Should I be worried about nephropathy?

[SweetSophia]

Hey guys I have a question about kidney disease. Is it common to have microalbuminuria when you're a newly diganosed type 1? And generally, have you had kidney problems that just went away?
When I was diagnosed, a couple of months ago, I was in DKA and everything else was typical for a newly diagnosed type 1. However, I've had microalbuminuria and then, after couple of weeks, my kidneys returned to normal and the doctors said it's nothing to worry about. My c peptide is very low.

I've read something about it lately and they said type ones are not typically presented with microalb. and that it's more common for type twos, because they have less elevated bs, but for a longer time so there is time to develop complications. I've also read that every damage to the kidneys is irreversible.

This whole thing about types is not important, it's just what lead me here. Is it possible that I've already developed some complications although all of it has happened very quickly? Should I be worried?

Ps. I know kidneys can be temporarily leaky because of high intensity physical activity, but I don't think that's the case here.

 

[TheBigNewt]

Type 1's certainly can develop diabetic nephropathy which can begin with microalbuminuria and progress to frank proteinuria and then renal insufficiency. But it generally is a late complication, not present on intial presentation like you. It indeed might have been just a blip, a glitch, a lab error. To be honest I haven't tested for it in probably 8-9 years. I figure if I keep my blood sugars under decent control, have A1Cs around 6-6.5 what else am I gonna do but worry about it?

 

[DCUKMod]

Type 1's certainly can develop diabetic nephropathy which can begin with microalbuminuria and progress to frank proteinuria and then renal insufficiency. But it generally is a late complication, not present on intial presentation like you. It indeed might have been just a blip, a glitch, a lab error. To be honest I haven't tested for it in probably 8-9 years. I figure if I keep my blood sugars under decent control, have A1Cs around 6-6.5 what else am I gonna do but worry about it?

Hi Newt - Just for your information really; in UK the urine test should be done at least annually. It's one of our 15 basics, along with HbA1cs, foot checks and so on. I realise in the US things run differently.

 

[Shannon27]

And generally, have you had kidney problems that just went away

Hi Sophia!
To be honest, I can't say whether it's normal or not, but I got told about 2 years ago that there were some problems with my kidneys after I had a blood test at my checkup. I panicked for months, but when I went back they said everything was back to normal, so I presume that they do kind of heal themselves if you give them chance? I'm no expert, someone else may say I'm wrong, but that's my experience
Shannon x

 

[Peppergirl]

Hi just a quick post. type 1 for 25 years, approx 10 years ago got a letter stating I had microalbinuria, no action needed. Really concerned but annual appointment the year after, no trace of it and nothing since. Not sure if this is common but I wouldn't be overly concerned. Just keep on controlling BG as best you can. Best wishes

Sent from my SM-G925F using Diabetes.co.uk Forum mobile app

 

[SweetSophia]

Hi Sophia!
To be honest, I can't say whether it's normal or not, but I got told about 2 years ago that there were some problems with my kidneys after I had a blood test at my checkup. I panicked for months, but when I went back they said everything was back to normal, so I presume that they do kind of heal themselves if you give them chance? I'm no expert, someone else may say I'm wrong, but that's my experience
Shannon x

Hi Shannon Thanks for answering, sounds like I should be optimistic about this
May I ask: have they told you you have problems based solely on blood test or you've done the diuresis test (24h urine)?

 

[TheBigNewt]

Hi Newt - Just for your information really; in UK the urine test should be done at least annually. It's one of our 15 basics, along with HbA1cs, foot checks and so on. I realise in the US things run differently.

OK I'll be the devil's advocate here. The patient has pretty tight control, runs A1C's of around 6 (like me) for a long time. He's taking lisinopril for renal protection (like me). So you make them do a microalbuminuria test and it shows some. Are you gonna push for tighter control and risk hypos? Seriously what would you do differently? One age old principle of medicine is if you run some test (and we run LOTS of tests trust me) the results need to change the treatment somehow. If not don't run it. I've said it for years: running tests often times leads to running more tests lol. I realize they run these tests because it says it's what you do in the book about diabetes, I get that. They do it here too. This thread is a good example: they run the test, it's abnormal, and they tell her not to worry about it. Well she's worried about it. Right?

 

[TheBigNewt]

Delete post.

 

[DCUKMod]

OK I'll be the devil's advocate here. The patient has pretty tight control, runs A1C's of around 6 (like me) for a long time. He's taking lisinopril for renal protection (like me). So you make them do a microalbuminuria test and it shows some. Are you gonna push for tighter control and risk hypos? Seriously what would you do differently? One age old principle of medicine is if you run some test (and we run LOTS of tests trust me) the results need to change the treatment somehow. If not don't run it. I've said it for years: running tests often times leads to running more tests lol. I realize they run these tests because it says it's what you do in the book about diabetes, I get that. They do it here too. This thread is a good example: they run the test, it's abnormal, and they tell her not to worry about it. Well she's worried about it. Right?

@TheBigNewt - I wasn't point scoring or challenging your approach, merely pointing out a difference between UK and US approaches to day to day diabetes care. Historically, you have often done this yourself.

As an educated person, how you decide to approach your own care is up to you, but urine tests not being done for years on end would be considered unusual and undesirable here in UK.

 

[TheBigNewt]

@TheBigNewt - I wasn't point scoring or challenging your approach, merely pointing out a difference between UK and US approaches to day to day diabetes care. Historically, you have often done this yourself.

As an educated person, how you decide to approach your own care is up to you, but urine tests not being done for years on end would be considered unusual and undesirable here in UK.

Oh it's the same here as it is there. Whenever I've gone to an endo (it's been years!) they want an A1C and microalb. For sure. I mean it's what they do right? But they don't change my insulins or how I manage it because I'm under control. Doctors earn their money on the tough cases not ones like me. The brittle young people on pumps with CGMs and stuff.

 

[Shannon27]

Hi Shannon Thanks for answering, sounds like I should be optimistic about this
May I ask: have they told you you have problems based solely on blood test or you've done the diuresis test (24h urine)?

This was based on a standard urine test that they did at my local hospital at a check up, not a 24 hour one. That sounds like a nightmare!

 

[SweetSophia]

This was based on a standard urine test that they did at my local hospital at a check up, not a 24 hour one. That sounds like a nightmare!

I thought proteins in urine are measured as an amount/time relation, now I'm slightly confused
The 24h test: They give you large 4 l bottle. First time you pee in the morning you do it in cups or just in the toilet and then for the rest of the day you have to pee in the bottle and the next morning you also pee in the bottle and then you're done.
It's not so terrible when you're a guy, but for us girls...it can be inconvenient

 

[Shannon27]

I thought proteins in urine are measured as an amount/time relation, now I'm slightly confused
The 24h test: They give you large 4 l bottle. First time you pee in the morning you do it in cups or just in the toilet and then for the rest of the day you have to pee in the bottle and the next morning you also pee in the bottle and then you're done.
It's not so terrible when you're a guy, but for us girls...it can be inconvenient

I'm sorry I'm not trying to confuse you, just letting you know you're not the only one this has happened to 24h test still sounds awful!

 

[TheBigNewt]

The 24 hour micro albumin tests are from the 90's. Now they can test for it with a single cup of urine like they can for ketones and gross protein. Once in awhile they'll want the 24 hour one but usually not anymore.

 

[SweetSophia]

The 24 hour micro albumin tests are from the 90's. Now they can test for it with a single cup of urine like they can for ketones and gross protein. Once in awhile they'll want the 24 hour one but usually not anymore.

Thanks for the info
I'd be surprised if my doctors used a method that isn't outdated...