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Opinions & Advice re ACR

Posted , 3 users are following.

sarah77498
sarah77498

Hi, new here and I have received a letter today for a follow up appt from my recent annual review at my diabetic clinic. The appt is for September and it is discuss my increased ACR. Wondered if anyone could offer any input?

Background

- Female, 40 in couple of months, non-smoker/drinker.

- Dx Type 1 aged 30 (just over 9yrs ago). Insulin dependent.

- Naturally very slim, weight never goes beyond 56kg.

- Cholesterol/HDL/LDL/Trigs always within normal range.

- BP always low-mid end of normal range.

- HbA1c (blood glucose test) has consistently been in the 40's for as long as I can think back which signifies tight control. 

Now, I've had to cast my mind back, but I had a couple of consecutive clinic reviews in the past (likely between 2011-14) where I was required to repeat my urine sample due to slightly increased protein. I made sure I was very well hydrated on the repeat tests and they came back fine.

So here are the results of my last three lots of tests:

2015 

- ACR: 4.6mg/mmol

- eGFR: 82ml/min

- Creatinine: 70umol/L

2016 

- ACR: 2.1mg/mmol

- eGFR: 79ml/min

- Creatinine: 72umol/L

2017 

- ACR: 3.8mg/mmol

- eGFR: 86ml/min

- Creatinine: 66umol/L

So, I have had fluctuating ACRS and slightly decreased eGFRs. I don't actually understand the creatinine as I keep coming across different range values online. 

So, my questions are; is there anything that particularly leaps out regarding my values? Anything especially bad or good or how they read as a whole? Especially considering my normal BP/Cholesterol, generally good blood glucose control and the fact that I have been diabetic less than 10yrs (most kidney probs seem to start at least 15yrs in, but obviously I'm generalising). 

Secondly, I assume this follow-up appt is to discuss possible medication. Now, the consultant's report in 2016 acknowledged the fluctuating ACR and mentioned the possible use if ACEI's but stated that given my low BP it was doubtful I could cope with even a small amount of this medication. So, what happens in this instance? Are there any alternatives considering kidney problems seem so tied up with hypertension?

Also, would insufficient hydration have much bearing on these results?

Any advice gratefully received.

0 likes, 4 replies

4 Replies

  • KenR
    KenR sarah77498

    Posted

    Hi Sarah, let me start by saying I am not a medical professional, just someone with a severe kidney problem who has studied the numbers!

    Your numbers look reasonable, Creatinine below the norm for a woman ( higher is worse), your eGFR seems ok as with age this falls a bit anyway. ACR below 3 is what the docs call the Reference range, so you are just nudgeing over that number.  If your blood pressure is normal for your age and weight then I would question the need for anything like ACE inhibitors.  They are often prescribed for people with notable protein in urine to lower BP, and there is some professional discussion about how low the BP target should be. For kidneys with severe damage ACE inhibitors are not recommended and alternates are used for BP control.

    You already seem to be looking afteryourself well!

    Good luck,

    KenR

    • sarah77498
      sarah77498 KenR

      Posted

      Thank you Ken

      Yes, I'm under the care of medical professionals but in the meantime was interested in the opinions of those with real life experience, many who I know, educate themselves highly in regards to numbers, etc smile 

      Do you think I would like be given any meds? Obviously this appt in September is to discuss this. What is rather disconcerting is that I seem to be doing everything right, but yet the kidneys seem to just be nudging in the wrong direction despite this.

      I've read on the diabetic forum how people have protected their kidneys by lowering their blood glucose, losing weight, lowering BP, but none of those things are a factor with me. 

    • KenR
      KenR sarah77498

      Posted

      Hi Sarah,

      Yes I thought you seemed to be doing all the right things.  All I might suggest is to try to see a Nephrology Consultant who may either suggest a course of action, or more likely I think confirm that you are already on the right track. You may find other Forum members who have been in similar medical conditions who can tell you more. I am a bit further down the line with Stage 4 CKD and now with only 1 kidney, so I am as careful as I can be with meds and eating! Still feel ok though!

      KenR

  • jenny46928
    jenny46928 sarah77498

    Posted

    Hi Sarah,You probably have diabetic nephropathy。

    Normal value:

    - eGFR: 90-120ml/min/1.73m^2

    - Creatinine: 70-108umol/L

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