From Whitewater, Wisconsin, USA:
I am twenty years old and was diagnosed with Type 1 diabetes when I was about eighteen. I just had a test taken and the doctor found slightly elevated levels of protein in my urine. He wants to put me on Zestril [a blood pressure medication] but from the information I have found, this is for people with heart problems not kidney problems. What's the deal?
Zestril or Lisinopril is one of a group of drugs called ACE inhibitors (i.e., Angiotensin Converting Enzyme inhibitors). They have been used extensively in the treatment of high blood pressure and in congestive cardiac failure. In more recent years they have been shown to have an important role in managing 'microalbuminuria' in diabetes.
Microalbuminuria means the presence of a raised amount of albumin in the urine; but in amounts that are still not detectable by conventional dip sticks. It has come to be a routine test in diabetes using both a random and a timed overnight sample. There have been several studies that show that microalbuminuria can signal the onset of more serious diabetic kidney complications and that the use of ACE inhibitors can very significantly delay this process. The drug is used even when blood pressure is normal.
It is however rather unusual to develop diabetic nephropathy after having been diabetic for only two years, especially if you have been in good control. For this reason I think you need to discuss this problem again with your doctor. In the first place I think that the test should be repeated using both the random albumin/creatinine ratio and timed overnight excretion rates. Secondly it would be important to be sure that this small amount of proteinuria did not have another explanation. If you have ever had a urinary tract infection or some other form of nephritis for example, that could cause protein in the urine. Another source of error in young women could have been contamination of the urine sample with any vaginal discharge.
In short, whilst Zestril is certainly an orthodox treatment for diabetic microalbuminuria, you need also to be sure that that is indeed the problem, perhaps even getting a second opinion from a diabetic team who have had a lot of experience in the detection of early vascular problems in Type 1 Diabetes.
Original posting 27 Mar 1998
Posted to Complications
Last Updated: Tuesday April 06, 2010 15:08:56
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