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August 29, 2000

Complications

Question from Monrovia, California, USA:

My 11 year old daughter was diagnosed with type 1 diabetes at age eight. We consider her to be on tight control, but, even though her Hemoglobin A1c tests have always been between 6.0 and 6.8%, we recently found out that she has 51% microalbumin in her urine. What does this mean and how will this affect her?

Answer:

It would be very unusual, indeed, for an 11 year old, who has only had diabetes for three years, and, who has achieved such excellent control to have significant albuminuria on account of the diabetes. I think you need to talk over this figure of “51%” with your daughter’s doctor because this test is usually expressed in “micrograms per minute'” not as “%” and is performed on a timed overnight or 24 hour sample. If the figure turns out to be 51 micrograms/minute on a properly collected specimen, that is a little high. It would be important, if a repeat test was again high, to consider whether this could have been the result of an earlier urinary tract infection or of an episode of subclinical glomerulonephritis in the past or indeed from a carelessly taken specimen. Only if the microalbuminuria is clearly progressive, might it be necessary to consider a trial of an ACE inhibitor, a drug used to lower blood pressure but which can resolve diabetic microalbuminuria, or a renal biopsy.

DOB