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  1. stockjock
  2. General Nephrology Questions
  3. Saturday, 26 January 2019
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Hello. I am a type 2 diabetic, diagnosed last year. Since diagnosis, I've lost about 15-20 lbs and improved almost all of my numbers substantially. A1C went from 9.2 to 5.6 3 months later and more recent 6.1. Triglycerides dropped by more than 50% in 3 months and further progress last month.

However, my T2D was undiagnosed for several years. Was feeling better about things, but most recent follow-up random urine testing showed Microalbumin 703.2 mg/L, creatinine 165.1 mg/DL, and a microlbumin/creatinine ratio of 425.9 mcg/mg, most of which are obviously high. On the blood work, creatinine shows as 1.05/mg/dL, race white, GFL at 79 mL/min/BSA.

My doctor is concerned about potential kidney damage due to some of the high Microalbuminuria numbers. He will retest in a month or two.

Meanwhile, I got a home testing kit using dipsticks, which I'm sure are less accurate than the hospital's test strips and analyzer. Still, I'm a bit confused about the home results. It tests for Protein and Microalbumin. The protein test shows somewhere between "normal" and trace". The Microalbumin test is harder to read, but it looks like 30 mmol/L to 80 mmol/L and probably closer to 30.

If I'm reading this right, it sounds like the "protein" test is normal but the Microalbumin test is high. Not quite sure how to convert 30-40 mmol/L to mg/L though. Again, not sure how accurate these in-home dipsticks are.

Do you have any thoughts or suggestions?
Responses (4)
Accepted Answer Pending Moderation
There seems to be something wrong with your units above. Please attach the original lab report below after removing/obscuring your personal health information from the report. In general, I would not use home sticks to diagnose or quantify degrees of microalbuminuria.

Dr. Jordan Weinstein
Accepted Answer Pending Moderation
Hi there,

Based on your readings and manipulating the units, your albumin to creatinine ratio is 42.6 mg/mmol. This amount of protein is abnormal and does suggest that some amount of damage has occurred, either due to hypertension, diabetes, excess weight or all of the above. The reason this the protein registers as trace or 1+ is that it is not a large amount of excess protein, compared to some levels that could be present when large protein levels are present. Large amounts could show ratios in to the triple digits whereas yours is in the 40's. The priority is to ensure blood pressure is controlled to less than 130/80 mmMg, blood sugar is well controlled and consideration is given to using an ACE inhibitor or angiotensin receptor blocker. It would also be important to exclude other causes of kidney disease beyond those that I have listed above.

I can only base my opinion on the information provided and your health-care provider might arrive at different conclusions once you have provided an entire history and had a physical examination performed. As always, this forum provides general medical information only and is limited to educational use only. Please discuss the above remarks with your health-care provider.

Dr. Jordan Weinstein
Accepted Answer Pending Moderation
Hi Dr. Weinstein. Thank you for the reply.

I've asked my doctor for a referral to a dietician and also to a nephrologist. I've met with the dietician and candidly didn't get much out of the meeting. For example, I told her I'm at 50g-75g of carbs per day and she'd prefer that I do at least 45g of carbs per meal, which I believe would increase my blood sugar levels. But my doctor seems hesitant to refer me to a nephrologist. Do you believe I should be speaking with a referred nephrologist at this time given my numbers (retesting in a month or so)?

So far, he's put me on Losartan 25mg tablets. He's also prescribed Atorvastatin 40mg tablets, which I have not been taking as I've been using Red Rice Yeast (no Citrinin) and supplementing with 300mg COq10, which seems to be working. I think my doctor would prefer me to use the Atorvastatin, but I've been sticking w/the RRY because it seems to be working and I have zero known side-effects. Let me know if you have any thoughts in this regard.

Finally, I've made some changes to my diet. I've eliminated diet colas, reduced other foods high in potassium, and further reduced sodium. I've been drinking more water including one additional liter of water per day supplemented with about 1/2 teaspoon baking soda, which I've read can be beneficial with respect to prolonging kidney function. Let me know if you have any thoughts or suggestions along these lines, in terms of foods or supplements to embrace or avoid.

I appreciate your time and expertise in this area.
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