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Am I having diabetic manifestations of the kidney disease?

Q: I have type 2 diabetes and taking metformin 1000 mg daily and have high cholesterol too. For the past month I have been having terrible pain on my right side (flank) exactly where my kidney is. It has been waking me up at night too. I started spilling protein in my urine. I went to the doctor and they ordered 24 hour urine, which only showed a reduced creatinine clearance. An ultrasound and CT was ordered. So far the ultra sound did not show anything, only that my right kidney was slightly larger that the left. The pain is horrible. Do you have any advice? I am a nurse and know my body pretty well. It is clearly flank pain. Most people could not put up with the pain I am dealing with everyday. I am worried that my kidney could be giving up on me or showing some early signs of problems. Please let me know what you think.

A:It seems you are experiencing diabetic manifestations of the kidney disease. You have not mentioned how much protein are you spilling in the urine but it is one of the earliest evidence of kidney involvement. But, this doesn't explain the pain you are experiencing. Pain could be simply musculoskeletal or from the stretching of kidney capsule. If the right kidney is unusually large in size (you have not mentioned the size), further investigations in consolation of your nephrologist should be pursued. As far as the diabetic kidney disease is concerned, strict blood sugar control, strict BP control (<130/80) and use of medicines like Altace (which you are on) are known to help slow the progression of disease.

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