I am a 49 year old man who has had type 1 diabetes for 30 years. My doctor did a dipstick test in his office and told me I have protein in my urine. I have no retinopathy whatsoever. Is it odd to have kidney problems without any retinopathy? Should a kidney work-up be done?

It is more common to have both retinopathy and nephropathy than to have nephropathy by itself. However, unless you are examined and formally graded by an ophthalmologist, it may be premature to say you have no retinopathy. The usual teaching is that if you have made it over 20 years without clinical nephropathy, you usually are not at risk for chronic kidney failure. More questions need answering. These include a formal measure of the albumin excretion, serum creatinine, and your blood pressure. If you have not had a dilated eye exam, that is essential. To have dipstick positive protein is rather vague. Is it a special test for albumin or is it just for total protein? More quantitative measures are needed to more fully determine your risk. If you do have persistent albuminuria, you are a candidate for kidney preservation therapy with medication. Please discuss this more fully with your physician.

JTL