From Orlando, Florida, USA:
I am a 30 year old female with cystic fibrosis and was diagnosed with Type 1 diabetes 3.5 years ago. I am in good health with no CF complications and I carefully monitor my diabetes. Recently, my HMO primary care physician had a urinalysis done to check for albumin. Only a small amount of urine was analyzed in a test tube. It was not a 24-hour or overnight sample. He said there was an amount of 60 instead of the normal 30 or below "double the normal amount".
I am quite alarmed by this. I have only had diabetes for a few years and would hate to already be experiencing complications. He has ordered a 24-hour urinalysis that will analyze creatinine clearance and he nonchalantly stated that if there is a problem we will simply put you on an ACE inhibitor. Is there anything you can tell me that will at least put my mind at ease about this situation? I have tried to take care of myself and feel that I have had the diabetes for much too short a time period to be already experiencing difficulty. Are the tests my doctor ordered enough and could there be other reasons for my increased level of albumin?
Microalbumin (very small amounts of protein) may occasionally be the first warning of impending diabetic kidney disease, but are not completely reliable when obtained on a "random" urine sample. Your doctor is appropriately looking further, for the amount of waste material (creatinine) in a 24 hour urine sample, and should also be repeating the microalbumin measurement on the same 24 hour sample.
If indeed there's early evidence of possible diabetic kidney disease based on these tests, it is very appropriate for you to start on medications in a class called "ACE inhibitors" and then repeat the tests several months later: if the ACE inhibitor works, the level of urinary protein will probably decline. Of course, if the 24 hour lab studies are normal, then no medications would be needed, and repeat testing later (perhaps 6-12 months) would be advised.
See How to Protect your Kidneys for more advice.
Additional comments from Linda Mackowiak, diabetes nurse specialist:As Dr. Quick mentions, further testing is needed. One random sample is not enough to make a diagnosis. If after further evaluation, your microalbumin or urine protein is high, then you can not just assume it is from diabetes. Other causes need to be looked at. For example, adults with cystic fibrosis have usually previously taken medications that could cause kidney damage. I would also caution you to work with a doctor who is experienced in the care of adults with cystic fibrosis. At this time this may be a pediatric pulmonary specialist. If an ACE inhibitor is recommended, once again I would recommend that you work with a CF specialist, as ACE inhibitors may cause coughing.
Original posting 18 May 1998
Posted to Complications
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Last Updated: Tuesday April 06, 2010 15:08:58
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