I'm 59 with high blood pressure taking ramipril 5 mg, which is likely not enough since random readings have been high for several months, but otherwise fit. Long standing frequent need to urinate and often thirsty. Felt a little sick/rundown the last few weeks with some lower right back pain, and went to urgent care. Urine test showed protein was very high, over 300. Glucose also high, creatinine a bit low. No signs of any kind of infection apparently. Was referred to primary care doc today for evaluation for kidney disease. Primary care doc repeated blood and urine tests, and will get those results soon. (Last blood and urine test in November 2020 was normal.)
Can someone tell me what this all means? What is the best case, worst case, and anything in-between? Thank you.
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Welcome to the forum for Chronic Kidney Disease (CKD). You have reached a good site for support and sharing of information. Keep us posted on results if it is determined you have CKD.
Proteinuria isn't something you want long term. It tends to damage the kidneys and people with CKD and proteinuria are treated to minimise it. This isn't to say you have CKD.
High blood pressure is one of the leading causes of CKD so you would want to attend to that. 5mg ramapril is half max dose so wiggle room there.
CKD is established through serum creatinine. If its high it means kidney function has taken a hit. The higher the creatinine (over normal), the lower the kidney function
You may have something going on than CKD, some injury which isn't progressive (CKD is typically progressive) and from which you'll recover.
Ramapril, coincidentally, is prescribed by kidney docs to lower proteinuria (by lowering BP and by other mechanisms). So if proteinuria currently high then it would be higher if you weren't on ramapril.
Keep in touch when you get results. All the best in the interim
Thanks, Skeptix. I was a bit lax in staying on top of my blood pressure but that will change immediately. I will up the meds assuming the doc suggests that and start monitoring it more frequently.
What do you think it means that the proteinuria was high but the creatinine was low, .50 with a reference range of .60-1.20?
Also, is it unusual to have normal test results 18 months back and have these results now? I guess these things move fast?
I'm quite worried about it all, and wondering where I'm headed and imagining the worse.
It's hard to say, I only know a bit about my own situation!
Protein in urine is measured as a concentration. So many mg of protein (or, sometimes, a protein component, albumin in mg) per ml of urine.
Now, suppose you don't drink very much water pre test vs someone who drinks lots. Who will have the highest concentration of protein in their urine? They are passing the same amount of protein through their kidneys, but one person looks 'worse' than another.
Creatinine is a waste product, produced at fairly constant rates, which is filtered out by the kidneys. If its levels are elevated in the blood, that means the kidneys aren't filtering it out fast enough. Would that mean low creatinine in urine? I don't know.
If I were you I wouldn't be worrying. Not at this stage. Sure, you are being sent for checks but there are all kinds of reasons for things and results are only spot checks at a point in time. I got a 24hr urine collection sample done recently. Proteinuria is established in me but I want to see how various interventions are affecting it. And a spot test isn't much use - its too coarse, too snapshot.
Your not unusual in letting things hang until you get a fright! I have CKD and paid no attention until I took a drop post Covid. Suddenly I'm very alert to things, going so far as to go on a very low protein, vegan diet - ugh! Best to pay attention to your BP -even if you manage to dodge a kidney bullet this time around. BP is a bad idea from any number of angles- its like running your engine in the red line area all the time.
Your kidneys decline with age anyway (along with the rest of you). The question is if you've CKD, can you stretch em out so that you don't go on dialysis and die from something else.
That's what most of us here are at and should the news be "bad" come back and hear many talk of CKD being anything but a death sentence. There's stuff you can do to look after yourself and stretch the function you have out.
It's a bit like financial budgeting
Like vegan much?
Lets know how you get on in any event. And get onto your doc re bumping that ACE med. Invest in a decent BP monitor (upper arm, forget the tech gadgets that say they can measure BP, they can't) and start measuring twice a day to get a picture. You'd be well getting a 24hr ambulatory BP done as well to see that the day and night pattern is as it should be (even if higher than you'd like)
Lastly, ask your doc about taking the ACE before you go to bed (if you don't already) rather than in the day timr. It has more heart protective effect taken then, says the research.
Doctor just got back to me and says tests for kidney stuff were okay but waiting on some others results. Very relieved, and this is a definitely a wake-up call to stay on top on BP and things in general. Thank you for your replies, Skeptix.
