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April 26, 2001

Complications

Question from Missouri, USA:

Recently, my 12 year old son, who has had type 1 diabetes for almost four years, had protein in his urine. His doctor said they would check it again at the next visit, but didn't say what that might mean. His Hemoglobin A1c tests have always been below 7.6% At Does protein showing up in his urine have anything to do with his diabetes?

Answer:

Since your son is only 12 and has had type�1 diabetes for only four years with no rise in blood pressure and is in really very good control, I think that the urine protein is most unlikely to be a consequence of his diabetes.

That said, I think that the next step is to repeat the test. Presumably, a simple office dipstick method was used which can be a source of error, and, if the simple test is again positive, it would be a good idea to quantitate the amount of microalbumin present. If again confirmed, it might indicate a urinary tract infection which would be somewhat unusual in a boy, but again, if present, it would be worth not only treating but doing some simple X-rays to see if there is any evidence of a urinary tract malformation.

Its always possible too that your son has developed a subclinical glomerulonephritis that has nothing to do with his diabetes. If this persists and increases, it might be appropriate to consider a biopsy.

DOB

[Editor’s comment: A few additional thoughts:

Children this age should have an annual 24-hour urine collection for microalbumin done routinely anyway.
It is quite common for boys this age to have what is called “exercise-induced proteinuria.” Therefore, it is important that your son refrain from heavy physical activity for 24-hours prior to and, of course, during any urine collection.
If you are very concerned, you might your son’s doctor for a referral to a pediatric nephrologist.
SS]