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Re: [IP] An Ounce of Kidney Prevention- UPDATED

    I'm "cutting & pasting" what I'd written in December about my daughter's
kidney biopsy (and which Melissa Davis has graciously linked at her website)
in response to your question about who should be getting their urine checked &

     I called Melissa's ped. nephro's office, seeking a referral of a
colleague at Stanford (her prior post) for a parent in California I'd met on-
line. Surprisingly, she returned the call herself & continued our previous
discussion about the absolute need for checking all kids. She has now
convinced the head of ped. endo to start screening even the toddlers & has
been sent 3 referrals in the past month alone. I asked twice if she meant pre-
teens, and she definitely said - "no, even the really little ones" 

The on-going evidence continues to substantiate the view held by nephrologists
for years now that ace inhibitors are incredibly effective at reducing protein
in the urine & that these meds could/should be prescribed prophyllatically for
ALL diabetics. That view is pretty radical though in the absence of any
corroborating evidence. But.... 

Dr. Conley's endo. colleagues have concluded that the insignificant cost of
checking microalbumin in a spot urine upon dx, and annually thereafter VERSUS
the mammoth costs of coping with kidney damage in later years is a "no-
brainer" that all doctors should be implementing. 

To clarify her recommendations (and I went over this carefully with her) 

1.For all children under 12, upon dx, a "spot urine" should be checked..This
should be the SECOND urine of the day, after the child has been upright &
mobile....Keeping in mind that my daughter's FIRST a.m. urines were always
perfectly normal,(under 30 mgs. microalbumin), even though her 24 hr
collection went as high as 2600 at its worst 

2.If over age 12, a 24 hr collection is preferrable..... 

3.If the results are normal - terrific- repeat in a year 

4.If microalbumin IS present (30-300 mgs) should be re- checked in THREE
MONTHS & on a frequent basis thereafter 

5.Ace inhibitors should be discussed & considered with input from ped.
nephrologist if results indicate increasing amounts of protein in the
urine...since this is considered the earliest sign of kidney damage.... 

6.If you want to "read more about it", check out this List of Nephropathy
sites at the Dia B Tees site for current ('97) scientific reports & suggested

I'm sorry if my experience is "disturbing" but then so too was finding out
that despite doing everything I could to monitor my child's diabetes, and
despite A1Cs in the 7s the first 2 yrs, in the 8s year #3 (pre- pump) and in
the 6's this entire past year....that Melissa now has the earliest signs of
diabetic nephropathy..... 

I believe fervently in being an advocate for my child's health. From the day
she was dx'd, I've told Melissa that when she's a parent, I want my
grandchildren (egads- what a thought!!) to be able to turn to her & say "Mom,
we're so glad you took such good care of yourself when you were a little girl
because we wouldn't want you to be sick & suffering & not able to do things
with us now"...........Yes, it's truly "the luck of the draw" & sometimes even
when you do everything "right", bad things happen.........But..... 

So in the spirit of the holiday season, give yourself the "gift" of peace of
mind by asking your endo or ped. to "humor you & the nutty people who tell you
crazy things on-line" by running a very simple urine test............. 

OK - enough said..Happy Holidays everyone..... 


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