Background: The primary cause of end-stage renal disease in children with type 1 diabetes is diabetic kidney disease, which can be prevented. Therefore, it is critical to identify children who are at risk of developing DKD as soon as feasible. DKD is diagnosed with pentosidine and renal resistance index. Thus, in T1DM patients, our goal was to assess the significance of pentosidine and Renal Resistance Index as early indicators of DKD.

Methods: This cross-sectional study was conducted at the pediatric outpatient clinics of Zagazig University Hospitals on 48 diabetic children. Comprehensive assessments included medical history, physical examinations, Doppler and laboratory tests for hemoglobinA1C, serum creatinine,microabuminuria and serum pentosidine, measured using a Human Pentosidine ELISA Kit.

Results: serum pentosidine had high diagnostic accuracy for early-stage DN, with a sensitivity of 90%, specificity of 97.4%, and an area under the curve (AUC) of 0.964. The mean RI measured by Doppler sonography was 0.68, indicating a significant relationship with early-stage diabetic kidney disease. The Pentosidine and mean resistance index were significantly positive correlated with age, duration of the disease,estimated GFR and HbA1c.

Conclusion: Serum pentosidine levels and renal resistance index increase in the early stages of T1DM, potentially serving as early markers for diabetic kidney injury. Early identification of at-risk children and implementation of preventive measures are crucial to prevent progression to ESRD.