Chronic Disease Support/Management/microalbunaria??????

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QUESTION: Sir, my urine report for 24 hrs urine protin and urine cretinine clearence report
age 53 -- weight 99 kg-- height 5.7---  H B a1c always below 7 -- cretinine mostly arround 1.2  ,-- 24 hrs volume 2200ml-- ,protin in urine 53,  24 hrs urine protin 116mg(normal  range they have stated(between 28-140)24 hrs urine protin they have calculated in gram .116, 24 hrs urine cretinine 38 , s.cretinine blood  1.2, 24hrs urine cretinine clearance they have calculated as 48.3( slighltly ormild ??) microalbunaria??? ph urine 5  sp gravity 1030 pus cells 3-5  mucus present urine was reddish  turbid --ultra sound -nofinding , hemoglobin blood 12.3 wbc 8700  platelet 3.21000 sodium 138mg  s pottasium 4.8mg  s calcium 1.23mg,  earlier gravity 1005  1025 earlier e-gfr  was 76with cretinine 1.02

I am diabetic range around 200 to 250 when metformin fail due to even slight eating more.Blood pressure always under control. Rarely increased upto 170 time being only in 2 or 3 months

kindly guide me--can I dis cont. metformin and start Glicisize-40 mg twice with 25 mg ARB as suggested by physician or consult super specialist? I am also patient of Ventricle premat beats under control now and metroplolar 25 mgonce cont.already with 75mg aspirin lipid profile normal without any drug due to oil restriction
am I patient of microalbunaria? they have tested protin not microalbumin. can u predict future of my kidney? am I now able to save my kidney from microalbunaria ?????kindly guide me completely and advice further tests after starting treatment
--(no symptoms at present)my kidney isdamaged ?temporary? curable?

ANSWER: Mr. Kumar - this is going to be a complicated answer for me.  Some of this is due to the subject matter and some of this is due to the language barrier.  Give me a day or two to deal with it and I will return with a better answer for you.

Dr. Cappuccilli

---------- FOLLOW-UP ----------

QUESTION: you can keeppendingfor more 3 days for detail answer

Answer
I am diabetic range around 200 to 250 when metformin fail due to even slight eating more.Blood pressure always under control. Rarely increased upto 170 time being only in 2 or 3 months.

    *** Diabetes is not about eating a little bit more - diabetic control is maintained by eating the right things.  In short - sugars or swiftly broken down carbohydrates are the things that you should be avoiding.  You can still eat until you are satisfied it is simply a matter of eating correctly.  The Mayo clinic (as well as many other online sites and support webpages for diabetics) offer healthy eating advice and options.  You do not have to starve yourself - just make better choices.

http://www.mayoclinic.com/health/diabetes-diet/DA00027

age 53

weight 99 kg / 219 lbs
   ***BMI Calculated at 34.3 which is not good.  You need to move more and eat less in the simplest terms.  A healthy (diabetes friendly) diet and exercise are the answer to this - NO ONE LIKES THAT ANSWER LESS THAN ME BELIEVE ME!

height 5.7

HBA1c always below 7

creatinine mostly around 1.2 WNL (Within Normal Limits)

24 hrs volume 2200ml
    ***The normal range is 800 to 2000 milliliters per day (with a normal fluid intake of about 2 liters per day).

Protein in urine 53
    *** WNL on a spot urine test this is within normal limits  

24 hrs urine protein 116mg (normal range they have stated is between 28-140)
    *** WNL

serum creatinine 1.2 WNL
     ***The normal value is less than 80 milligrams per day, or less than 10 milligrams per deciliter of urine.

ph urine 5
     ***Within Normal Limits

(Need clarification on this)  Specific Gravity of Urine 1030
     *** Are you certain that the measurement wasn't 1 POINT 03?  As in 1.03.  That would be within normal limits.  I can't imagine it being 1030 or 1000X the normal upper limit.

pus cells 3-5  

mucus present urine was reddish  turbid ultra sound -no finding

hemoglobin blood 12.3

wbc 8700  platelet

3.21000 sodium 138mg  

s pottasium 4.8mg  

s calcium 1.23mg,  
earlier gravity 1005  1025

earlier e-gfr  was 76
    ***This is lower than it should be.  It indicates decreased renal function.  The nephrons in the kidney are among the smallest blood vessels of any kind that we have in the body and they are sensitive to disease and infections.  In the absence of some type of nephritis (infection of the nephrons) this indicates mild kidney disease.  This is unfortunately common with poorly controlled blood glucose.  http://www.davita.com/gfr-calculator/index.cfm

cretinine 1.02

can I dis cont. metformin and start Glicisize-40 mg twice with 25 mg ARB as suggested by physician?
     *** Yes - you need to treat your diabetes more aggressively and the arb also has renal protective effects.  I think you should follow your doctors instructions on this immediately.

am I patient of microalbunaria?
     ***Yes
they have tested protin not microalbumin
     *** Albumin is the most common bodily protein found in serum.  Albumin = Protein

can u predict future of my kidney?
     *** No - the future of your kindey function depends a lot on how well you manage your diabetes.

am I now able to save my kidney from microalbuminurea?
     *** No - you can take steps to reduce the progress or decreased renal function but your body will not regenerate nephrons. Also,  I want you to think of it in terms of renal function - the albumin reading or microalbuminurea is an indicator to the level or presence of decreased renal function.  The albumin secretion is a symptom of decreased renal function NOT the disease that causes it.

kindly guide me completely and advice further tests after starting treatment
--(no symptoms at present)
     ***That is good
my kidney is damaged.
     ***True
Temporary?
     ***No
Curable?
     ***Strictly speaking no it isnt - you can however stop the progression (due to disease) with rigorous control of your diabetes.

Steps:

1) Consult a resource for a diabetes healthy diet

2) Keep strict testing records of your blood glucose so your provider can know if and when more aggresive medicinal therapy is needed

3) You need to exercise - it stinks I know - and you need to reduce your BMI and reduce the overall stress your body mass is putting on ALL of your organs.

4) Take your meds like your life depends on it - forgetting or running out or stopping because you feel ok should not be an option - ever.

Best of luck.

Dr Cappuccilli  

Chronic Disease Support/Management

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Dr. Joshua Cappuccilli

Expertise

I can answer most questions about chronic disease management with drug therapy and lifestyle changes.

Experience

Most commonly I deal with patients with the following disease states (not all inclusive) chronic cardiac issues, diabetes, hypothyroidism, hypogonadism, pain, and joint afflictions such as RA. I am also experienced in management of liver failure, renal failure and renal transplant patients. The most common issues with chronic disease state management that I see in my practice are drug therapy modifications as they relate to the progression of the particular disease state.

Education/Credentials
BA from University of South Florida 1999 Doctor of Pharmacy 2008 University of Florida College of Pharmacy

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