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A 34-year-old woman complains of increasing urinary frequency. She also reports several urinary tract infections over the past year. She has no prior medical history and is not taking any medications. She denies weight loss. There is a very strong family history of diabetes. On examination she is noted to be obese. Lung, heart and abdomen examinations are unremarkable. A fasting glucose is mildly elevated. The patient expresses concern about renal failure as her father and brother undergo dialysis. Which of the following tests should be conducted to evaluate this patient™s risk for renal failure?
A. Creatinine clearance
B. Renal ultrasound
C. Serum creatinine level
D. Urinalysis
E. Urine albumin level
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patient™s risk for renal failure in a diabetic
E. albuminuria
although in this case they dont give definite Dx of DM
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E. microalbuminuria is the screening test for the early detection of diabetic nephropathy compn.
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The correct answer is E. Diabetic nephropathy may be functionally silent for 10-15 years. Clinically detectable nephropathy is marked by microalbuminuria with 30-300 mg of albumin/24 hours. Microalbuminuria precedes nephropathy in patients with diabetes mellitus.
The filtration rate in diabetics may be elevated at the time of onset of albuminuria (choice A). Creatinine clearance is a reflection of the filtration and may lag development of nephropathy.
A renal ultrasound (choice B) is a good test for evaluating hydronephrosis from post obstructive renal failure but is not a good test for screening for diabetic nephropathy. Changes consistent with diabetic nephropathy will require a renal biopsy.
Azotemia begins a decade after the diagnosis of diabetes (choice C). Thus creatinine level is not a reliable way to detect early diabetic nephropathy.
A urinalysis (choice D) with a urine dipstick may detect albumin. However, this is a less sensitive test than the 24-hour urine collection study.
