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Urinary and Genital Disorders (Children)

7 Y/O with high BUN and BUN/Creat ratio

03/11/2011

Question:

My son went to the doctor last week, because he has been eating a lot. I was concerned about diabetes and so was his pediatrician. They did a UA dipstick in the office and it showed 30+ protein in his urine. He has had this issue for about a year now and nothing has been done about it. Everything else was negative. No ketones, glucose, bacteria, blood, ect. The doctor ordered a cmp, hbga1c, insulin, and cbc. His hbga1c came back slightly elevated. So the doctor said he had an increased risk for diabetes. His BUN was 22 and his BUN/Creat ratio was 35. He is scheduled for a renal ultrasound on the 23rd. Should I be concerned with this? Should I take him to a pediatric nephrologist? What could be causing this? He is otherwise health, healthy weight and height with no other medical problems.

Answer:

It is difficult to answer your questions from the information you've sent, but here are some initial thoughts:

An increased appetite can certainly suggest diabetes, but this is usually accompanied by increased thirst, increased drinking, glucose in the urine, high blood glucoses (not a "slightly elevated" hgb A1c), and weight loss. Occasionally, children can develop type II, or adult onset diabetes, but this is usually seen in children who are very obese, with a family history of diabetes; and again, increased thirst and urination, glucose in the urine, and high blood glucoses would be expected.

I gather from the BUN of 22 and ratio of 35 that his creatinine level must be around 0.63, which is normal and which tells us that his kidneys are doing a good job of excreting creatinine (a normal waste product). BUN is also a waste product, and even though the level is high in the blood, this may be due to something else than kidney problems -- it may be related to dehydration or protein intake, for instance.

The protein in the urine is of concern; if this has been found on only one testing, it should be repeated and "quantified" as well (in other words, not just a dipstick that reports 30, 100, or 300), but a definite number on a so-called "spot urine protein/creatinine ratio." If the urine protein is high, then yes, he definitely needs a renal ultrasound and a visit to a pediatrist nephrologist (kidney specialist). There are a number of diseases that can cause protein in the urine, and the nephrologist can help to do the appropriate tests, in the appropriate order, to get to a diagnosis.

Hope this information is helpful. If not, please feel free to write again.

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Response by:

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