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Cystatin C levels
0%
0/66
Urine microalbumin to creatinine ratio
95%
63/66
Hemoglobin A1C
Urine protein dipstick
2%
1/66
Urinalysis
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The most sensitive test for detecting renal impairment in diabetic patients is the urine microalbumin to creatinine ratio. Nephropathy is a microvascular complication of diabetes mellitus. Diabetic patients undergo thickening of the glomerular basement membrane and mesangial expansion, leading to increased glomerular filtration. This results in microalbuminuria. Patients should be screened for microalbuminuria with a urine microalbumin to creatinine ratio in order to detect early renal dysfunction. Patients with a urine dipstick that is positive for protein have already progressed to macroalbuminuria. Roett et al. state that diabetes is a major cause of chronic kidney disease. While it usually takes 10 years from diagnosis to develop in type 1 diabetics, type 2 diabetics may present with nephropathy at their initial diagnosis of diabetes. Diabetics should be screened for microalbuminuria with a spot urine albumin/creatinine ratio. A diagnosis of diabetic nephropathy can be made if two out of three spot urine albumin/creatinine ratio tests are positive in a six month period. Ahmad reviews the management of diabetic nephropathy. He states that diabetic nephropathy affects approximately 20 to 30% of diabetics. Diabetic nephropathy is associated with increased cardiovascular mortality. Treatment modalities known to slow the progression of diabetic nephropathy include glycemic control, blood pressure control, and ACE inhibitors. Illustration A depicts nodular glomerulosclerosis in a patient with diabetic nephropathy. Incorrect Answers: Answer 1: Cystatin C is a biomarker of kidney function that is elevated in chronic kidney disease, but it is not the most sensitive screening test of diabetic nephropathy. Answer 3: Hemoglobin A1C levels are used for detecting the three month average plasma glucose concentration, but it is not the most sensitive screening test of diabetic nephropathy. Answer 4: Urine protein dipstick can detect macroalbuminuria, rather than microalbuminuria, and is a less sensitive test for detecting diabetic nephropathy. Answer 5: Urinalysis may be altered in patients with renal dysfunction, but it is not the most sensitive screening test of diabetic nephropathy.
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