Hi doctor,My girlfriend is 35 years old. She is obese, exercises regularly and tries to watch her diet. In spite of these, she is prediabetic. Her fasting blood glucose is typically around 105 mg/dL. Her A1C is normally in the range of 5.7% to 6%. She takes Metformin to manage the prediabetes. Her blood pressure is checked regularly and is always good. Last time, her blood pressure was 120/80 mmHg. Her eGFR has been tested several times and is always above 90.Recently, she had a medical checkup in her office, and the report was obesity and protein in the urine. So, she went to She went to her GP who performed a 24-hour protein in the urine test. 520 mg per 24 hours was the result of this test. She was referred to an endocrinologist and a nephrologist. The nephrologist did perform an ultrasound. Neither the endocrinologist or the nephrologist were terribly concerned. My girlfriend discussed using ACE inhibitors with the nephrologist, but he did not think they were necessary as her blood pressure was normal. He recommended diet, exercise, weight loss and monitoring.The nephrologist did not tell her that she has phase 1 CKD. But, it sounds like she has. Is this correct? Both the endocrinologist and the nephrologist felt that it would not impact her ability to live a healthy life. Is this correct? If she has CKD, how long will it take to progress? What is the long-term prognosis? Is healthy pregnancy possible? Apart from diet, exercise and weight loss, are there other things you would like to recommend?
Hi. Welcome to ChatDoctor. We are here to help you. Considering her prediabetes a cause of her proteinuria, yes, she would be categorized in stage 1 CKD (chronic kidney disease). However, that is very unlikely that such a prediabetes at this age is going to cause proteinuria. Yes, this is not going to impact if does not worsen further. It will not progress much as her diabetes is well controlled. The prognosis of her condition is good, and a healthy pregnancy without any complication is possible. I want to mention that she needs a repeat 24 hours protein test done after a month to reach a conclusion as a single time urine protein can occur due to many causes like heavy exercises and fever. I would recommend ACE inhibitors, ANA (anti-nuclear antibody), C3, C4 level test and ultrasound kidneys in case her urine protein persists even after one month. 