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Diabetes

Blood test concerns

03/10/2009

Question:

Non-diabetic at this time. However, my mother and her father both had to have their legs amp. above the knee and I have a slight insulin resitant problem. My blood work came back and it showed a high ratio of BUN/creatinine (30). My BUN is 18 and my creatinine is 0.61. My mother and her 2 sisters had kidney dialisis and it did not go well and both chose to be taken off and of course they died. As you can see I have some concerns and want to take care of the problem before it gets out of hand. At the time I had a hip problem and was on cellibrex. Since that time I have had my hip replaced on Sept 22, 2008 and no longer take the medication. I have also lost about 25 lbs. because of course I can now move and get some excercise. I have to excercise more than the normal person in order to achive my goals but that is okay. My main concern is of course I do not want to get either desease. Just wanted to know if the medication could cause the high ratio. I will be getting a new blood test this year. Hope I have made sense of this.

Answer:

You don't mention your age but the basic message that I do get is a person who has a strong family history of diabetes progressing to renal failure warranting dialysis, with past use of NSAIDs (non-steroidal anti-inflammatory drugs) and a hip replacement concerned about the future potential for diabetes and diabetic end stage kidney disease.  I think it is appropriate to take a long view and do the best job you can to prevent future damage - at the same time, I am not clear on what your present risk is for lack of some information.  The BUN and creatinine results, assuming both are in mg/dl, are each in the normal range.  A high BUN/creatinine ratio most commonly represents "pre-renal azotemia," i.e. inadequate blood perfusion of the kidneys, either because of dehydration, inadequate heart pumping (congestive heart failure) or least commonly narrowing of the arteries to the kidneys impeding blood flow.  Dehydration is very common and very reversible.  I would be diligent about screening for diabetes in your situation.  Experts disagree on whether to wait for the criteria for diabetes to be present before initiating treatment for diabetes.  I would certainly consider your strong family history of diabetic renal disease to be a compelling reason to consider a lower threshold for instituting treatments that would improve glycemic control.  I think it might be very helpful to discuss this with either an endocrinologist or nephrologist or both, experts in diabetes and kidney disease, as you are looking at the long-term strategy here.

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Response by:

Robert M Cohen, MD Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati