulonephritis complicating diabetic nephropathy. Arch Intern Med 137:732–734PubMedGoogle Scholar
  29. 29.
    Wass JAH, Watkins PJ, Dische FE, Parsons V (1978) Renal failure, glomerular disease and diabetes mellitus. Nephron 21:289–296PubMedGoogle Scholar
  30. 30.
    Aziz S, Cohen AH, Winer RL, Llach F, Massry SG (1979) Diabetes mellitus with immune complex glomerulonephritis. Nephron 23: 32–37PubMedGoogle Scholar
  31. 31.
    Rao KV, Crosson JT (1980) Idiopathic membranous glomerulonephritis in diabetic patients. Arch Intern Med 140:624–627PubMedGoogle Scholar
  32. 32.
    Kobayashi K, Harada A, Onoyama K, Shimamatsu K, Maeda T, Fujimi S, Omae T (1981) Idiopathic membranous glomerulonephritis associated with diabetes mellitus. Nephron 28:163–168PubMedGoogle Scholar
  33. 33.
    Garstens SA, Hebert LA, Garancis JL, Piering WF, Lemann J (1982) Rapidly progressive glomerulonephritis superimposed on diabetic glomerulosclerosis. JAMA 247:1453–1457PubMedGoogle Scholar
  34. 34.
    Bertani T, Olesnicky L, Abu-Regiaba S, Glasberg S, Pirani CL (1983) Concomitant presence of three different glomerular diseases in the same patient. Nephron 34:260–266PubMedGoogle Scholar
  35. 35.
    Kasinath BS, Mujais SK, Spargo BH, Katz AI (1983) Nondiabetic renal disease in patients with diabetes mellitus. Am J Med 75: 613–617PubMedGoogle Scholar
  36. 36.
    Sabnis SG, Antonovych TT (1983) Diabetic nephropathy with superimposed immune complex glomerulonephritis. South Med J 76: 456–461PubMedGoogle Scholar
  37. 37.
    Cavallo T, Pinto JA, Rajaraman S (1984) Immune complex disease complicating diabetic glomerulosclerosis. Am J Nephrol 4:347–354PubMedGoogle Scholar
  38. 38.
    Yum M, Maxwell DR, Hamburger R, Kleit S (1984) Primary glomerulonephritis complicating diabetic nephropathy. Hum Pathol 15: 921–927PubMedGoogle Scholar
  39. 39.
    Amoah E, Glickman JL, Malchoff CD, Sturgill BC, Kaiser DL, Bolton WK (1988) Clinical identification of nondiabetic renal disease in diabetic patients with type I and type II disease presenting with renal dysfunction. Am J Nephrol 8:204–211PubMedGoogle Scholar
  40. 40.
    Krolewski AS, Warram JH, Christlieb AR, Busick EJ, Kahn CR (1985) The changing natural history of nephropathy in type I diabetes. Am J Med 78:785–794PubMedGoogle Scholar
  41. 41.
    Andersen AR, Christiansen JS, Andersen JK, Kreiner S, Deckert T (1983) Diabetic nephropathy in type I (insulin-dependent) diabetes: an epidemiological study. Diabetologia 25:496–501PubMedGoogle Scholar
  42. 42.
    Goldfarb S, Simmons DA, Kern GFO (1986) Amelioration of glomerular hyperfiltration in acute experimental diabetes mellitus by dietary myo-inositol supplementation and aldose reductase inhibition. Trans Assoc Am Physicians 99:67PubMedGoogle Scholar
  43. 43.
    Seaquist ER, Goetz FC, Rich S, Barbosa J (1989) Familial clustering of diabetic kidney disease. N Engl J Med 320:1161–1165PubMedGoogle Scholar
  44. 44.
    Luke RG, Byrne CM, Blodgett JR, Nedelman JR (1990) The relationship between socioeconomic status, race, and the incidence of end-stage renal disease. J Am Soc Nephrol 1:337Google Scholar
  45. 45.
    Krolewski AS, Canessa M, Warram JH, Laffel LMB, Christlieb AR, Knowler WL, Rand LI (1988) Predisposition to hypertension and susceptibility to renal disease in insulin-dependent diabetes mellitus. N Engl J Med 318:140–145PubMedGoogle Scholar
  46. 46.
    Jensen JS, Mathiesen ER, Nørgaard K, Hommel E, Borch-Johnsen K, Funder J, Brahm J, Parving H-H, Deckert J (1990) Increased blood pressure and erythrocyte sodium/lithium countertransport activity are not inherited in diabetic nephropathy. Diabetologia 33: 619–624PubMedGoogle Scholar
  47. 47.
    Mogensen CE (1986) Early glomerular hyperfiltration in insulin-dependent diabetics and late nephropathy. Scand J Clin Lab Invest 46: 201–206PubMedGoogle Scholar
