You are amazing!!!! Scrupulous education, I learned so much within the 1st 5 minutes and I haven’t even finished watching the video, I subscribed so fast I got whiplash! Thank you so much!! 💕💕💕💕
Thanks for wonderful video, Liz! Quick question, I had DM pt who had severe cough reaction to ACE/ARB. She had microalbumin >200mg/day If I remember correctly. She was on Amlodipine which is CCB as well, but I was not sure to switch to verapamil/diltiazem. Would amlodipine be appropriate alternative for her?
Oh interesting, yes in terms of ACE/ARB switching, any of the top 4 HTN choices according to JNC8 guidelines (CCB, thiazide) are appropriate depending on their other comorbids! Although won't protect from microalbuminuria. I'll have to make a post about CCB options!
If patients with type 2 diabetes can afford it, the addition of an SGLT2 inhibitor to an ACE inhibitor can be beneficial, provided that the side effects are tolerable and the estimated glomerular filtration rate is satisfactory.
I must admit, I need to make a correction here. The absolute benefit with SGLT2 inhibitors (SGLT2-I) is particularly significant for macroalbuminuria. I can't express enough how deeply moved I was by this video, especially when it comes to discussing microalbuminuria. The way you began and concluded the video was incredibly heartfelt and touching. It's evident that you genuinely care for your patients, and for that, I am sincerely grateful. Individuals like yourself make this world a truly enjoyable place to live. Thank you.
Hi Liz! Another great video! Question for you… If a diabetic, patient has persistent but stable microalbuminuria, at what point would you refer to nephrology? I have a diabetic patient with a normal GFR, controlled BP and A1C (6.1), and they are already on an ARB; but they continue to have elevated MAUs. Thank you in advance for your guidance!
Hi Alex, ARB's are the best option for DM with microalbuminuria- per guidelines. MAU may persist but if MAU is > 300mg/day this is consider macroalbuminuria and a referral to nephrology may be helpful.
Thank you for this video! I have also been taught that all patients w/ diabetes should take an ACE-I or ARB for renal protection. Can you help me find a source that you cited where ACE-I/ARB for renal protection should only be with those with HTN? Thank you!
Thank you for this question! It's actually a bit nuanced as there's conflicting resources. The ADA Standards of Diabetes Care 2018 recommends Ace-inhibitors in patients with either microalbuminuria who are normotensive, or patients with hypertension (ace-i are first line for hypertension in diabetes), but doesn't recommend preventative ace-i in patients not in either situation. I haven't read the full 2021 updates yet but on the summary of changes I didn't see any updates. The reason it's nuanced is because there are studies showing that everyone with diabetes could benefit from an ace-i but I don't think it's sufficient data to be included as part of the ADA guidelines. But totally, I also learned everyone is supposed to take one! Perhaps that's splitting hairs, it's unlikely that it would be harmful and is probably beneficial but I like having guidelines to back me up :)
Crestor by itself can proteinuria but not thought by most to be benign. In some rare cases rosuvastatin at high doses may effect renal function so its' important to monitor closely.
Hi ! When evaluating microalbumin labs you want to look at the microalbumin/creatinine ratio. The 96.8 microalbumin is not an accurate depiction of renal function. If you want to evaluate just microalbumiin then you will need to collect a 24-hr urine test.
I have a dipstick that is in mmol/l how do you convert that to mg. Mine is showing up high in urine. I had kidney function test, ct scan all showed ok. But the doctor didn’t test for micro albumin only standard protein. I’m trying to figure it out.
Hello! I am sorry, but for legal and safety reasons, I can’t advise on this lab result. We do recommend you follow up with your primary care provider. Thank you!
Yes! SO sorry I missed this comment. It can. I don't have great data on how much it'll improve or if it'll go back to normal, but when you improve the offending agents, it can get better.
Should the serum and urine creatinine (.77 and 11.7 respectively) tests be done fasted.. does it affect the test if one drinks lots of water prior? In the case "borderline" alb/creat (26) , A1C (5.7), fasting glucose (101).. how accurate is the estimated GFR spot-test versus the full 24hour GFR test to measure total albumin is < 30mg? Do you think fasting insulin tests are useful?
Fasting is not necessary for serum creatinine but increasing water take prior to testing can decrease serum creatinine levels. A urine creatinine is usually collected over 24 hrs as these are a more accurate picture of kidney function and gfr. A fasting insulin test is beneficial when considering differentials insulinoma or insulin resistance.
Good video but you talk very very rapidly and do not forget that many non-Americans are listening. Besides you have a very beautiful face and a very revealing voice. Thank you a lot . I love your videos.
You can click on the gear at the bottom of the playback screen and choose the speed at which to playback the video. It's set to normal, but you can slow it down to a speed that works for you!
