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Review
. 2024 Jun;39(6):1865-1873.
doi: 10.1007/s00467-023-06254-9. Epub 2023 Dec 21.

Kidney biopsy findings in children with diabetes mellitus

Lasanthi Weerasooriya  1 , Alexander J Howie  2 , Matthew P Wakeman  3 , Susan Cavanagh  3 , David V Milford  1
Affiliations
Review

Kidney biopsy findings in children with diabetes mellitus

Lasanthi Weerasooriya et al. Pediatr Nephrol. 2024 Jun.

Abstract

Background: Diabetic nephropathy may begin in childhood, but clinical kidney disease ascribable to this is uncommon in children with type 1 (insulin dependent) diabetes mellitus.

Methods: We reviewed our experience of kidney biopsies in children with type 1 diabetes mellitus.

Results: Between 1995 and 2022, there were biopsies in 17 children, with various clinical indications for kidney biopsy, making this the largest series of biopsies in diabetic children with clinical kidney abnormalities. Four biopsies showed diabetic nephropathy, three showed the combination of diabetic nephropathy and IgA nephropathy, and ten showed a variety of conditions other than diabetic nephropathy: minimal change disease (2), membranous nephropathy (2), thin glomerular basement membrane lesion (2), non-glomerular chronic damage in Wolcott-Rallison syndrome (2), acute pauciimmune necrotizing crescentic glomerulonephritis (1) and IgA nephropathy (1). Clinical clues of something other than diabetic nephropathy included acute kidney injury, microscopic haematuria or chronic kidney impairment with little or no proteinuria and the nephrotic syndrome after a short duration of diabetes.

Conclusions: We confirm that changes better known in adults with either type 1 or type 2 diabetes mellitus can occur in children with type 1 diabetes mellitus: overt diabetic nephropathy either on its own or combined with other conditions and kidney disorders other than diabetic nephropathy.

Keywords: Diabetes mellitus; Diabetic nephropathy; Kidney biopsy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

None
A higher resolution version of the Graphical abstract is available as Supplementary information
Fig. 1
Fig. 1
Glomerulus in a child with diabetic nephropathy, class 2a (case 4). There is mild mesangial expansion, with hyaline arteriolosclerosis (arrow) and a capsular drop (double arrowheads)
Fig. 2
Fig. 2
Glomerulus in a child with diabetic nephropathy, class 3 (case 3). As well as hyaline arteriolosclerosis (arrow), there is a mesangial nodule (double arrow)
Fig. 3
Fig. 3
Electron micrograph of the glomerular basement membrane in a child with thin glomerular basement membrane lesion (case 13). Scale bar = 1 mm
Fig. 4
Fig. 4
Electron micrograph of the glomerular basement membrane of normal thickness in a child with minimal change disease (case 10(1)). There is effacement of podocyte foot processes. Scale bar = 1 mm
Fig. 5
Fig. 5
Electron micrograph of thickened glomerular basement membrane in the child with diabetic nephropathy illustrated in Fig. 1 (case 4). Scale bar = 1 mm
Fig. 6
Fig. 6
Electron micrograph of glomerular basement membranes in a child with diabetic nephropathy, class 2a (case 1), showing thickening that is irregular in places, with projections on the epithelial and endothelial aspects and a fibrillary appearance. Scale bar = 1 mm
See this image and copyright information in PMC

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