Q: I am 54 years old and have been a diabetic for the past ten years. Sugar levels have been under reasonable control and the current HbA1C reading is 6.4 and the one done three months ago was 7.2. For a period of two years, my control was poor with HbA1C touching 10. I am currently taking Metformin 500 mg 1 tablet twice a day and also Amaryl once a day. I had tested for urine microalbumin almost 2 years ago and then last year. The readings were 7.4 mg/l and 5 mg/l respectively. In a recent test, my creatinine level was 65 umol/L and my microalbumin was 27 mg/l. The microalbumin / creatinine ratio was 10. The doctor says this is high and could be the early stages of kidney disorder. He has prescribed half tablet a day of Cezaar 50 mg. Is my condition alarming and could my kidney function deteriorate over time? How could the microalbumin, which was 5 last year, go up to 27 mg/L now? Are any other tests necessary before I start the medication or should I start taking Cezaar? Is this condition reversible with medication?

A:Microalbuminuria and Diabetic Kidney disease Increased urinary protein excretion is the earliest indicator of diabetic nephropathy. The urine dipstick, however, is a relatively insensitive marker for initial increases in protein excretion, not becoming positive until protein excretion exceeds 300 to 500 mg/day (upper limit of normal less than 150 mg, with most subjects being under 100 mg). Persistent albumin excretion between 30 and 300 mg/day is called microalbuminuria and, in patients with diabetes usually indicative of diabetic nephropathy and above 300 mg/day are considered to represent overt proteinuria. This must be confirmed with repeated (at least two positive) and this should not be taken during fever, after exercise, heart failure, and poor sugar control as they can cause transient microalbuminuria. The early diabetic nephropathy, microalbuminuria is also associated with cardiovascular disease. Progression from microalbuminuria to overt nephropathy within a 10-year period occurs in 20 to 40 percent of patients with type 2 (non-insulin-dependent) diabetes and may be more rapid in Indians. There are other factors like hyperglycaemia, hypertension, and cigarette smoking, which can worsen the disease. The most important is control of blood pressure below 130/80 with medication like ACE inhibitor (cardace) or ARB, which decrease or atleast delay the progression of diabetic nephropathy. In regards to your urine, test values and units are not very clear. So, if your doctors says you had two positive microalbumin tests, then you should be on medication like Cezaar 50 mg and your blood pressure should be less than 130/80 mmHg, besides excellent glucose control, which you have any way as your HbA1c is 6.4%. Your creatinine and potassium should be checked 10 days after starting Cezaar 50 mg.