I am a 36 year old diagnosed with type 1 diabetes six years ago, and, at my recent doctor’s visit, I was told I have mild hypertension and a high level of protein in my urine (based on one sample taken in the clinic), so the doctor prescribed an ACE inhibitor. I realize I could have kidney damage, but I was wondering if the test was affected by the fact that it was taken one day before I started menstruating. My doctor has not ordered a 24-hour urine test, and I had no indication of high protein three years ago. This is a new doctor. Should I demand a 24-hour urine test or other tests? Does the menstrual cycle affect protein amounts? I appreciate any help you can offer!

An alternative to the 24-hour urine specimen for the measurement of microalbumin is the spot urine test. The spot urine measures both albumin and creatinine and expresses the result as a ratio in mcg albumin/ mg creatinine. Abnormal levels are 30 mcg/ mg creatinine. This roughly corresponds to 30 mg albumin per 24 hours. When you use the albumin assay, there is more specificity than using the total protein. It is also easier so that patients do not have to return with jugs on different days. If levels become elevated or there is ever a question, a 24-hour urine test can still be used. The total protein may be elevated with menses. Albumin is more specific, although it would be best to measure the specimen when you are not menstruating.

I would suggest that the ACE inhibitor be titrated until you have a normal blood pressure (less than 130/80) and to the point that your albumin excretion goes back into the normal range.

JTL

[Editor’s comment: Starting what might be lifetime therapy with a medication that (like all prescription drugs) has some degree of risk of side effects) based on a single office BP measurement and a single lab result does seem a little extreme. I’d suggest you discuss your concern with your physician, and ask for further testing or a referral to a specialist.

Also, see How to Protect your Kidneys at the Diabetes Monitor.

WWQ]