I have had diabetes for 21 years, just had some blood work done and was wondering if you could explain a few things about my numbers. I have no eye or nerve problems, but I did have protein in my urine during a pregnancy and was put on an ACE inhibitor afterwards. For several years, I have not had any protein in my urine. My doctor didn’t want to test for protein but for microalbumin this time. What is the difference? How elevated is my microalbumin? Shouldn’t the ACE inhibitor have made this disappear too (like the protein)? I am very concerned about this.

My A1c is 6.7%, my urine protein and glucose are negative, my microalbumin is 22.4 mg/L, my urine creatinine in is 47 mg/dl, and my microalbumin/creatinine is 47.7 mg/G on a random sample. Should I request a 24 hour urine for more accurate results? Can someone have a pregnancy with microalbumin in her urine or is that a bad idea (too much stress for my kidneys)?

Proteinuria is often first diagnosed by a dipstick test on a random urine sample. Microalbumin is a particular kind of protein that is measured using a test that is more sensitive than the usual urine dipstick test. Microalbuminuria is more specific for diabetes and is an earlier sign of diabetes-related kidney problems. Pregnancy can be associated with proteinuria outside the course of kidney involvement from diabetes. Usual microalbuminuria testing is once a year. The usual normal limit is up to 30 mg/G creatinine. By looking at your results, you have an elevated result.

I would agree that an ACE inhibitor is an appropriate intervention. It is not unusual to have some degree of hypertension when microalbumin levels rise in the urine. The good news is that ACE inhibitor therapy has been shown to stabilize or inhibit the progression of kidney involvement from diabetes. At this point, I would recommend not only that you be on an ACE inhibitor, but have the dose adjusted upward to normalize the microalbumin level in the urine (less than 30 mg/g creatinine). Your hemoglobin A1c is pretty good. Most normal range limits are up to 6.0%. There is some information to suggest good control may also have a favorable effect on microalbumin excretion. If you smoke, this also raises the level of microalbumin in the urine. It is important for you to discuss these results with your physician.

JTL

[Editor’s comment: You should also be aware that it is advised to avoid use of ACE inhibitors during pregnancy. They can cause injury and even death to the developing fetus in the second and third trimester.

WWQ]