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Wednesday, April 23, 2014
Quality Health Care and You - Diabetes
High Microalbumin 85.1 mg/g Creat
I am a Diabetic 2. I have had high blood sugars since I was diagnosed 6 or so years ago. My current A1C is 6.8. I recently had my microalbumin checked and it came back with 85.1. I am very concerned about my damage to my kidneys. Doctors don`t seem to take this serious but I do. I started a new medication, Byetta 5mg bid. I also take Glucophage XR 2000mg/day and was also on Glyburide 5mg./day. My blood pressure is always very low 60/90, 90/110. My cholesterol is 163.
The only problem is my glucose/A1C and this albumin in the urine. Does this seem I already have kidney disease with the 85.1 which is terribly high based on range of 1.0-14.8. I did not fast to get these test. Maybe that had an influence. My doctor said I did not have to fast and took the tests in her office. Please tell me is this is right and I should be very worried? I do everything right, take my medication, don`t overeat, exercise 5 times per week at the gym by swimming laps and weights. I am very worried and don`t know what else to do. I have been to several doctors. A month ago I had to go through a procedure to remove kidney stones. Could that have caused my kidney damage?
A ratio of 85 is not terribly high (normal is usually considered to be less than 30; high is greater than 300). Your slightly elevated ratio means that your kidneys are leaking a small amount of protein, which is usually an early sign of kidney damage, presumably due to your diabetes. The recent procedure that you had for kidney stones should not affect your microalbumin ratio. And your doctor is right, fasting makes no difference: the ratio can be done on a urine sample obtained any time, under any conditions.
Having a high microalbumin/creatinine ratio does not mean that you have kidney failure, because it does not tell you about the actual function of your kidneys, as far as their ability to get rid of waste products. To measure kidney function in this sense, we use the BUN and serum creatinine. See the article on "Kidney Tests" for more information on these and other tests.
So if it turns out that your BUN and creatinine are normal, and only your urine microalbumin/creatinine ratio is elevated, then you are at a very early stage of kidney disease. Elevation of the MA/creat ratio is often treated with meds called "ACE inhibitors" (which include meds like lisinopril, accupril, enalapril, quinapril). At this stage, careful treatment may actually be able to prevent kidney damage from progressing.
Other important things for you to do at this point to prevent further kidney damage are to keep your diabetes, blood pressure, cholesterol, and weight under excellent control, and to avoid (or stop) smoking. A1C should be less than 7.0, so you might be able to improve yours even more. I would also ask your doctor about referring you to a nephrologist (kidney specialist) and about starting you on an ACE inhibitor, if you are not on one already. Otherwise, it sounds like you are indeed doing all the right things -- keep up the good work!
Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University