November 23, 2001
Complications
Question from St. Paul, Minnesota, USA:
My 12 year old daughter, diagnosed with type�1 diabetes 22 months ago, had a very high random urine protein level five months ago, so she is now seeing a kidney specialist. She has done three 24-hour urine tests and a few random urine tests which show that the protein levels are still rising. She had a kidney biopsy and blood tests done last month, but everything came back negative. Her blood pressure is great (almost on the low end of the scale).
The last random urine test showed that they ran was to see how much of the protein was albumin, and now her doctor wants to try blood pressure medication to slow down the kidney filtration. Could there be any other reason as to why she is leaking so much protein? What will the affects of the blood pressure medication do to her?
The doctors she is see are wonderful but is there something that they could be overlooking. They have stated to us that our daughter’s situation has them really stumped. If you could offer some sort of advice my husband and I would greatly appreciate it.
Answer:
It sounds like you are getting excellent advice, and all the testing seems very appropriate. Is there a family history of hypertension or other vascular problems or kidney problems? Sometimes having diabetes just brings this out sooner than would otherwise be the case.
We would also routinely advice cutting back animal-source protein and total protein intake. This will likely need some insulin dose adjustments since the carb intake would then increase. Sometimes this also helps. If improving the blood glucose and hemoglobin A1c levels cannot be done, and cutting back protein intake does not help the microalbumin levels, then adding an ACE inhibitor is also a common recommendation. We have had great success with this approach and usually use Zestril or Lisinopril once a day.
Go back and chat with your diabetes team in some more detail so that they can reassure you of their approach and the steps to be followed next.
SB
[Editor’s comment: Also, see How to Protect your Kidneys at the Diabetes Monitor.
WWQ]
