[Previous Months][Date Index][Thread Index][Join - Register][Login]
[Message Prev][Message Next][Thread Prev][Thread Next]

Re: [IP] Re:24 hr. urine test(long)

In a message dated 11/20/00 5:25:35 PM Eastern Standard Time, 
email @ redacted writes:

> Somehow, it did not show in those microalbumin tests.
> It is my guess that it would have gone even higher before it would show if I
> had stayed with the other doctor who did not ever test with a 24 hour urine.

   Since today is the 3 year anniversary of my then 14 yr old daughter's 
kidney biopsy, it's apropos that I reply to this now. I agree completely with 
your comments & Melissa is a perfect example why. Although she was & is 
completely asymptomatic, and her blood tests were & are in normal ranges, she 
was predisposed to "shed" protein. Orthostatic proteinuria is a relatively 
benign problem, often seen in adolescents. In my daughter's case though, the 
diabetes exacerbated & accelerated the effect of this innate predisposition. 
Her 24 hr urine was first done at age 12 & there were 300 mgs. No 
intervention was recommended, other than a follow up test 2 years later..at 
which point it had risen to 500 mgs. She was started on Lisinopril which 
upset her stomach, so she was switched to Vasotec. By September, her 24 hr 
urine showed 1100 mgs of protein, which had her doc baffled, so he ordered 
another & it was 1200. He took her off the meds for 2 wks, re-ran it & almost 
turned me grey overnight when he called to say it had soared to 2600!!! Her 
lab studies nonetheless all reflected "normal renal function"!
   She started back on Vasotec with 2.5 mgs, slowly titrated it up to 10 mgs 
( which she still takes- 5 am and 5 pm), underwent a kidney biopsy to rule 
out any other plausible explanations (thankfully none discerned) & when 
re-checked in the spring of '98, her 24 hr urine showed 288 mgs; one year 
later it was 300 mgs and this spring (after resorting to one of those "day of 
the week" pill boxes to enhance compliance!)  it was an astounding 166 mgs!!!
   Will it stay that way forever? Well if I knew that, I'd be out buying 
lottery tickets, instead of typing this! LOL...But I do know that had it 
continued unchecked, her ped, nephrologist believes she'd have been facing a 
transplant within 5 years.....And our former hospital which did nothing when 
she was at 300 mgs 5 yrs ago now routinely starts teens on ACE inhibitors as 
soon as they are above the top normal of 30 mgs (30-300 is considered 
microalbuminuria/ above 300 is proteinuria)
   So, to those who think a 24 hr urine collection is a "pain", keep in mind 
that my teen has done this about a dozen times, & we consider it a valuable 
diagnostic tool. Keep in mind too that Melissa's story is highly aberrant, 
BUT her first a.m. spot urinalysis was always "normal" & although all the 
blood work showed "nothing", the cumulative effect would have weakened her 
kidney functioning eventually.Since many diabetics are diligent about annual 
eye exams, etc. it makes sense to do an annual 24 hr urine too to make sure 
the kidney filtration is as "normal" as blood tests are reflecting. By the 
way, her bp pre-ACE inhibitors was 90/70 and  has remained in that range.
   Off the "leaky kidneys" soapbox (which I revisit periodically! )....Happy 
Turkey Day everyone...
Regards, Renee (Melissa's pump -mom)
for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
send a DONATION http://www.Insulin-Pumpers.org/donate.shtml