kidney problems

[Zhnyaka]

I recently discovered that I have proteinuria, I had urine test strips and they showed a value somewhere between the norm and the first green square, which was designated as 0.1 g/l. Scared, I did a protein analysis in daily urine, the protein value in urine was 36.9, which is higher than normal, and the daily concentration was 45mg/day which is absolutely normal. I turned to a nephrologist and he said that this was the first stage of nephropathy and prescribed me half a tablet of perindopril a day. I'm a little worried that this drug lowers blood pressure because my blood pressure is 110/65. Also, when I asked the nephrologist if I needed to change my very protein-rich diet, he replied that there was no need, kidney ultrasound was also absolutely normal.
I don't know at all how to react to this news. On the one hand, I understand that "a little nephroprotectors will not hurt you" does not mean "your kidneys will soon fail", but on the other hand, I feel sad. Of course, almost 20 years of diabetes cannot pass without a trace.
I probably want moral support more than help in understanding what is happening, because I trust a professional doctor. Just tell me if you had something like that and how it ended

 

[Antje77]

I had similar results a while back, and started this thread about it: https://www.diabetes.co.uk/forum/th...-urine-would-like-thoughts-on-my-labs.193395/

I've had lab results again last month, and the albumin had now dropped from 51 mg/l to 32, still significantly higher than the reference of <16.

But my diabetes nurse explained that they look mostly to the albumin/creatinin ratio, which is fine at 2g/mol, so she's not worried about it and I don't need to come back for labs until next year.

prescribed me half a tablet of perindopril a day. I'm a little worried that this drug lowers blood pressure because my blood pressure is 110/65.

Have you looked up what the actual dose is, and what common doses are? Half a tablet doesn't tell you anything.
I was on a low dose of enalapril already (going by the name a close cousin of your perindopril) because of BP, and we upped the dose a bit.

The good thing about ACE-inhibitors is that they don't work that long, so should your BP get uncomfortably low, you may have a bit of an uncomfortable dizzy day but you should be back to normal the next.
In the thread I linked some people mention taking their ACE-inhibitors before bed to minimise side effects.

 

[Antje77]

Oh, and tagging in @Grant_Vicat , he knows all about kidneys.

 

[Zhnyaka]

I was on a low dose of enalapril already (going by the name a close cousin of your perindopril) because of BP, and we upped the dose a bit..

2g, but I always thought that nephropathy should be accompanied by high blood pressure, and I have it below normal. On the other hand, why else can there be protein in the urine? Is protein in the urine always an indicator of poor kidney function? Should I retake the analysis? I love cottage cheese and eggs, but it is unlikely that this will lead to proteinuria. No one asked me to come in a month and see how the disease was going, the doctor just prescribed perindopril, saying that it would have to be taken for life. Maybe you should go to another nephrologist?

Do I understand correctly that you are not taking medication now and everything is fine with you?

 

[Antje77]

Is protein in the urine always an indicator of poor kidney function?

Not according to my diabetes nurse.

Do I understand correctly that you are not taking medication now and everything is fine with you?

I'm still on enalapril. My last urine test showed I had still higher amounts of protein in my urine than normal, but the diabetes nurse assured me that because the albumin/creatinin ratio was perfectly fine, it's likely that my kidneys are perfectly fine as well, so I'm not worried for now and happy to see if things have changed in a year.

2g

I suppose you meant 2mg?
That's a very low dose, starting doses are often 4mg: https://www.drugs.com/dosage/perindopril.html
Being prescribed such a low dose looks like this doctor has taken your lowish BP into account, and also like he isn't too worried about your results.

No one asked me to come in a month and see how the disease was going, the doctor just prescribed perindopril, saying that it would have to be taken for life. Maybe you should go to another nephrologist?

To be honest, everything you say sounds like no-one you saw felt there is anything serious going on at the moment, even if your lab test was slightly outside the normal parameters.

the protein value in urine was 36.9

In my country the cut off point lays at 16, but as you can see in the thread I linked, in other countries up to 30 is considered normal. And you're very close to that.

