By: Robert Tanenberg
Annual screening for microalbuminuria (low levels of protein in the urine, indicating early signs of kidney disease) in type 1 diabetes should begin with puberty and/or after five-year disease duration of diabetes.
In patients with type 2, screening should begin at the time of diagnosis.
Consider an ACE Inhibitor
Numerous scientific studies have demonstrated that angiotensin converting enzyme (ACE) inhibitors, such as Vasotec, Altace, lisinopril and others, are the antihypertensive drugs of choice in all patients with diabetes. They reduce microalbuminuria, which is the hallmark of early diabetic kidney disease (nephropathy).
Therefore, the American Diabetes Association’s Standards of Care recommends these medications for all nonpregnant adult patients with diabetes.
Lifetime therapy with the drug is required.
Once begun, the dosage of the ACE inhibitor should be increased to the maximum tolerable dose for the greatest efficacy.
Possible reasons for the failure of ACE inhibitors to reduce microalbumin include:
- Inadequate dose
- Excess salt (sodium) in the diet
- Another cause of kidney disease (in addition to diabetes)
- Advanced kidney disease (serum creatinine over 3)
Or Maybe an ARB
If ACE inhibitors cannot be tolerated, one of the angiotensin receptor blockers (ARBs), such as Cozaar and Diovan, should be substituted.
This group of drugs has also been demonstrated to reduce albuminuria and prevent kidney failure in both type 1 and type 2 diabetes. In certain cases, physicians may prescribe both classes of drugs for patients with diabetic nephropathy or hypertension.
Other anti-hypertensive agents may be useful, but none have yet been shown to be equivalent to the ACE inhibitors or the ARB drugs in preventing or reducing diabetic nephropathy.
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How can I reduce my level of microalbuminuria
- Stay in good glucose control
- Keep your A1C under 7%
- Don’t smoke
- Keep your blood pressure below 130/80
- Keep your cholesterol level on target
- Take your prescribed medications
The microalbumin-creatinine ratio is obtained from a urine sample. Bear in mind that:
- Higher values may represent false-positive results from fever, exercise prior to the test, heart failure or poor glucose control.
- To maximize accuracy, vigorous exercise should be avoided 24 hours prior to the test.
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What are the factors that contribute to diabetic kidney disease?
Non-modifiable risk factors (you can’t change these):
- Older age
- Longer duration of diabetes
- Genetic profile
Modifiable risk factors (you can lower these risks)
- Hyperglycemia (A1Cs above 7%)
- Cholesterol disorders
- Frequent urinary tract infections