Diabetic Kidney Disease in Childhood and Adolescence: Conventional and Novel Renoprotective Strategies

Uwaezuoke, Samuel N; Ayuk, Adaeze

doi:10.33590/emjnephrol/20-00077

Cited by 2 publications

(5 citation statements)

References 82 publications

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“…These renoprotective effects can therefore be adjudged as glucose-lowering dependent. Strict glycemic control and glucose-lowering agents (such as sodium-glucose transporter 2 inhibitors, glucagon-like peptide-1 analogs, and dipeptidyl peptidase 4 inhibitors) enhance or synergize with the renoprotective activity of vitamin D ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

“…Conventional renoprotective interventions against DKD progression target specific modifiable risk factors, whereas the novel strategies act at specific stages of disease pathogenesis ( 14 ). Both conventional interventions (strict glycemic control, control of hypertension, treatment of dyslipidemia, and lifestyle modification) and novel drugs (uric acid antagonists, vitamin D analogs, endothelin receptor antagonists, and glucose-lowering agents) are effective in slowing down the onset of DKD or its progression to ESKD.…”

Section: Introductionmentioning

confidence: 99%

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Vitamin D Analogs Can Retard the Onset or Progression of Diabetic Kidney Disease: A Systematic Review

Uwaezuoke

2021

Front. Clin. Diabetes Healthc.

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IntroductionPrevious studies have shown that vitamin D analogs (such as paricalcitol) can reduce albuminuria in patients with diabetes mellitus and retard the progression of diabetic kidney disease (DKD). A recent systematic review reported significant improvement of renal function in patients with DKD who received vitamin D or its analogs. Study-driven data about their use in improving DKD outcomes have continued to accumulate over the years.AimThis paper aims to systematically review the contemporary evidence about the effectiveness of vitamin D analogs in retarding the onset or progression of DKD.MethodsWith appropriate descriptors, two electronic databases (PubMed and Google Scholar) were searched for articles published between 2015 and 2021 in the English language. Primary studies that fulfilled the inclusion criteria were selected; their titles and abstracts were screened, and duplicates were removed. Relevant data were retrieved from the final selected studies using a preconceived data-extraction form.ResultsA total of eight studies (three randomized-controlled trials, one prospective study, and four cross-sectional studies) were reviewed. A total of 6,243 participants were investigated in the eight studies and comprised young adults, middle-aged adults, and the elderly with a male-gender predominance. One randomized controlled trial reported that paricalcitol significantly improved renal function in type 1 diabetes patients with renal impairment when combined with renin-angiotensin-aldosterone system (RAAS) blockers. A strong correlation between vitamin D deficiency and DKD risk was noted in the majority of the cross-sectional studies. High doses of cholecalciferol (4,000 or 10,000 IU/day), given early in DKD, significantly reduced disease prevalence.ConclusionParicalcitol may retard the onset or progression of DKD, especially if administered in combination with RAAS blockers. The association of vitamin D deficiency with DKD risk also supports this therapeutic effect. Future systematic reviews are still needed to strengthen the current evidence on therapeutic benefit of vitamin D or its analogs in DKD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vitamin D Analogs Can Retard the Onset or Progression of Diabetic Kidney Disease: A Systematic Review

Uwaezuoke

2021

Front. Clin. Diabetes Healthc.

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“…Chronic hyperglycemia leads to the occurrence of diabetic nephropathy, retinopathy and neuropathy as well as macrovascular complications (cardiovascular disease: Stroke, coronary artery disease, peripheral vascular disease)[ 1 , 19 , 20 ]. DKD recognizes four major pathogenic mechanisms: Glomerular damage, tubular injury, inflammation and oxidative stress[ 21 ] (Figure 1 ).…”

Section: Pathophysiologymentioning

confidence: 99%

“…The estimated GFR (eGFR) in children and adolescents with T1DM or T2DM should be screened at diagnosis and then annually[ 36 ]. These ongoing changes help us to assess DKD stages, which are presented in Table 2 [ 20 , 21 , 37 ]. Normal GFR values according to child age are listed in Table 3 .…”

Section: Diagnosismentioning

confidence: 99%

“…A recent systematic review confirmed that early high doses of vitamin D supplementation in combination with renin-angiotensin-aldosterone system blockers may slow the onset or progression of DKD[ 64 ]. Standard and some novel proposed therapies in early-stage or late-stage development of diabetic nephropathy are presented in Table 5 [ 20 , 64 , 65 ].…”

Section: Prophylactic and Therapeutic Strategies For Dkdmentioning

confidence: 99%

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Diabetic kidney disease in pediatric patients: A current review

Muntean¹,

Stârcea²,

Banescu³

2022

WJD

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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.

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Diabetic Kidney Disease in Childhood and Adolescence: Conventional and Novel Renoprotective Strategies

Cited by 2 publications

References 82 publications

Vitamin D Analogs Can Retard the Onset or Progression of Diabetic Kidney Disease: A Systematic Review

Vitamin D Analogs Can Retard the Onset or Progression of Diabetic Kidney Disease: A Systematic Review

Diabetic kidney disease in pediatric patients: A current review

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