My 13 year son, diagnosed with diabetes today, had hemolytic uremic syndrome (HUS) at age three, and when he was five, my husband donated his kidney to our son due to renal failure. Does diabetes mean that his new kidney is no longer working properly?

There is no reason to believe that this new diagnosis of diabetes is related to some problem with the transplanted kidney. I presume your son was diagnosed with type 1 diabetes, which is usually due to a process in which the body’s own immune system produces antibody proteins that “attack” the pancreas and interfere with insulin production. Your son’s diabetes team can look for the presence of these pancreatic antibodies.

The kidney does not make insulin. I have seen the acute effects of hemolytic uremic syndrome (HUS) lead to pancreas dysfunction and diabetes (the same vascular problem that lead to the kidney injury), but at or near the time of the diagnosis, not eight years later.

On the other hand, if your son receives anti-rejection therapy for the transplanted kidney (like steroids or tacrolimus/FK506), those medications can lead to high glucose. Tacrolimus can interfere with insulin production. So there may be a relationship, but an indirect one, and not one associated with poor function of the transplant.

Kidney function is easily tested for by blood measurements that you probably know called BUN and creatinine. Poorly functioning kidneys can lead to prolonged effects of insulin which might lead to low blood sugar –not diabetes.

Talk with your son’s various doctors and make sure they communicate.

DS