Early diabetic nephropathy in a paediatric patient

Abstract EN

Diabetic nephropathy is the most common cause of end stage renal disease in adults in the United States, and accounts for 16% of adult patients with end stage renal disease in the United Kingdom.

Around 25 - 45% of patients with type 1 diabetes will develop overt nephropathy, the natural history of which includes several stages occurring over 10 to 15 years following the diagnosis of diabetes.

Hence it is considered to be very rare to encounter overt diabetic nephropathy in the paediatric age group. In this case report we describe a 13-year-old girl, who was known to have type I diabetes mellitus, and who was noticed to be poorly controlled because of non-compliance.

After 4 years of diagnosis our patient developed overt nephropathy manifested with oedema and proteinuria of 3.5-g/ day.

Despite the absence of other microvascular complications of diabetes in this particular patient, and the short duration between diabetes and the onset of proteinuria the diagnosis of diabetic nephropathy was confirmed by kidney biopsy and the patient was managed accordingly. Currently it is generally recommended to start screening for macroalbuminuria after five years of diabetes.

This case report plus few others raise the issue of whether screening should be done at an earlier stage than currently recommended, especially so in patients with identified risk factors including poor glycaemic control and pubertal growth spurt