I’ve had type 1 diabetes for 16 months. Recently, I did a timed overnight (9.5 hours) urine test. The test showed a urine albumin of 28 mg/L [0 to 30]. My first urine albumin at diagnosis was 10 and the laboratory range showed less than 20 as normal and urine alb/creat ratio of 5.0 and less than 3.5 as normal) microalbumin of 32.2ug/min [0 to 20]. The urine total protein was 0.17 g/L, protein excretion was 0.11305 g/9.5 hours, urine creatinine was 6526 umol/L. I’m not sure what the UTP, protein excretion and urine creat mean, but the laboratory reported that I have microalbuminuria. I’m due to see the endocrinologist soon and was wondering if it is worth doing something to protect my kidneys now or wait and see if things get worse. I know my grandma’s brother, who also had type 1, started developing kidney problems less than two years after his diagnosis with diabetes. Because of that, I’m wanting to let the endocrinologist know that I’d rather not take a “wait and see” approach. What should I do?

The first step is defining whether you truly have microalbuminuria is knowing more about the tests you have had. First, a urine with only the concentration (mg/L) is not helpful. You need either a random urine that measures the albumin in mcg/mg creatinine or a timed urine. Then, the urine albumin excretion can be quantitated as mg/unit time. You are correct that most random urines are abnormal above 30 mcg/mg creatinine or time specimens above 20 mcg/min. This gets additionally more complicated because there is a great deal of interindividual variation in the same person, let alone in the population. I generally confirm elevated albumin excretion rates by performing more than one urine test for presence of microalbuminuria. If more than one sample shows the presence of microalbuminuria, I will start therapy with an ACE (which stands for angiotensin converting enzyme) inhibitor or an ARB ( which stands for an angiotensin receptor blocker). Both types of agents operate on the same pathway and have been shown to have renal protection properties. If blood pressure elevation is also present, and it often is, it should be normalized. The goal blood pressure is less than 130/80 mm Hg. Similarly, the albumin excretion should be normalized by the escalation of the drug dose upward so that blood pressure and albumin excretion should be normal on therapy. Some physicians elect to treat their patients with these agents without an elevated blood pressure or an elevated albumin excretion rate. There is no support in the literature for this type of empiric therapy. However, there is a large amount of information about the benefit of blood pressure lowering and treatment of microalbuminuria in patients with both type 1 and type 2 diabetes. If you have a relative who has also had nephropathy, you are at increased risk for nephropathy as well. Treatment with these types of agents would be recommended.

JTL