Q: My father is 67 years old. He is a diabetic patient with sugar level at 168. The serum creatinine level is 0.91 but microalbumin in his urine is 134 and microcreatinine is 14.5. He has high blood pressure. Is his kidney function normal? How should I get him treated?

A:Presence of excess albumin/protein in the urine is a sign of kidney damage, which along with normal level of serum creatinine in a longstanding diabetic like your father, reflects early stage of diabetic related kidney disease (called “Diabetic nephropathy”). It is an early stage of the disease process where kidney’s filtering function remains normal. As part of the management, he would require a strict blood pressure (BP) control (goal BP <130/80) along with well-controlled blood sugar level. This is intended to delay the kidney disease progression in near future, which becomes obvious from a steady rise in serum creatinine value (or decreased filtering function) and/or worsening protein leakage in the urine. Your father would certainly benefit from the addition of blood pressure medications called Angiotensin Converting Enzyme (ACE) inhibitors or Angiotensin Receptor Blockers (ARBs). Studies have shown that these medications help delay the progression of kidney disease usually through the reduction of protein leakage in the urine and also reduce the risk of cardiovascular disease (heart disease). Besides, I would advise testing fasting lipid profile and aggressively treating any elevation if noted in the cholesterol level.