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April 8, 2004

Complications

Question from Regina, Saskatchewan, Canada:

I have never had a problem with my kidney test results by my endocrinologist so he told me I didn't need to do a 24 hour test, which I wanted to do. My family doctor put me on an ace inhibitor and because I have proliferative retinopathy, my eye doctor told me I should check. Well, the test came back and said that I had a low creatinine clearance, but I'm pretty sure everything else was normal. She wants to recheck in a month, what does this mean?

Answer:

Creatinine clearance refers to a test that is performed to measure the ability of the kidney to filter normally. With diabetes, a fall in creatinine clearance can be a late finding of diabetes involvement of the kidneys. Prior to a fall in the creatinine clearance, there is a period of increasing protein excretion in the urine. We have used the time-honored approach of using a 24-hour urine to perform the creatinine clearance test. However, before there is a decline in this test, albumin excretion should be routinely measured in all patients with diabetes. This is now most often performed as a spot urine and expressed as a ratio of albumin to creatinine with most labs reporting normal values as less than 30 mcg/mg creatinine. If microalbumin is found, an ACE inhibitor is an appropriate medication. The ACE inhibitor is also appropriate therapy for any patient with diabetes and hypertension. There is also some data to suggest that ACE inhibitors can positively impact diabetic retinopathy.

JTL