Hypertension/microalburia

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QUESTION: dr falkenburg,i am 79 years old and have diabetes and hypertension both well controlled.about 6 months ago I had 300 units of albumin in my microallbumin test.at 79 this is ist time it appeared.from what I read at my age of 79 it is unlikely it will progress to kidney failure.im on ace inhibitor lisinilopril.from what I read evenwith proteinuria it would take 10 years to kidney failure.no swelling or other symptons.think chances are high it will stabilize,thanksroger

ANSWER: Good afternoon, Roger and thank you for your question.

There are a variety of complications of diabetes.  The first and best known consists of abnormalities of the blood sugar and the issues resulting from glucose levels being acutely elevated.

Diabetics, also, have accelerated hardening of the arteries because of sugar related abnormalities of fat handling and the abnormal deposition of saturated fats and cholesterol onto the vessel walls leading to their narrowing.  Diabetes is, therefore, associated with an increased incidence of heart attack and stroke as well as vascular issues involving the extremities. All diabetics need to restrict their fat and cholesterol intake and nearly all should be on a statin medication such as Lipitor or a related drug.

The third abnormality and the one that concerns you, consists of what are called the micro-vascular complications of diabetes. Chronically elevated blood sugars result in a chemical reaction between glucose and all proteins in the body.  It produces what are called  "glycosalated proteins".  These altered proteins can be conceived as sticky and adherent and they become stuck in the very small blood vessels of the body.  Effected areas include the eye (diabetic retinopathy), the nerves in the extremities, stomach  and intestinal tract and the kidney. Abnormal symptoms can result from any of these sites.

The kidney, of course, is of great concern because kidney failure, occurring in the setting of diabetes, is the most common cause of kidney failure, requiring dialysis, in the USA. The presence of  "micro albumin in the urine is the earliest and first sign of diabetic nephropathy. Your levels are abnormal but not very high. If you follow your diet faithfully, keep your A1C levels less than 7, take medications called ACE inhibitors (this is what lisinopril is) in doses sufficient to reduce the micro-albumin levels, as much as possible, (you will probably need as much as 20 mg per day) your kidneys will likely last you for the rest of your life and possibly, your nephropathy will not progress at all.  

I should add that the control of your blood pressure is, also, paramount and it should, if at all possible, kept at or below 130/80.  However, at age 79, this goal might have to be modified because we do not want to reduce your blood pressure too much.

So, this is my story and I'm sticking to it!

Roger, This is complicated material and, if you wish, feel free to flow up and I'll try to clarify anything you don't understand.

Good luck to you!

Sincerely,

Dr Falkinburg








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

QUESTION: thanks for the answer.it took me 2 days to digest it all.going back to my question,i read once a type 2 diabeteic gets microalburiaonly 20%progress to kidney failure in 20 years its a long process taking many years.what is your opion on this

Answer
Good morning, Roger,

Microalbuminuria is the result of damage to the kidney filters caused by chronically elevated levels of glycosalated proteins which are toxic to the filters within the kidney (as well as other tissues).  The rate at which the kidneys are destroyed is proportional to the AVERAGE height of the blood levels of those destructive proteins. ON AVERAGE, the process is slow but, in the individual, specific case, the course can be much faster if noncompliance with the therapeutic regimen exists and the appropriate diet and medicinal program is not followed.

In general, however, I agree with the statement that it is a long process, usually.  In your case, as age 79, if you treat your diabetes as it should be treated, it will, certainly, be a very long process that, probably, will not effect the quality of your life.  This assumes that you are, otherwise, healthy and compliant.

I don't mean to hedge or be evasive, but, if nothing else, human beings are very diverse and averages, often, do not have significance when applied to a specific case. We are very complicated and the devil lies in the detail. We ignore this at our peril.

Best of luck to you.

Sincerely,

Dr Falk

Hypertension

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Newell R. Falkinburg, M.D. FACP

Expertise

Any question regarding hypertension or clinical nephrology

Experience

35 years of experience in the field of nephrology & hypertension. Emeritus Professor of clinical Medicine at a major medical school and director of Nephrology & Hypertension at a university affiliated medical center.

Education/Credentials
M.D. Board certified internal medicine Board certified Nephrology & hypertension

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Fellow, American College of Physicians

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