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June 25, 2005

Complications

Question from Napa, California, USA:

My daughter's albumin/creatinine ratio came back at 25.6 ug/mg This was a first morning collection then taken to the laboratory. My laboratory slip has a range of 0.0-29.9. I asked if this was on the high side. The answer was that is was elevated but still in the normal range. In Understanding Insulin-Dependent Diabetes, Dr. Peter Chase says that for anything over 20 micrograms, there is a 95% chance of nephropathy and kidney failure. If nothing is done, what do these numbers mean? Should we be alarmed? If so, what do we do what questions should we ask? Her A1c is 6.6 a little higher than we like, but a good number. Her cholesterol is higher, 219, with a LDL of 146. We need to see if we can bring that number down. My daughter has celiac disease so her diet is tough. These numbers are very concerning to my husband and I. If we need to be proactive at a young age to ensure healthy kidneys, we want to do whatever we can. If you have any recommended reading on the subject, please let me know.

Answer:

A single lab abnormality should require you to have this repeated several times to see if it is real or not. Sometimes having just had a viral infection or having a day of lots of activity will also produce some protein spillage. This does not have the same long term implications as persistent protein leakage or progressively increasing protein leakage. You may also want to do a timed overnight urine collection for quantitative microalbumin as well as albumin excretion rate. Your diabetes team should be able to arrange this. If several values are abnormal, then one should consider medication such as lisinopril to provide kidney protection.

Also, with abnormal lipid values, one should consider medication such as Zetia and/or a statin like Lipitor since high lipid values would further potentially compromise kidney blood vessels as well as other blood vessels in the body. Her A1c is in the excellent range, so I would also be interested in knowing about family history of similar problems, i.e. hypertension, heart attack, stroke, lipid abnormalities, since this may represent genetic family problems rather than just diabetes related complications.

SB