Proteinuria and Elevated Blood Sugar: A Guide for Patients

Urinary protein and blood glucose?

A few days ago, my father went to the clinic for a blood test, and the results are as follows: Urine protein 1+, fasting blood glucose 125 mg/dL (after fasting for just over 7 hours), total cholesterol 127 mg/dL, triglycerides 229 mg/dL, HDL 39.2 mg/dL, LDL 42.0 mg/dL, AST 40 IU/L, ALT 69 IU/L, creatinine 0.86 mg/dL, eGFR 97.08 mL/min/1.73m².
The clinic doctor only advised my father to exercise more without further explanation.
Six months ago, my father's urine protein test was +/- and now it is 1+, but the kidney function appears normal based on the test results, and the fasting blood glucose is elevated, although it does not meet the criteria for diabetes.
Should he undergo further testing? My father's BMI is 25.3, he has hypertension with blood pressure maintained between 140-150, and he is taking medication for hypertension and lipid-lowering.
He smokes about a pack a day, drinks enough water, has no exercise habits, and occasionally drinks alcohol at night to help him sleep.
Please clarify these concerns, thank you.
🙏

WLM, 20~29 year old female. Ask Date: 2017/06/29

Dr. Hong Yuanbin reply Internal Medicine

Hello,
In response to your father's concerns, here are my replies:
First, regarding the protein in urine, the clinic report indicates a preliminary positive result.
It is recommended to visit a larger hospital for a quantitative urine protein test, and possibly a 24-hour urine protein test, to determine the exact condition.
The suspected cause is nephrotic syndrome; however, further detailed examinations are necessary to confirm this.
Second, concerning blood glucose levels, a single blood sugar reading cannot determine the presence of diabetes.
It is advisable to have a blood glucose meter at home and measure levels 3-4 times a day, with at least 2 readings taken before meals.
After about a week, bring the blood sugar readings to the physician for evaluation.
Third, regarding blood lipids, triglycerides are still elevated.
It is suspected that your father's diet remains high in fats, so dietary control should be strengthened.
Fourth, your father is at risk for the three high conditions (hypertension, hyperglycemia, and hyperlipidemia).
It is recommended to encourage him to exercise to prevent the occurrence of stroke or heart disease.
If needed, you can consult at a family medicine clinic.
Thank you for your inquiry.

Reply Date: 2017/06/29

More Info

Understanding proteinuria and elevated blood sugar levels is crucial for managing your father's health, especially considering his existing conditions such as hypertension and his lifestyle choices. Let's break down the findings from his recent lab results and discuss the implications.

Proteinuria
The presence of protein in the urine, indicated by a 1+ result, can be a sign of kidney issues, but it is essential to interpret this result in context. Proteinuria can occur for various reasons, including transient conditions like dehydration, exercise, or stress. However, persistent proteinuria may indicate underlying kidney damage or disease, particularly in patients with risk factors such as hypertension or diabetes.

Given that your father's kidney function appears normal (with a creatinine level of 0.86 mg/dL and an estimated glomerular filtration rate (eGFR) of 97.08 mL/min/1.73m²), this suggests that his kidneys are still functioning adequately. However, the increase in protein levels from a previous test (where it was +/-) warrants further investigation. It would be prudent to monitor this condition closely, possibly through repeat urinalysis or a 24-hour urine collection to quantify protein levels.

Elevated Blood Sugar
Your father's fasting blood sugar level of 125 mg/dL is above the normal range (typically less than 100 mg/dL) but does not yet meet the criteria for diabetes (which is diagnosed at 126 mg/dL or higher on two separate tests). However, this level indicates that he is in a prediabetic state, which is a significant risk factor for developing type 2 diabetes.

Lifestyle Factors
Several lifestyle factors can contribute to both proteinuria and elevated blood sugar levels:
1. Diet: A diet high in processed foods and sugars can lead to elevated blood sugar levels. Encouraging a balanced diet rich in whole grains, fruits, vegetables, lean proteins, and healthy fats can help manage blood sugar levels.

2. Exercise: Regular physical activity is vital for maintaining healthy blood sugar levels and overall cardiovascular health. Since your father currently does not have an exercise routine, introducing moderate exercise, such as walking or swimming, could be beneficial.

3. Weight Management: With a BMI of 25.3, your father is at the upper end of the normal range, bordering on overweight. Weight loss, if needed, can significantly improve insulin sensitivity and help lower blood sugar levels.

4. Smoking and Alcohol Consumption: Smoking is a known risk factor for cardiovascular disease and can exacerbate hypertension. Reducing or quitting smoking, along with moderating alcohol intake, can lead to better health outcomes.

Recommendations
1. Follow-Up Testing: It would be advisable for your father to have follow-up tests, including a repeat urinalysis to monitor protein levels and possibly an HbA1c test to assess his average blood sugar levels over the past three months.

2. Consultation with a Specialist: Given the combination of proteinuria and elevated blood sugar, consulting with a nephrologist (kidney specialist) and an endocrinologist (diabetes specialist) may provide a comprehensive approach to his care.

3. Lifestyle Modifications: Encourage your father to adopt healthier lifestyle habits, including a balanced diet, regular exercise, and smoking cessation. These changes can have a profound impact on his overall health and help manage both his blood pressure and blood sugar levels.

4. Medication Review: Since your father is already on medication for hypertension and cholesterol, it may be beneficial to review these medications with his healthcare provider to ensure they are appropriate given his current health status.

In conclusion, while your father's current lab results indicate some areas of concern, proactive management through lifestyle changes, regular monitoring, and specialist consultations can significantly improve his health outcomes.

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