September 15, 2006
Question from Texas, USA:
For the past six months, my son has taken an ACE inhibitor because of the results from two 24 hour urine sample tests. The testing of the 24 hour urine samples showed he was spilling protein in his urine. I do not know what to expect at this point. I understand from my own reading, that if caught early enough, the kidneys could recover. How would a medical professional determine if my son's kidneys are damaged? Do most endocrinologists make this determination? How does an endocrinologist determine if the ACE inhibitor dose is the correct amount? My son has had good control. His A1c in the past few years has been between 7.0 and 7.9. He has recently started pump therapy, but was on Lantus and Humalog since June 2001.
Your questions are excellent. Many pediatric endocrinologists will manage “microalbuminuria” on their own with ACE inhibitors or even ACE receptor blockers. Some will refer to a nephrologist. Kidney biopsy is the BEST way to determine the extent of diabetes-related kidney disease. The urine albumin excretion is a less specific, but fairly sensitive marker. If the albumin excretion remains small (“microalbuminuria”) or improves, I think you can fairly comfortably say that the medication and diabetes control are okay. If not, and the urine albumin excretion gets to higher levels (“macroalbuminuria”), I think many endocrinologists would certain refer to a nephrologist.
Other monitoring in this regard, in addition to good glucose control, should include blood pressure monitoring.
The correct dosage depends on experience, the medical literature, and of course the patient’s response. Remember: “Medicines NEVER work, if you don’t take them.”