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Kidney Diseases

Microalbumin/Creatinine Ratio High

05/24/2007

Question:

My microalbumine/creatinine ratio this May 2007 is 50.6 mg/mmo. This is High relative to the reference range of 0-3.4 mg/mmol. Last Jan 2007, this ratio was 39.0. The corresponding creatinine (via urine) values were 2.71 mmol/L (May 2007) and 16.61 mmol/L (jan 2007). My creatinine (via blood) is 62 umol/L (May 2007) and 71 umol/L (Jan 2007). My microalbumin via random collection of urine is 137 mg/L (May 2007) and 647 mg/L (Jan 2007). Another thing I observed is that my WBC was high in May 2007 at 10-20 where the reference range was 0-5 /HPF. In Jan 2007 this was normal in the 0-5 range. I am female, almost 48 yrs old, successfully managing my hypertension via 10 mg Vasotec (an ACE inhibitor) since my latest reading is 122/82. I exercise at least 3x a week on the treadmill and am now in the normal weight range for my age and height (135 lbs.) I have no diabetes & my cholesterol is 5.49 mmol/L as of last Jan 2007. My microalbumine/creatinine ratio has consistently been high in the past years (e.g., 16, 88) when I was overweight (I have lost 52 lbs and maintained it since Jan 2006). I have recently changed my primary healthcare physician, who will be referring me to a specialist because of these readings. (1) What is your initial assessment of my condition? (2) What are tests that you recommend I have, to further the investigation? (3) What questions should I be prepared to ask the specialist (it will either be an internist or a nephrologist, depending who is available sooner, according to my doctor). (4) In the meantime, are there dietary suggestions you would make? (5) Any other suggestions?

Answer:

The high microalbumin/creatinine ratio means that your kidneys are leaking very small amounts of protein.  This ratio has been primarily studied in diabetics as a very early sign of diabetic kidney disease.  However, since it hasn't been studied a lot in nondiabetics, it's not clear to me what an elevated level means in your situation.  Your kidney function otherwise seems normal and your blood pressure is well-controlled.  The white cells in your urine may or may not be significant; they can be present in a variety of kidney diseases or if there's a bladder or kidney infection, but contamination of the urine by vaginal secretions can also cause white cells to appear in the urine.  If you have burning when you urinate, or lower abdominal pressure and a sensation of needing to go all the time, the urine can be cultured to see if it grows bacteria. 

Being very overweight can sometimes result in kidney damage with protein leakage; so it is good that you lost the weight and are trying to maintain a healthy lifestyle and diet.  Hypertension can also cause small amounts of protein leakage.  When you see the kidney specialist, be prepared to give a complete medical history (including the history of your hypertension, your weight loss, and any hospitalizations or surgery you've had in the past).  Be sure to bring all your meds with you so that names and dosages can be checked.   Be prepared to give a medical history of your relatives: diabetes, cancer, hypertension, heart disease, kidney disease.  The physician will want to recheck blood and urine tests and probably will order some sort of renal imaging (most likely an ultrasound).   Good luck with your investigations; and in the meantime, avoid smoking, take your meds, stay on a low-salt diet, and exercise! 

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Response by:

Mildred   Lam, MD Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University