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High Albumin, serum creatinine ratio, urine test, diabetic profile, lipid profile tests, protein test, ultrasound scan, urinary bladder infection, hypertension, taken telmisartan

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Dear doctor, I am 42 years old. Height is 165 CMs., with a weight of 73 Kgs. Recently I could find a high Albumin Vs.Creatinine ratio in the Urine test done by Thyrocare. Diabetic Profile and Lipid Profile tests are under normal range only. Later I got tested Urine Albumin in another lab which is found to be 4+. But, Serum Creatinine is in a normal range only. Then after the advice of my Physician, I have gone for a 24 Hour Protein Test, in which the Protein is found to be 980mg. in 3600 ml. quantity of 24 Hour Urine. Ultrasound Scanning Report is normal with respect to both the Kidneys. No Nephritis is found. But, there were small 5mm and 6mm Renal Calculi found right & left kidneys respectively. There is a mild Urinary Bladder infection found. Hypertension is found to be 140/82 at that time. All this has happened almost 22 days back. My Physician suggested me to take Telmesartan 40mg once daily for a period of 3 months and then to get 24 Hr.Urine tested for Protein. I would like to have a second opinion from you. Can you please guide me in this regards.
Posted Tue, 24 Apr 2012 in Kidney Conditions
Answered by Dr. Deepak Anvekar 1 hour later
Hello and thank you for your query.

From the history provided it seems that you might be having hypertensive nephropathy. This is a condition in which due to persistent high blood pressures, the kidney units ( called nephrons) are leaking protein in the urine.

Normally, there should not be any leakage of protein in the urine, other than that due to normal wear and tear of the cells of the urinary tract. The normal urine protein excretion is up to 150 mg/day.

In your case, Presence of 980mg of protien in a 24 hr urine sample is still a indicator of mild and reversible renal pathology.

In case this level increases to > 2 grams per day, it would indicate a progressive renal disease ( Including conditions like Glomerulonephritis).

Persistent Proteinuria above the normal range is a sign of chronic kidney disease (CKD), which can result from diabetes, high blood pressure, and diseases that cause inflammation in the kidneys.

In your case, since tests for diabetes have been normal and your blood pressure is above normal, control of hypertension would be very helpful to decrease the risk of progressive renal disease.

Since your age is above 40 years, urine protein is about 1 gram per day and presence of blood pressure on the higher side; Such factors are indications for initiation of medications to control proteinuria as well as reduce blood pressure.

Telmisartan, is a Angiotensin receptor blocker, and has been found by studies and research to reduce the proteinuria and prevent progressive renal disease and also reduce morbidity and mortality due to renal disease. Hence this would be a excellent choice of treatment in a case such as yours.

Treatment with this medication, would probably in the long run, reduce the proteinuria, as well as reduce the risk of progressive renal disease.

In short, the treatment and the strategy to evaluate your condition is a standard protocol followed by all physicians and you should definitely follow his advice.

Presence of urinary tract infection and small renal stones (< 1cm diameter) might be a co-existant condition. High proteinuria can result in stones due to condensation of protein with calcium in the urine. But they are treatable and conditions that do not cause long term renal damage.

I hope this helps to clear your doubts.

In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.

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