Also, proteinuria can be a temporary thing, caused by all kinds of stuff.
If this is the first time you had a slightly high result I'd be happy with just waiting to see the next result.

 

[Grant_Vicat]

Oh, and tagging in @Grant_Vicat , he knows all about kidneys.

Thank you @Antje77 . I shall do my best, but please don't shoot the defective messenger!

 

[Grant_Vicat]

I recently discovered that I have proteinuria, I had urine test strips and they showed a value somewhere between the norm and the first green square, which was designated as 0.1 g/l. Scared, I did a protein analysis in daily urine, the protein value in urine was 36.9, which is higher than normal, and the daily concentration was 45mg/day which is absolutely normal. I turned to a nephrologist and he said that this was the first stage of nephropathy and prescribed me half a tablet of perindopril a day. I'm a little worried that this drug lowers blood pressure because my blood pressure is 110/65. Also, when I asked the nephrologist if I needed to change my very protein-rich diet, he replied that there was no need, kidney ultrasound was also absolutely normal.
I don't know at all how to react to this news. On the one hand, I understand that "a little nephroprotectors will not hurt you" does not mean "your kidneys will soon fail", but on the other hand, I feel sad. Of course, almost 20 years of diabetes cannot pass without a trace.
I probably want moral support more than help in understanding what is happening, because I trust a professional doctor. Just tell me if you had something like that and how it ended

As @ANTJE says, 2mg is a very low dose. Also as she says, 39 is close to the standard parameters (in the UK <30 is the target). Non diabetic children can often show signs of proteinurea and it is not usually a cause for concern. It is also heartening that @ANTJE has come down 19mg/l, which would have thrilled me in my earlier years. It is always disturbing to hear of complications beginning, but I would suggest that this is an isolated test and that once you have a good picture of say a year's readings, then would be the time to evaluate how you stand. This is easy for me to say, since I remember how I felt when a diabetologist gave me very unwelcome news when I was a student. As I regularly mention, the best help is controlling blood sugars to the best of your ability. I wouldn't be in a hurry to abandon your nephrologist - it looks like he is being cautious and very much keeping your wellbeing in mind. Try not to stress about this - it will only put your blood sugar (and blood pressure!) up. Here's to a favourable test next time!

 

[Zhnyaka]

and also like he isn't too worried about your results.

If he hadn't said "for life", I would have decided that he prescribed me some homeopathic medicines just to calm me down But probably when a patient comes to you and starts a conversation with the phrase "I have type one diabetes for 19 years" nephropathy is the most obvious assumption.

Also, proteinuria can be a temporary thing, caused by all kinds of stuff.

Hmm... I only know about dehydration and physical activity, but I specifically skipped boxing training so that it would not affect the analysis
Probably I am so worried because I know that nephropathy is a common complication, I would hardly worry much if my tests concerning something that is not a complication of diabetes were a little higher than normal

Try not to stress about this - it will only put your blood sugar (and blood pressure!) up.

Stress for some strange reason normalizes my bg, and my blood pressure is already low, so I'm fine

 

[Antje77]

Probably I am so worried because I know that nephropathy is a common complication

It's also a very. very slowly developing complication, especially if you have reasonable blood glucose, like you have.
Look at Grant_Vicat, he lived with serious CKD for 40 years and decades of very high BG, unlike you.
At this point I don't think there is a way to see if this is just a blip in your results or very early kidney disease.

Either way, I think the recommendation is either wait and see, or start a low dose of ACE-inhibitors and check again in a year, which is exactly what is happening.

 

[Zhnyaka]

It's also a very. very slowly developing complication,

May I share a meme on this topic?

In fact, the fact that you have elevated protein scares me even more, because screenshots of your blood glucose graphs make me think something like "wow, how cool! Can diabetes really be controlled so well?!". I've never been able to make my schedule so smooth, besides 19 years is a long enough time for any complications to develop

But thank you, I am pleased with your words that everything is much better than I think

 

[Grant_Vicat]

Look at Grant_Vicat, he lived with serious CKD for 40 years and decades of very high BG,

Just to put things in perspective, my blood sugars were very erratic from 1959-1979. After all there were no meters then, merely urine testing tablets which had a limited range of colours, looking like this in the link:

Test for urine sugar using Clinitest Reagent Tablets

Series of photographs depicting a test for urine sugar using Clinitest Reagent Tablets manufactured by the Ames Company. Included in the photographs are directions for conducting the test and the color chart used to analyze the result.

digital.sciencehistory.org

So at it's worst it was a rusty brown, which could mean anything between 13 - 44 in today's measurements. With meters being properly available in 1979, it made life better for guaging control, but the damage had already been established before that! I can assure you that I am extremely grateful, even to primeval treatment, to be able to type this now!