The one thing that's likely the underlying cause for everything is your diabetes. I look at glucose as a type of sandpaper, scrubbing out vessels throughout the body, resulting in high blood pressure, kidney disease, blindness, cardiac issues, amputations and more. In diabetes, among the the main causes of proteinuria are high blood glucose levels over a period of years. Diabetes moves slowly but deliberately in its destruction - after a decade or two, it shows its destructive properties. Unfortunately, it's so commonplace, most are lulled into complacency. So you're very fortunate that you received this status report before actual kidney damage occurred. My husband, a T2D, simply relied on his medications to keep it in check until it was too late. In his case, uncontrollable blood pressure sent him into emergency dialysis. He has since received a transplant. Did this have to happen? Probably not. His mother, when told she needed to go on medication for her diabetes, took another route. She immediately addressed her sugars and carbs, dropped her weight, never needed any medications for it. She lived well into her 80s. So there are great outcomes for those who seek them. Sending you encouragement that you, too, will live long and fulfilling life.
I encourage you to ask questions - and bring up the diabetes issue head-on. Doctors rarely educate their patients properly on it - probably skirting the hard realities of it. When I asked how many patients in our dialysis center were diabetics, the answer was "almost all" of them. This is a great site that educates well: niddk.nih.gov/health-inform...
I simply noticed your statement that your glucose levels were "high" and assumed you were diabetic. I shouldn't have made that assumption. I would, however, address that high glucose report with your doctor - the reason for it. It may well be that you're not diabetic. And that would be great!
When you said thirsty and urinating frequently I jumped to diabetes, T2 immediately. Surprised your doctor didn't suggest and A1C for you. You might ask.
One thing I'd recommend is getting a copy of ALL of your lab results and tracking them either in a spreadsheet or notebook. Any you don't understand look it up via Google. Write down all of your questions and take that to your appts. Doctors are not all knowing and many neglect to tell their patients to lose weight, don't smoke, limit alcohol, exercise, etc. And if they do it's in an off hand kind of way with no details on how or why so you MUST educate yourself and advocate for your health, it's your only one so take care of it. Of course there are a lot of people who ignore health advice and opt of pills when things go south so I kind of get doctors.
It might mean that you are eating wrong. Just because you are fit does not mean you get to have a meat fest. So if you are a mean eater, you might want to travel a different road. I had similar issues with protein but my sugar was not high. Pre diabetes with protein >>>there are new drugs our for this = the SGLT 2 inhibitors. They are highly effective but all studies I read were in conjunction with Lisinopril. I am on 2.5 MG. My protein had been 600 plus. The mistakes past doctors made were starting me on standard dose of high bp meds,, but I still maintain a low protein diet.
Best to address cholesterol and your BP then so. You kidneys appear okay but those two things aren't good for your heart outlook (and BP is the main doer-inner of kidneys and much else).
The better you attend now, the less you'll have to do later
But glad you've dodged immediate bullets (espec diabetes, which sounds like dropping your body systems in battery acid).
Yes, this has all been a wake up call. Appt with cardiologist next month to adjust meds and such and will keep closer watch on everything going forward.
If kidney labs are normal now but the protein in your urine continued to be an issue, you will likely develop CKD. This is the most important reason why the recommendations by the ASN and NKF include the test for UCAR. Simply put for all humans to have protein in the urine is to have a problem. There could be several reasons why you may have this problem many benign and self-correcting but a few to be concerned about and demanding an examination to determine the cause. Protein in the urine long-term always damages the kidneys for good reason. With excess protein in the urine having to be filtered by the kidneys (instead of in the bloodstream used by the muscle cells and other cells) this process destroys the nephrons that make up the unique filtering process only found in kidney cells. We all start out with about 800,000 - 1.2M nephrons per kidney. I have an average eGFR of 20. If I started with 1M nephrons per kidney, I now have about 200,000 nepheons. Since kidney cells with nephrons do not regenerate as other cells in the body do (skin and over being the most beneficial to our health) and regardless of how my eGFR my “go up” I will never have any more nephrons than I have now. When my nephron level per kidney declines to below 120,000-150,000 nephrons I will need dialysis and/or transplant. The unused “waste” protein molecule is larger than the nephron in the kidney so just like a bumper car ride at a fair, the protein molecule destroyes every nephron molecule encountered. This is the reason that knowledgeable, attentive and patient concerned nephrologists monitor closely for this is the current CKD patients they treat. While healthy patients have to lose about 40% of their nephrons before their bloodwork identifies them as CKD stage 1, we as CKD patients can't afford a loss of even 1. So while your appointment with the cardiologist to address any cardio issues, be sure to identify the cause of your protein in your urine and if needed to treat that cause because it will eventually lead to a diagnosis of CKD if it persists untreated. Best of luck!
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