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October 18, 2003

Complications

Question from Indiana, USA:

When protein is found in the urine of a teen with type 1 diabetes, why is it necessary to take a prescribed pill daily for life? Why can't the urine be re-tested periodically, and if none is present at the later testing, the daily pill be stopped?

Answer:

Protein leakage is a sign of kidney damage, one of the hallmark complications of chronic high blood glucose levels. About 20-30% of all people with type 1 will end up with kidney failure, and we are only just learning from research studies how such people may be detected and who is at highest risk. High sugars, smoking, high blood pressure and other kidney problems can also show up with protein leakage and kidney damage.

The most sensitive early warning tests of such kidney problems is a special urine lab test called microalbumin. So, when protein leakage occurs in anyone, teenagers or adults, the first idea is to repeat it several times to see if it is a real abnormality and how serious the problem is. Not smoking or quitting often helps. Looking for other causes of such protein leakage is also important (e.g., thyroid problems). Cutting down animal-source protein, especially if it is being eaten in higher amounts, also may help. The most important thing to do is to improve glucose levels since high sugars are the most important factor in causing such protein leakage/microalbuminuria. Lowering the hemoglobin A1c and lowering the daily blood glucose readings sometimes will also allow the kidneys to heal and filter better without so much protein leakage.

If none of this works and repeat testing (24 hour urine samples, overnight urine samples or special spot samples to measure the smallest amounts of albumin = microalbumin) remains abnormal, then using medication is warranted. ACE inhibitors as well as diuretics and calcium channel blockers all have been shown to help reduce microalbuminuria. Improved control was demonstrated in the DCCT to slow down further kidney problems. A discussion with your diabetes health care team will highlight the benefits and any risks of each of these approaches. If the values completely normalize, then, after a period of time, it may be worthwhile to slowly stop such medications and see if they are still needed. The goal of such medications is to preserve future kidney function so that kidney failure is averted and kidney transplantation is not needed.

SB

[Editor’s comment: See How to Protect your Kidneys at the Diabetes Monitor.

WWQ]