High Proteinuria

I am a 23 year old guy who was diagnosed with diabetes back in 2014. For
the past two months I dropped the ball on my bg goals and ended up with
a 9.7 a1c which is a big jump from my 7.9 a1c 6 months ago. Recently my
doctor did 2 microalbumin tests 4 weeks of each other and the results
were that I had 750 microgram/ml or 75 mg/dl of albumin in my spot
urine. But everything else regarding kidney functions came back normal
such as serum creatinine (.7mg/dl) , egfr 130, and BUN (10mg/dl). The
only thing was a high serum and urine glucose which was 274. I know that
this is unacceptably high and I am currently on strict blood sugar
control (having a average reading of 150 after testing 7 times a day).
My question is that, does this mean I have an advanced kidney disease
and I cannot reverse it or does it mean I need dialysis really soon?

I very seriously doubt you have anything to worry about at this stage. Keep in mind that I’m just another (experienced) diabetic, not a doctor – kidneys are nothing to fool around with, so MANAGE THIS WITH YOUR PHYSICIAN.

That said, when sugars are way out of control you can have very high albumin in urine until BG is brought back under control for a time, and kept there. So don’t be nervous yet – keep your BG in line, and your albuminuria should resolve.

You are way too young, too new with diabetes, and do not have the symptoms of End-stage Kidney Disease.

If it helps, after having had a T2 diabetes diagnosis for 12 years, I let it get completely out of control for a bit over a year. When I finally got my act together, I was running BG over 500, a1c nearly 12%, microalbumin tests higher than yours.

Got my diabetes under control (I went much farther than you need to right now, and started insulin therapy, got a pump and CGM, and resolved to live tight control for the rest of my life), my a1c down in the low sixes, and have pretty much followed that for the last 3 years. My microalbumin spot test comes out 80-90 pretty much all the time, and my doctors are not concerned – as long as I keep my BG under control.

So, don’t worry. Be happy! Keep your BG under control, and you’ll do fine.

Kidney disease is usually determined by stage, using the egfr result. Yours is 130, which is excellent. >90 is normal.
I’ve had T1D for 50+ years, with much of my early years with high BGs due to lack of tools we have today. My egfr has dropped under 60 a few times, which is considered Stage 3 CKD, but then bounced back to 60-89 range, which is Stage 2. But this is still considered ‘okay’, as the kidneys can still function well in Stage 1, 2, and ok in Stage 3. Dialysis is not until 4/5.

However, it’s a good wake up call for you to do what you can now to help prevent damage to your kidneys and eyes. Getting your A1C down to 7 or less is the best way to reduce/eliminate chances of these complications.

(from labtestsonline . com)
The following table summarizes estimated GFR and the stages of kidney damage:

1 Normal or minimal kidney damage with normal GFR 90+ Protein or albumin in urine may be high, cells or casts rarely seen in urine (see Urinalysis)
2 Mild decrease in GFR 60-89 Protein or albumin in urine may be high, cells or casts rarely seen in urine
3 Moderate decrease in GFR 30-59
4 Severe decrease in GFR 15-29
5 Kidney failure <15

1 Like

The microalbumin test is very sensitive. And you can normally dump some protein, it doesn’t necessarily mean anything. You can also do things which cause you to dump protein (like exercise) (hint: don’t exercise in the 48 hours preceding a microalbumin urine test).

It is fine to be concerned. You can ask to be referred to a kidney specialist (a nephrologist) who will run more extensive tests (the fun one is the 24 hour urine collection).

1 Like

Kidney disease cannot be diagnosed with just a spot check - likewise a spot check can also potentially miss early signs. You do however, probably need more extensive testing - do NOT let your doctor brush your concerns off.

You should aim for an A1c no greater than 6.9. (I aim for much lower than this for my daughter). I suspect that if you tightened up your management and consistently achieved A1c’s in the 6s or lower, your kidney function tests would return to normal.

1 Like

I continue to have very high protein in my urine. It is flaged at 3+. Has been at 2+ for past 10 years. All other labs are normal for urine. Doctor said too long to worry??? I am worried but I am over 75. Any advice?

Is this microalbumin? Is your doctor a nephrologist? Some people just dump protein and a nephrologist can tell you whether the protein is an issue or not. My daughter dumps protein and after a number of tests her nephrologist concluded that nothing was wrong.