Id be interested in any of the issues raised by my dad's personal blog here about my mum resonate with others on here who have a single kidney: ocnutrihealth.com/blog/chro...
In particular, the uncontrollable albuminuria despite slightly better proteinuria which indicates that the former may be less relevant for non-diabetics, as per embedded link in the blog.
All related comments appreciated!.
PS Please dont refer to medical team as nephro been unhelpful for 7y, despite constant asking!
I haven't really looked into the relationship between proteinuria and albuminuria. Apparently albuminuria is excess albumin (most common but very tiny protein) present in urine; proteinuria is an excess of multiple blood proteins present in urine. Albuminuria info is a wake up call for diabetics since diabetes is a leading cause for organ failure of all kinds and it isn't always reflected in eGFR. For diabetics, it's all about glucose control. High glucose and high albuminuria together indicates trouble - namely, the glucose is taking out the filters in the kidneys. However, there other reasons for albuminuria too. You raise an interesting question - is proteinuria data or albuminuria data more significant for some more than others? I'm going to ask my hubby's nephrologist about this at his next appointment.
Many thanks for your reply and your understanding of albumin/albuminuria seems spot-on.
The reference to "experts" in dad's blog is based on this clinician's review mdedge.com/clinicianreviews... which clearly states "Proteinuria and albuminuria are not the same thing" as well as the stronger association between albuminuria for diabetics which is repeated in the embedded report by Guh in the blog which states "Based on the current evidence, ACR might be recommended for the diabetics and PCR for the non-diabetics".
I'd be interested to know your hubby's nephro's views on the relative significance of albuminuria and proteinuria. It's unclear if my mum's does or doesn't recognise/understand any difference for her (a non-diabetic). Whilst he appears to be less interested in uncontrollable albuminuria in terms of her results, he did state in her 2 Feb consultation that we cannot ignore it and that he's continuing to monitor both. And his subsequent letter states that we were concerned in the consultation about proteinuria - but it's actually albuminuria which we expressed concern about!.
Lol. Doctors are humans so they sometimes get a little confused too, like everyone else. I'll let you know what our neph says about it the two tests and the importance of either (or both) to the various types of kidney populations. Apparently albumin is a protein made by one's liver. So I'm wondering, too, if there's a connection with high glucose levels in diabetics hurting the liver, making albumin of interest more in that population. Our appointment with the neph is at the end of this month. I hope he doesn't get complicated and talk over my head. Lol. I'll get back to you with his comments.
Thanks. Interestingly in mum's latest results in Jan, her liver marker ALT suddenly trebled to over-range for first time ever. I suspect it's because of acyclovir drug she had to take for shingles 3m earlier. Her nephro hasn't included in retests mid-2024 (!!) so we've suggested it.
Also ger hba1c dropped significantly for 1st time albeit only 5% to 38. Mmmm..
Back again...my hubby and I visited his nephrologist today. As I promised, I brought up albumin and protein tests with the doctor and asked for an explanation. He said the albumin test is a newer and more contemporary test which detects that common protein earlier than the older protein test. He noted that the quicker a problem is detected, the quicker solutions can be found. (He compared the kidneys to a boat, the more holes that are poked into it, the quicker it sinks. So it's best to pay attention when the first leak shows up.) This early warning is particularly important for diabetics because high glucose levels harms not only the kidneys but especially the heart and surrounding vascular system. Hence, endocrinologists will order the albumin test for diabetics quite often and, if needed, adjust diabetes meds to lower the damaging effects of glucose. A bit later, the older protein test results will confirm the albumin test. In instances where the two tests may not trend in the same direction, it can involve things like cancer.
I also asked about single kidney and two kidney functions. Did a single kidney really take over the work of two? He answered that in young individuals, a single kidney can indeed grow and increase capacity. But it can't completely take over the function of two - it will only reach the 85% point at best. Overtime, because it is only one kidney, the labs will reflect the wear and tear on that kidney. So nephrologists will keep that one kidney situation in mind when reviewing lab data. That led to a discussion on how mother nature often gives us "one and spare" in case one fails - two eyes, two ears, two kidneys, two ovaries, two testes, etc. And he added, "If you need to lose something, it's better to lose a kidney than an eye. One can live well on one kidney. Sure, the eGFR and creatinine may be out of the normal range to some extent, particularly as the aging process set in, but I usually tell my patients to live their lives! Just be sensible - keep weight in check and so on and don't let anyone damage it (like a car accident or rough sport)!"