  48. 48.
    Lervang H-H, Jensen S, Brøchner-Mortensen J, Ditzel J (1988) Early glomerular hyperfiltration and the development of late nephropathy in type I (insulin-dependent) diabetes mellitus. Diabetologia 31: 723–729PubMedGoogle Scholar
  49. 49.
    Mogensen CE (1990) Prediction of clinical diabetic nephropathy in IDDM patients. Diabetes 39:761–767PubMedGoogle Scholar
  50. 50.
    Mauer SM, Steffes MW, Ellis EN, Sutherland DER, Brown DM, Goetz FC (1984) Structural-functional relationships in diabetic nephropathy. J Clin Invest 74:1143–1155PubMedGoogle Scholar
  51. 51.
    Ellis EN, Steffes MW, Goetz FC, Sutherland DER, Mauer SM (1986) Glomerular filtration surface in type I diabetes mellitus. Kidney Int 29:889–894PubMedGoogle Scholar
  52. 52.
    Østerby R, Parving H-H, Nyberg G, Hommel E, Jørgensen HE, Løkkegaard H, Svalander C (1988) A strong correlation between glomerular filtration rate and filtration surface in diabetic nephropathy. Diabetologia 31:265–270PubMedGoogle Scholar
  53. 53.
    Steffes MW, Østerby R, Chavers B, Mauer SM (1989) Mesangial expansion as a central mechanism for loss of kidney function in diabetic patients. Diabetes 38:1077–1081PubMedGoogle Scholar
  54. 54.
    Bilous RW, Mauer SM, Sutherland DER, Steffes MW (1989) Mean glomerular volume and rate of development of diabetic nephropathy. Diabetes 38:1142–1147PubMedGoogle Scholar
  55. 55.
    Chavers BM, Bilous RW, Ellis EN, Steffes MW, Mauer SM (1989) Glomerular lesions and urinary albumin excretion in type I diabetic patients without overt proteinuria. N Engl J Med 320:966–970PubMedGoogle Scholar
  56. 56.
    Howey JEA, Browning MCK, Fraser CG (1989) Biologic variation of urinary albumin: consequences for analysis, specimen collection, interpretation of results, and screening programs. Am J Kidney Dis 13:35–37PubMedGoogle Scholar
  57. 57.
    Gibb DM, Shah V, Preece M, Barratt TM (1989) Variability of urine albumin excretion in normal and diabetic children. Pediatr Nephrol 3:414–419PubMedGoogle Scholar
  58. 58.
    Laborde K, Levy-Marchal C, Kindermans C, Dechaux M, Czernichow P, Sachs C (1990) Glomerular function and microalbuminuria in children with insulin-dependent diabetes. Pediatr Nephrol 4: 39–43PubMedGoogle Scholar
  59. 59.
    Neuman RG, Bonomini LV, Braunstein SNL (1990) Evaluation of new rapid office test for microalbuminuria and its comparison to fully quantitative radioimmunoassay. Diabetes Care 13:1069–1073PubMedGoogle Scholar
  60. 60.
    Feldt-Rasmussen B, Mathiesen ER, Deckert T (1986) Effect of two years of strict metabolic control on progression of incipient nephropathy in insulin-dependent diabetes. Lancet II:1300–1304Google Scholar
  61. 61.
    Mathiesen ER, Hommel E, Guse J, Parving H-H (1990) Captopril postpones and may even prevent development of diabetic nephropathy. Diabetes [Suppl] 39:72AGoogle Scholar
  62. 62.
    Task Force on Blood Pressure Control (1987) Report of the second task force on blood pressure control in children — 1987. Pediatrics 79:1–25Google Scholar
  63. 63.
    Nørgaard K, Feldt-Rasmussen B, Borch-Johnsen K, Saelan H, Deckert T (1990) Prevalence of hypertension in type I (insulin-dependent) diabetes mellitus, Diabetologia 33:407–410PubMedGoogle Scholar
  64. 64.
    Mauer SM, Chavers BM, Steffes MW (1990) Should there be an expanded role for kidney biopsy in the management of patients with type I diabetes? Am J Kidney Dis 16:96–100PubMedGoogle Scholar

Copyright information

© IPNA 1991

Authors and Affiliations

  • Pascale Lane
    • 1
  • Michael Steffes
    • 2
  • S. Michael Mauer
    • 1
  1. 1.Department of PediatricsUniversity of MinnesotaMinneapolisUSA
  2. 2.Laboratory Medicine and PathologyUniversity of MinnesotaMinneapolisUSA

Personalised recommendations