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April 20, 2007

Complications

Question from New York, USA:

I am 35 years old and father of two children under the age of five. It�s been three years since I was diagnosed with type 2 diabetes. Also, my cholesterol levels were little high so our family doctor prescribed pills. After taking medications, both my blood sugar and my cholesterol levels were reduced to normal, including triglycerides. My A1c was under 6.4 except the last one, which was 7.7. Also, the doctor asked me to do a fasting test of blood and urine. Most of my blood pressures were 130/80. Two years ago, I had a stress test, the results of which were normal. I travel and work at a desk. Here are my test results: Urine Microalbumin 4.2 mg/dl (Normal 0 to 2.8), Creatinine 106 mg/dl (No normal ranges given); Micro albumin/Creatinine 40 mcg/mg (0-28); blood BUN 10 mg/dl (Normal 8 to 21), Creatinine 0.9 mg/dl; EGFR Ml/Min greater than 60 (Normal greater than 60); ALT SGPT 47 UL (Normal 10 to 44); HDL 61 mg/dl, LDL 62 mg/dl; triglycerides 141 mg/dl; Cholesterol/HDL 2.48 The doctor has recommended that I start an ACE inhibitor (lisinopril) and suggested that I go back in six weeks. I am hoping it is so the doctor can confirm the test results. What stage kidney disease do I have? Is it reversible? Is it controllable? I am worried about my children's future.

Answer:

Please do not be alarmed. Your physician is practicing appropriate medicine with your best interest in mind. Microalbumin refers to the measure of albumin in the urine at concentrations less than what might be present if you were to have your albumin tested with the old fashioned urine dipstick test. Even though these amounts of albumin are low, the amount of albumin excreted is still more than normal. There have been previous studies that have shown that patients treated with ACE inhibitors have preservation of kidney function long-term (over seven years) if they take the ACE inhibitor as opposed to not taking it. Therefore, I would suggest your doctor is looking out for your best interest. You need to talk with your doctor further about how to follow this test, how to adjust the medication, and what the side effects are. It has also been shown that ACE inhibitors may also have some benefit in preventing eye disease progression in diabetes.

JTL