When to Ask for a Nephrologist

I recently had a sudden recurrence of edema after a long time of being on furosemide (Lasix). In addition to my diabetes, my endo had a urinalysis run showing a very high Albumin urine count. My PCP suggested and I had done an ultrasound on my kidneys. The PCP said things were normal but the lab numbers still are shocking I definitely have proteinuria based on these numbers but I am skeptical that something isn’t going wrong in my kidneys Has anyone else had normal kidneys but abnormal lab numbers?

I have had protein in my urine since 2003 – it varies between very large amounts to moderate. I haven’t had any other signs of kidney problems nor have I seen a nephrologist. Did they put you on an ACE inhibitor to help lower that?

I found that if I have my urine test after exrercising I had protein in my urine. My daughter (who is non-diabetic) has protein in her urine, but when she saw the nephrologist and had additional tests performed (like the 24 hour collection), she was told she was fine.

But the real question is, your profile shows an A1c of 16%, that corresponds to an average blood sugar of over 400 mg/dl. If your blood sugar is really that high, you may well have kidney damage. If that is the case, I do hope you can get those blood sugars down and it would be wise to see a nephrologist.

No strange numbers for me; but I’d look at creatinine, not albumin alone.
Did you really mean 16 for an A1c in your profile? Tell us about it.

Chiming in kinda late, but the short answer is, it depends on the stage of kidney damage, which is determined by looking at the amount of protein being spilled together with the ability of your kidneys to filter blood (GFR). Stage 1 is mild kidney damage, usually some amount of abnormal protein spillage with normal GFR, while Stage 5 is kidney failure.

Any amount of abnormal protein spillage in the urine may be indicative of some kidney damage but, usually, referrel to a nephrologist won’t happen until Stage 2 or 3 when there is a significant loss of GFR to go along with a significant amount of protein spillage. Blood tests may or may not indicate kidney damage at that point, but, as kidneys lose the ability to retain albumin, the levels of albumin found in blood will start to drop.

As others have stated, all kinds of things can affect the amount of protein you spill in urine without affecting your GFR, so transient amounts of abnormal protein spillage, alone, does not mean kidney damage necessarily. IIRC, they won’t even diagnose any amount of kidney damage unless you have 2 straight urinalyses, at least a month apart, showing abnormal amounts of protein spilled.

Hope this helps.