Early kidney involvement remains a concern in type 1 diabetes mellitus (T1DM), and screening practices require careful evaluation. A systematic review published in Diabetes Research and Clinical Practice examined screening strategies for diabetic nephropathy in children and adolescents with T1DM, assessing optimal age, diabetes duration, and follow-up frequency.

The review included 36 studies from 1995 to 2024 with a total of 21,778 participants, most of which were cross-sectional. Moderate albuminuria occurred in 9.5% of individuals, predominantly in those older than 14 years and with ≥7 years of diabetes duration. Rare cases were reported as early as 8.5 years of age and within two years of diagnosis. Severe albuminuria ranged from 0.3% to 14.6%. End-stage kidney disease was rare, and no deaths were reported.

Elevated HbA1c levels (≥9%) strongly correlated with nephropathy risk. Evidence for additional risk factors such as hypertension was limited. No randomized controlled trials comparing screening strategies were identified, and heterogeneity in diagnostic methods constrained the strength of conclusions.

These findings support current guideline recommendations to begin screening at age 11 years or puberty after two to five years of T1DM duration. Higher-risk individuals, particularly those with poor glycemic control, may benefit from closer monitoring. Prospective studies are essential, especially in low- and middle-income populations.