From Gainesville, Florida, USA:
I am a 36 year old insulin dependent diabetic diagnosed 33 years ago. Until recently, I have had absolutely no complications. Ten weeks ago I gave birth to a beautiful baby girl. Up until the 31st week, the pregnancy was pretty uneventful with nothing more than typical discomforts of pregnancy. I maintained extremely tight blood sugar control before conception and through the entire pregnancy.
At 31 weeks gestation, I was diagnosed with preeclampsia and was hospitalized. I was put on bed rest in an attempt to keep my condition from worsening and to allow the baby additional time to mature. My blood pressure gradually went up and I gained a lot of weight due to water retention. The delivery was induced at 33 weeks gestation because I had extremely high levels of protein in my 24 hour urines. At 4 weeks postpartum, there was still protein and microalbumin in my urine. My obstetrician said the protein would gradually disappear and not to worry about it. My endocrinologist said the microalbumin was an early indicator of kidney damage and I should begin taking ACE inhibitors to slow the progression of the damage. I resisted because he said I would have to stop breast feeding so he said he would repeat the test in 3 months to see if I still had microalbumin in my urine.
What is the difference between protein and microalbumin? Since both doctors said the problem may correct itself in time, why would I need to start medication? If I do have kidney damage, is it more likely that it was caused by having preeclampsia during my pregnancy, or did being diabetic for 33 years finally catch up with me? If it is caused by the preeclampsia, would delivering the baby sooner have prevented kidney damage? Should I see a nephrologist or do endocrinologists usually have a good knowledge of the type of kidney damage associated with diabetes?
You have several questions which I will answer in the order you wrote them. Albumin is a component of the all the protein excreted in the urine. Microalbumin is referring to the amount of albumin (usually defined as 30-300mg in 24 hours). Although the presence of albumin in the urine may reverse, it does represent a progression of renal disease due to diabetes. Therefore, the ACE inhibitor may be of benefit in delaying future renal impairment.
The fact that you are now having albumin in your urine is probably mostly due to your diabetes and less so to the preeclampsia. Usually, the protein in urine due to preeclampsia reverses in a few days. Delivering the baby any earlier probably would not have changed the outcome for your kidneys. Seeing a nephrologist is probably worthwhile at this time, although an endocrinologist with a special interest in diabetes is probably capable of managing your disease.
[Editor's comment: There are several terms for the presence of protein in the urine: proteinuria, albuminuria, and microalbuminuria. Although these terms technically refer to slightly different chemical concepts, the terms are frequently used interchangeably. The one difference that we doctors use, is to use "microalbuminuria" to refer to very small amounts of protein, and either "albuminuria" or "proteinuria" to refer to larger amounts. Thus, according to this logic, you wouldn't have both "proteinuria" and "microalbuminuria" at the same time: it's one or the other, depending on the amount of protein involved.
Whether the amount is small (microalbuminuria) or larger (proteinuria), if it's not due to transient reasons like preeclampsia, it should be treated, and not ignored! As you've already been told, this will include the use of medications called "ACE inhibitors" and other advice: see How to Protect your Kidneys.
Although most endocrinologists can handle problems with early diabetic kidney disease, I usually advise my patients to get a "second opinion" from a kidney doctor (nephrologist). WWQ]
Original posting 1 Jul 1998
Posted to Complications
Last Updated: Tuesday April 06, 2010 15:08:57
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