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Friday, December 6, 2013
Urinary and Genital Disorders (Children)
7 Y/O with high BUN and BUN/Creat ratio
My son went to the doctor last week, because he has been eating a lot. I was concerned about diabetes and so was his pediatrician. They did a UA dipstick in the office and it showed 30+ protein in his urine. He has had this issue for about a year now and nothing has been done about it. Everything else was negative. No ketones, glucose, bacteria, blood, ect. The doctor ordered a cmp, hbga1c, insulin, and cbc. His hbga1c came back slightly elevated. So the doctor said he had an increased risk for diabetes. His BUN was 22 and his BUN/Creat ratio was 35. He is scheduled for a renal ultrasound on the 23rd. Should I be concerned with this? Should I take him to a pediatric nephrologist? What could be causing this? He is otherwise health, healthy weight and height with no other medical problems.
It is difficult to answer your questions from the information you've sent, but here are some initial thoughts:
An increased appetite can certainly suggest diabetes, but this is usually accompanied by increased thirst, increased drinking, glucose in the urine, high blood glucoses (not a "slightly elevated" hgb A1c), and weight loss. Occasionally, children can develop type II, or adult onset diabetes, but this is usually seen in children who are very obese, with a family history of diabetes; and again, increased thirst and urination, glucose in the urine, and high blood glucoses would be expected.
I gather from the BUN of 22 and ratio of 35 that his creatinine level must be around 0.63, which is normal and which tells us that his kidneys are doing a good job of excreting creatinine (a normal waste product). BUN is also a waste product, and even though the level is high in the blood, this may be due to something else than kidney problems -- it may be related to dehydration or protein intake, for instance.
The protein in the urine is of concern; if this has been found on only one testing, it should be repeated and "quantified" as well (in other words, not just a dipstick that reports 30, 100, or 300), but a definite number on a so-called "spot urine protein/creatinine ratio." If the urine protein is high, then yes, he definitely needs a renal ultrasound and a visit to a pediatrist nephrologist (kidney specialist). There are a number of diseases that can cause protein in the urine, and the nephrologist can help to do the appropriate tests, in the appropriate order, to get to a diagnosis.
Hope this information is helpful. If not, please feel free to write again.
Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University