 

[Antje77]

In fact, the fact that you have elevated protein scares me even more,

For what it's worth, I had to have a medical assessment when I started sailing professionally when I was 21, 25 years ago, and 18 years before being diagnosed with diabetes.

The GP I saw for the assessment told me to keep an eye on the protein he saw in my urine.
Well, being 21 and invincible, and not in the least interested in what that could mean (plus we didn't have internet much back then), of course I never followed up on that.

I only remembered when I got the elevated protein result this year.
So no idea what was going on 25 years ago, but it does show that a one off result of protein doesn't necessarily mean anything significant.

 

[Zhnyaka]

Just to put things in perspective, my blood sugars were very erratic from 1959-1979. After all there were no meters then, merely urine testing tablets which had a limited range of colours, looking like this in the link:

Test for urine sugar using Clinitest Reagent Tablets

Series of photographs depicting a test for urine sugar using Clinitest Reagent Tablets manufactured by the Ames Company. Included in the photographs are directions for conducting the test and the color chart used to analyze the result.

digital.sciencehistory.org

So at it's worst it was a rusty brown, which could mean anything between 13 - 44 in today's measurements. With meters being properly available in 1979, it made life better for guaging control, but the damage had already been established before that! I can assure you that I am extremely grateful, even to primeval treatment, to be able to type this now!

If you think that 20 years ago I had a cgm or at least a cool blood glucose meter, you are very wrong . We had something like this

moreover, these strips had to be cut into three thinner parts, because they were very expensive

 

[Grant_Vicat]

If you think that 20 years ago I had a cgm or at least a cool blood glucose meter, you are very wrong . We had something like this
View attachment 60776
moreover, these strips had to be cut into three thinner parts, because they were very expensive

I remember doing that! But as the technology progressed they made sure this was not possible. Was that produced in the UK?

 

[Zhnyaka]

Was that produced in the UK?

I have no idea

 

[Grant_Vicat]

I have no idea

I just noticed it is all in English. I wondered whether it was made by Ames, like the old clinitest and ketostix were? Obviously it must have been imported.

 

[Zhnyaka]

I just noticed it is all in English. I wondered whether it was made by Ames, like the old clinitest and ketostix were? Obviously it must have been imported.

I just found a similar photo in Google. I don't remember the name of the company that produced it, I just remember how it looked. And even if a medicine or analyzer is exported, all its labels must be translated.

 

[Grant_Vicat]

I just found a similar photo in Google. I don't remember the name of the company that produced it, I just remember how it looked. And even if a medicine or analyzer is exported, all its labels must be translated.

Probably Boehringer Mannheim and could be USA. Not that it matters!

 

[Zhnyaka]

Hell, I went to practice today and couldn't do half of what I usually do. My blood sugar level was absolutely normal (yes, I checked it on a glucose meter), but I felt bad, as if I decided to train with hypoglycemia. I wonder if it could be caused by perindopril? 2 mg seems like a dosage that should not lead to me lying on the floor like a rag after 15 push-ups. Could it be caused by the fact that I almost didn't eat animal protein for a whole week? Vegans don't have a problem with sports, do they? On the other hand, I felt better when I drank coffee and ate a chicken sandwich. I also decided to drink a course of potassium, magnesium and omega-3 for the heart, but I do it every year. Even my coach asked if I was okay. What the hell kind of medicine did my nephrologist prescribe for me?

 

[Antje77]

Between the pendinopril and not eating animal protein for a week, there is no way to guess if it's either of those being the culprit.
Or it may be something else altogether, like a cold brewing or such.