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Re: [IP] Kidney Problems

   WHOA..slow down girl!! To quote Billy Crystal in "City Slickers: "jump off 
that bridge WHEN you get to it, not before!"
    Microalbuminuria occurs when the amount of protein in the urine exceeds 
30 mgs. 30-300 mgs is considered microalbuminuria & beyond that it's 
proteinuria. Basically it reflects the kidneys' inability to retain that 
protein, because of pressure building up in the kidney when the flow of blood 
out of the organ is impeded by narrowed vessels. The use of an ACE inhibitor, 
traditionally given to hypertensive pts, dilates these vessels, allowing for 
less restricted blood flow, & hence less pressure in the kidney which 
"pushed" that protein out, potentially weakening & damaging the kidney 
filtering mechanism. (Help me out here Spot if I'm misquoting) My own 
scientific/medical background is nil, other than "on the job training" & a 
quick crash course from a cardiologist friend. He told Melissa to picture a 
very thick milkshake & a very narrow straw...then picture how more readily 
the milkshake could flow, if the straw was of a wider diameter. Voila! Now 
THAT I can visualize! LOL
   Anyway, in Melissa's case, the ACE inhibitor(Vasotec) that she began 
taking 3 yrs ago at age 14, reduced the amount of protein in her 24 hr 
collection by 90%!!! Her saga is an aberrant one, and yes, just like Pat's 
son Eric, she too has had very good control since she was dx'd 8 yrs ago. The 
high protein levels are less an indication of "poor control", than simply an 
innate predisposition to "leak protein" which was probably exacerbated by the 
strain of diabetes on the body. That said though, there have been studies 
indicating that minimal changes CAN occur in the kidneys within a few years 
of diagnosis IN THOSE SO PREDISPOSED. The renowned researchers to whom I've 
spoken all believe that the advent of using ACE inhibitors (in those for whom 
they are indicated) will alter the course of diabetic complications' 
progression in years to come. Not only are these meds efficacious in the 
kidney, but may also have benenficial effects on the eyes and heart, also 
areas of concern for microvascular problems. Bottom line, as one researcher 
pointed out, think about it this way - the "old school of thought" was that 
kidney problems never surfaced for 15-20 yrs...but that was because no one 
thought to look for impending signs years prior....so usually by the time it 
was detected, there had already been significant deterioration. Now that it's 
possible to monitor alterations via 24 hr urine collections, intervention can 
be started long before the situation becomes more dire.
   Hope this helps alleviate your anxiety. I always liken the use of ACE 
inhibitors to women & osteoporosis. If there was nothing that could be done 
intervention-wise, it would only be discouraging to know. But since women 
whose DEXA scan reveals osteoporosis CAN take meds like Fosomax to strengthen 
their bones; and since patients with diabetes CAN take ACE inhibitors & 
ameliorate their microalbuminuria, then why NOT be an "informed consumer".

Regards, Renee ( pump mom)
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