To prevent or slow progression to end-stage renal disease, Robert Stanton, MD, chief of nephrology at Joslin Diabetes Center in Boston recommends taking the following steps:
- Maintaining an HbA1c near 7% or lower.
- Maintaining blood pressure at 125/75 mm Hg.
- Using ACE inhibitors or an angiotensin receptor blocker.
- Eliminating smoking.
- Restricting dietary intake of animal protein to 0.6 to 0.8 gm per kilogram of body weight. One kilogram=2.2 pounds. Therefore, a 170- pound person (77.11 kgs) could eat 46-62 grams of protein per day.
- Treating urinary tract and bladder infections promptly.
- Checking albumin-to-creatinine ratios two to four times per year, or every time you see your physician.
Stanton adds that a program of nutritional counseling and exercise is important to achieving glucose and blood pressure control.
A Little Goes A Long Way—Kidneys Benefit from Small Amounts of Kidney Medicine
You may not have to take large amounts of an ACE inhibitor to enjoy its kidney-protecting properties, says a study focusing on 1.25 mg and 5 mg doses of the ACE inhibitor ramipril (Altace).
Even low doses of Altace can reduce microalbuminuria in people with type 1 diabetes who do not have high blood pressure, say researchers in a study published in the December 2000 issue of Diabetes Care. Microalbuminuria, or small amounts of protein in the urine, is a marker for both kidney disease and heart problems.
Researchers studied 140 people with type 1 diabetes and normal blood pressure over a two-year period. Those in the study had urinary albumin rates between 20 and 200 picograms or trillionths of a gram per minute (pg/min). Early signs of microalbuminuria or leakage of protein in the urine was 30 to 300 mg in 24 hours or 20-200 pg/min in a timed overnight sample. One group took a placebo, while two other groups took either 1.25 mg or 5 mg of Altace.
In the placebo group, the albumin excretion rate increased from an average of 54 to 70 pg/min, while declining from 49 to 36 pg/min on the 1.25 mg dose and from 45 to 38 pg/min on the 5 mg dose.
Researchers say it would be both wise and more cost-effective for health-care providers to begin treatment with a low dose of an ACE inhibitor and increase it if the albumin excretion rate increases.
What Is a Normal Lab Value for Creatinine?
Elevation in creatinine, which is a normal non-protein component of blood, can signal kidney damage.
According to Robert C. Stanton, MD, chief of nephrology at Joslin Diabetes Center in Boston, normal lab values are:
- .50 to 1.4 mg/dl for creatinine.
- 0 to 30 mcg/mg for a microalbumin-to-creatinine ratio.
Stanton says patients are generally started on medication when the microalbuminuria reaches 30 mcg/mg.