Many thanks for replying after hubby's nephro meeting. In response:
1. Para 1. That makes complete sense except maybe doesnt explain why mum's proteinuria increase reversed (and 24h protein and PCR arguably stable) whilst albuminuria hasnt. But WE are effectively treating it as an early warning signal - despite no sign mum's nephro is - so trying more non-pharmaceutical interventions.
If the cancer reference means one continually increases whilst the other continually decreases, that shouldnt be a concern 🤞
2. Para 2. At least in terms of eGFR, mum's single kidney did completely "take over" for a while, increasing from 36 to 76 at one point but has now gradually fallen back to 50 which is 83% of the pre-nephrectomy figure of 60. If it at least remains around 50 🤞that's quite consistent both with your hubby's nephro and the reported 56 figure in the blog that I linked in my OP 👍.
So your hubby seems to have a much better nephro than mum (I dont suppose youre based in NW England? 😜). I plan to attend her next consultation in ~6m so will hopefully get answers that were not forthcoming in telephone ones!
Btw, Im assuming your hubby has TWO kidneys so didnt ask about his albuminuria.
Thanks again.
Appreciate your update. Like your mom, my hubby only has one functioning kidney, a transplant. You mention your mom's albuminuria remaining the same while the protein increase reversed and that appears a bit odd. Interestingly, a transplant surgeon told me that other things like urinary tract infections, nonfunctioning kidneys, etc. can "slough off" proteins into urine, so sometimes tests don't always reflect a situation accurately. I occasionally wonder if the "size" of the albumin protein relative to other proteins has an influence in labs, too. I dunno. Anyway, here are my hubby's most recent lab numbers. These apparently are based on blood: eGFR flagged as low at 50, BUN is high at 30, creatinine is high at 1.46. BUN/creatinine ratio and everything else is normal. Then, here are the urine based numbers: albumin/creatinine ratio is high at 652. protein is normal at 6.1, albumin is normal at 4.0. Then there there are lots of other numbers that are wonky because of his transplant - RBC, WBC, bacteria in his urine due to his constant low level uti, etc. Anyway, our nephrologist, in our discussion, referred to the albumin/creatinine ratio and (I thought) protein/creatinine ratio, but I don't see the latter here. Maybe I heard him wrong? None of my hubby's specialists seem to care about eGFR. (His "cleaned up" donor kidney came from a man who would now be 48). It's clear my "smarts" isn't at the save level of my hubby's nephrologist. I hope your nephrologist can shed some light on your questions. Understanding things is a good thing!
Thanks. Mums albuminuria is not unchanged - her increase is, that is it's 100%/yr. Her proteinuria has generally also increased per year but also dropped a couple of years ago. Her nephro believes that means it's stable.
I'll compare other data you've listed after doing conversion to UK units. Then I'll reply again.
Mum's latest test results to compare with your hubby's are:
eGFR also now 50 (trend as per my last message)
Serum urea (related to BUN) = 11.1 mmol/L (or 66.6 mg/dl) so 62% over normal (N) range
Serum creatinine = 100 umol/L (or 1.13 mg/dl) so 13% over N range
uACR = 31.4 mg/mmol (or 278 mg/g) so 900% over N range
uProtein = 0.23 g/dl (or 23 mg/l). No N range provided & not shown as abnormal but this link indicates bit high healthcheckup.com/general/p...
uPCR = 45 mg/mmol so 320% over N range
uAlbumin = 160 mg/l (or 16mg/dl) so 900% over N range
Hope conversions correct.
Interesting that hubby's uACR seems >2x mum's despite mostly better other results!!.
Your mom's eGFR is pretty good since her kidney probably has more age on it than my hubby's (48 years), in my view, considering they're both living on one kidney. I noticed that my hubby's uACR was that high too while everything else was pretty good (other than blood cell stuff. It's a outlier, for sure. And I have no explanation. It's just weird how doctors just scan everything and go "Eh, you're fine! See you later!" Looking at your mom's, one notices that she does have kidney issues and one sometimes wonder exactly "how many holes will sink one's ship" as our nephrologist would say. Yet the body is indeed amazing and resilient! And you're doing a wonderful job keeping an eye on her health and diet. We're both curious types. I suspect both of us will asking for explanations from the doctors. 
Creatinine of 18, but kidney function returning. 
CKD and Kidney Stones
cancer in left kidney
Bio-artificial kidney
Genetical Kidney Disease, female, 24
