We have been told that our 12 year old son, diagnosed about 15 months ago, is spilling large amounts of protein in his urine. His endocrinologist has told us that this could be the beginning stages of renal disease and is re-testing through another 24 hour urine study. What does this mean for my son? What can we do to prevent this from going any further?

Your endocrinologist is correct in repeating the test. You need two or three tests to be sure that this is a real abnormality and exactly how abnormal this is. Also, there should be minimal exercise for about 24 hours prior to the urine collection since exercise can produce falsely elevated protein values. High protein intake and steroid use, as well as long time high sugar levels, all are associated with urinary spillage/leakage of microalbumin. Other kidney diseases also can be associated with microalbuminuria.

The most sophisticated methods of assessing early kidney damage (in diabetes) is a test called microalbumin or albumin excretion rate [AER]. Most people without any kidney problems of any kind have less than 7 ug/min in timed urine collections. Older normal values suggested values less than 20-30. Exact normal values vary according to the test methodology.

Treatment is:

Maximize glucose control and lower hemoglobin A1c safely (that is, without excessive or severe hypoglycemia).
Decrease protein intake to less than 18-20% of total caloric intake.
Watch blood pressure values and aggressively treat even mildly elevated blood pressure
Consider use of medication called ACE inhibitors. Lisinopril, Zestril, and Prinivil are the most commonly prescribed in the US.
set up sequential microalbumin testing in the same laboratory to determine if anything else needs to be done.

SB

[Editor’s comment: Also, see How to Protect your Kidneys.

WWQ]