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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)
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