March 9, 2004
Complications
Question from Pennsylvania:
My 10 year old son, who was diagnosed five years ago and has been pumping for three years, recently had a 24 hour urine test done. His A1c has always been between 7 and 8. He is active in a number of different sports. I’m not sure if I should be worried about the results and discuss them with his endocrinologist or not. I was hoping you could provide me with some direction. The results were as follows:
24 hour creatinine = 1.11 (range.6 – 2.0)
Creatinine clearance = 169 (range 72 – 137)
24 hour protein = 126 (range 50 – 100)
Is this the beginning of kidney problems? His endocrinologist is contemplating beginning him on an ACE inhibitor. What are the long term effects of taking such a medication?
Answer:
I wonder if the urine was not collected properly. We usually do overnight and not 24 hour collections because of such commonly seen timing problems. Also, the key test is not 24 hour protein but 24 hour microalbumin since the microalbumin represents a very sensitive early assay for urinary protein losses while the standard protein assay is very insensitive in the lower ranges when such leakage is showing up. We usually repeat the overnight urine sample or the 24 hour urine sample several times before starting medication because the test is so difficult to do and interpret properly. So, please go back and discuss with the diabetes team.
SB
