Microalbuminuria after four years with type 1 diabetes

Patient

Q: Hello, I am a 17-year-old girl with diabetes diagnosed at age 13. My sugar level is sometimes better, sometimes worse, but I keep trying to make it work. Usually it's between 60-230 mgdl, rarely over 250 mgdl; thankfully though, most of the time I manage to keep it around 80-150. Few months ago I found out that I had microalbuminuria and also a little bit higher blood pressure (about 125 over 80 while it'd used to be about 105 over60). My nephrologist recommended taking my BP every day and prescribed me Inhibace: at first 1mg, then changed to 2.5mg and now it's 5mg. The microalbuminuria level dropped after starting the treatment, but now it started going up again. Apart from this I don't have any other health problems nor signs of neuropathy or retinopathy. My question is if I can be sure the kidneys problem appeared due to diabetes, or there are some other possibilities? My nephrologist says it's certainly because of diabetes; unlike my diabetologist, who is convinced that there's no way diabetes caused it so early and that the problem is somewhere else. Thank you. Natalia from Poland

Doctor

A:   In patients with type 1 diabetes, hypertension is usually caused by underlying diabetic nephropathy and typically becomes manifest about the time as development of microalbuminuria or proteinuria. The peak onset of nephropathy in type 1 diabetes is about 10 years after the onset of the disease.Onset of proteinuria less than 5 years from the documented onset of diabetes may be due to a glomerular disease other than diabetic nephropathy, for example membranous nephropathy, minimal change disease, IgA nephropathy, Henoch-Schonlein purpura, or proliferative glomerulonephritis. In order to confirm the cause of kidney problems, investigative procedures like ultrasound or kidney biopsy may be an option.

In patients with type 1 diabetes, hypertension is usually caused by underlying diabetic nephropathy and typically becomes manifest about the time that patients develop microalbuminuria or proteinuria. The peak onset of nephropathy in type 1 diabetes is between 10 and 15 years after the onset of the disease.Onset of proteinuria less than 5 years from the documented onset of diabetes may be due to a glomerular disease other than diabetic nephropathy, for example membranous nephropathy, minimal change disease, IgA nephropathy, Henoch-Schonlein purpura, or proliferative glomerulonephritis. In order to confirm the cause of kidney problems, investigative procedures like ultrasound or kidney biopsy may be an option.


 

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