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  Wednesday, 13 February 2019
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I am a 47 year old woman, physically fit, and very active. About 10 years ago I found out in routine medical exam that I had proteins in the urine ( 3 g/l)
My ratio micro albumine/ creatinine was over 85, constantly for a few months and then I was send for a biopsy revealing a glomerular necrosis (12%) performed on one kidney. All that time my blood work was fine and showed that my estimate GFR was optimal. No metabolic disease, no signs of autoimmune disease, low blood pressure ( 87/52), normal weight 5’3”-112 lbs. Mediterranean diet.
I use to be followed by a nefrologist back in Canada, but now I live in France since 5 years and I only have a generalist physician. Since 3 years I notice a serious drop in my urine, I now have 0.17 g of protein in my urine and although my ratio microalbumine/creatinine is still abnormal it dropped to 13. ( instead of 85). Blood work is always the same, ( around 104 eGFR) .
I was wondering how is this possible since I was told the damages were permanent? Should I still seek for nephrology medical attention or the generalist is enough to monitor my condition?

It would be helpful if you posted screen shots of your blood/urine tests so we can be sure we are discussing the right parameters (please attache below after removing or blocking identifying personal information. That being said, kidney disease can fluctuate, namely your level of proteinuria. It would be important to know how much scarring was on your original biopsy and whether you are on any medication. It is reassuring that your eGFR is preserved and your urinary protein is quite minimal. Provided that no other systemic disease is present (e.g. diabetes, lupus etc) then this predicts a favourable prognosis.

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

Thanks for submitting your reports. I did not post them above but have read them. You have a very small amount of glomerular scarring and actually only a minimal amount of proteinuria based on your latest ACR of 13.5. Very often with biopsy reports such as this, we never determine a cause. Nevertheless, your recent protein levels represent a big improvement from the earlier report of 116 from 2013. Since you also have normal kidney function, your outlook is very good. In future, I would ensure that you have excellent blood pressure control and strong consideration given to using drugs such as an angiotensin receptor blocker (ARB) or ACE inhibitor to do so. These drugs not only control blood pressure but can reduce protein leaking in to the urine. In your case, as your blood pressure is already normal and proteinuria is improved, then the role of drugs at this point would be more controversial. In patients such as you, I have used medications such as losartan (an ARB) at low dose as it can minimize proteinuria without major impact on blood pressure - but it is always a balance when starting off with low blood pressure.

Of course, this advice should be discussed with your health-care provider first, but this would be my interpretation.

Dr. Jordan Weinstein
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