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December 11, 2002


Question from Regina, Saskatchewan, Canada:

I am a 49 year old female who has had type 1 diabetes for almost 39 years, my hemoglobin A1cs have been 5.9-6.4%, and according to my general practitioner, my kidneys are functioning normally according. However, since a colonoscopy for polyp removal three weeks ago, my urine has been mildly foamy. After reviewing my blood and urine results, the doctor I saw ruled out infection or chronic kidney disease due to the diabetes, yet I continue to produce foamy urine (although the amount of foam is lessening). I also have mildly puffy ankles, mild abdominal bloating, mild, intermittent abdominal pain, come-and-go headaches (mild), and a salty taste in the back of my mouth and throat which alternately lessens and intensifies. My urine is sometimes cloudy, sometimes clear, sometimes mildly dark in colour (usually in the morning). It is not painful to urinate, nor do I have the urge to urinate more often than usual. The urine stream does seem to be a bit slow. I do not have a fever. Despite the results, could this be either chronic or acute kidney disease? What else could be causing the foamy urine and other symptoms? Could it be related to a strep infection caused by the polyp removal? Should I get the tests redone in case of error? If it is strep related, will it clear up on its own, or does it need antibiotic treatment? If I leave it untreated, do I risk permanent kidney damage?


The foamy urine could be from protein in the urine., which your physician probably checked for. If it was negative for microalbumin, it is unlikely that the swelling in the feet and the changes in the urine are due to diabetes-induced kidney changes. The primary kidney problem with diabetes is leakiness to protein. A test for microalbumin tests for protein elevations earlier than the standard dipstick technique for total protein. You may want to ask your physician which test was performed.

I would also wonder whether a microscopic analysis of the urine was performed, as opposed to just a dipstick of the urine. If this occurred, I would have a urinalysis repeated with microscopic evaluation. The kidney is also the site of elimination of other foods and chemicals. It may be something in your diet that you detect. It is not unusual for the urine to be more concentrated after overnight sleep. Kidney failure is not a risk here if there is no increased excretion of protein in the urine.