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January 31, 2000

Complications

Question from Madrid, Spain:

My 5 year old daughter was diagnosed with type 1 diabetes a year ago. She has had very good HbA1c levels, 6,7 and 6,5 the latest, but she has microalbuminuria: 56 at diagnosis, then going down to 26, 22 and now 37 (normal 0-20) in 24 hour urine samples. Does this mean she is having kidney damage? Does it mean that she will have kidney problems? Would you recommend ACE inhibitor, low protein diet, or vitamin E supplementation? Any or all of the above?

Answer:

From the brief information you provided, it looks like the hemoglobin A1c levels are excellent. I assume that the normal range is approximately the same as usual, since exactly how the A1c test is done matters a great deal.

Nevertheless, it would be extremely unusual, in my experience, to see microalbuminuria in someone of this age. I wonder if there was some other type of kidney problem that preexisted before the diabetes began. It would be very important for your pediatric endocrinologist to explore this possibility. Treatment of pre-existing kidney problems would also be, in an asymptomatic child, making sure that blood pressure was normal and stayed normal and that protein losses did not increase over time. ACE inhibitors could be used as could decreasing total protein intake — while ensuring adequate overall protein intake for normal growth and development. Sometimes it may be necessary to do a kidney biopsy to make a more definitive diagnosis so consultation with a pediatric nephrologist may also be helpful.

SB