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June 15, 2000

Complications

Question from Franklin, Massachusetts, USA:

I'm a 42 year old female and have had Type 1 for 17 years. Recently, my doctor told me I had protein in my urine and prescribed blood pressure medication. Is this common and is this condition serious?

Answer:

Protein in the urine (also called proteinuria, microalbuminuria, and macroalbuminuria, depending on how much of the protein albumin appears in the urine, is the first signal that diabetes may be causing damage to the kidneys. The mechanism lies in the ever-narrowing small vessels which begin to choke off the blood supply to small vessels of the kidney. As these areas die off, they leak small amounts of protein which we measure at the very beginning of the pathological process as microalbuminuria (very small amounts of albumin-protein in the urine). As larger amounts come down through the urine, it is much later and much bigger a problem. This is called then macroalbuminuria or simply proteinuria. Much of this has been felt to be due to small areas of high blood pressure in these individual small arteries.

The group of blood pressure medicines called ACE inhibitors seems to be very well suited to halt this process even in non-hypertensive diabetic patients (and very recently also in renal patients who do not have diabetes) even though other blood pressure medications are very useful as well. Treatment must begin early (according to some, even before problems are clinically identified) for best success.

MS