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Quality Health Care and You - Diabetes

Elevated Lab Results

07/27/2009

Question:

I`m a type "1.5" diabetic, where my diabetes is secondary to a pancreatic disorder. I just received my lab results in the mail and I`m concerned about my results. My Microalbumin Ratio is 547.2, but my BUN is 10 and my Creatinine(mg/dL) is .7 and my Creatinine, Urine is 265.0. I called my doctor and he said that he would get back to me about my results. I`ve called several times over the last few weeks without speaking to anyone other than the receptionist. I`ve made an appointment, but my doctor isn`t able to see me for another 6 weeks. My main question is, what do these results mean? I was under the impression that a Microalbumin Ratio over 25 was a problem that needed attention, but my doctor doesn`t seem concerned.

Answer:

A normal microalbumin/creatinine ratio is less than 30, so yours is moderately high (but not extremely so -- very high, for instance, would be greater than 3000).  The elevated ratio means that your kidneys are leaking protein, which is usually the very first sign of kidney damage due to diabetes.

However, kidney function (in terms of waste-excreting function) is actually measured by BUN and blood creatinine levels; so yours is normal, which is good.

At this early stage of kidney damage, the protein leakage may possibly be reduced with meds called ACE inhibitors (which include meds like lisinopril, accupril, enalapril, quinapril).  With the amount of protein in the urine that you have, you should definitely be under the care of a nephrologist (kidney specialist), in addition to your family doctor. The nephrologist can monitor your kidney function (BUN and creatinine), make sure your blood pressure is OK, and try to reduce the protein (albumin) excretion, which in turn may halt (or at least slow down) the kidney damage.

The most important things for you 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. Best of luck to you, and please write again if I have not answered all of your questions.

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Response by:

Mildred   Lam, MD Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University