Kidney biopsy findings in children with diabetes mellitus

Abstract

Background Diabetic glomerulopathy 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 biopsy, making this the largest series of biopsies in diabetic children with clinical kidney abnormalities. Four biopsies showed diabetic glomerulopathy, three showed diabetic glomerulopathy and IgA nephropathy, and ten showed a variety of conditions other than diabetic glomerulopathy: minimal change nephropathy (2), membranous nephropathy (2), thin glomerular basement membrane disease (2), non-glomerular chronic damage in Wolcott-Rallison syndrome (2), acute vasculitic glomerulonephritis (1), and IgA nephropathy (1). Clinical clues of something other than diabetic glomerulopathy 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. In addition, there were biopsies in two children with cystic fibrosis that showed changes identical with diabetic glomerulopathy, although the children were not shown to have diabetes mellitus. 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: overt diabetic glomerulopathy either on its own or combined with other conditions, and kidney disorders other than diabetic glomerulopathy. Also, changes resembling diabetic glomerulopathy can be found in children with cystic fibrosis who are not diagnosed to have diabetes mellitus.