My nephrologist just called me to talk about the latest urine sample that I gave. He did a protein and protein/creatinine ratio. If I can remember correctly, he said the protein was 568 and the protein/creatinine ratio was 18.1. My creatinine was good at 1.1 I’m not sure what that really means. I see normals on-line, but these numbers seem so different. Could you explain what these numbers mean? I’m embarrassed that I don’t know this information already. Also, is there anything else I can be doing besides keeping my A1c close to normal? My last a1c was 6.8. I am already taking lisinopril.

In general, physicians who are routinely monitoring urine protein or urine albumin are going to do random urine collections where the results are expressed as a ratio of the protein or albumin concentration to the urine creatinine concentration. This creatinine concentration is not the same as the serum creatinine level done on your blood. The normal range for the ratio is what you want. For albumin, that level is less than 30 mcg/mg creatinine. You will have to check with your laboratory’s normal range to be sure what they are. These random collections have some of the same problems as twenty-four hour urine collections. There is a fair amount of interindividual variability so that multiple collections are more accurate than a single collection. However, they avoid the errors that frequently occur with the twenty-four hour collections. I prefer to check microalbumin levels, as they are probably more specific for diabetes-related proteinuria. If the levels are positive, I routinely increase the lisinopril to a level that completely normalizes the microalbumin ratio. Therefore, if you are on lisinopril, and your urine protein or albumin excretion is still excessive, you may want to talk to your doctor about increasing your lisinopril.

JTL