Diabetic Nephropathy

Leaky 2

Step 1: View clinicals

A 60 year old man who was diagnosed with type II diabetes mellitus 10 years ago presents for routine follow up. He is currently on Metformin 850 mg/day only. His medical and surgical histories are otherwise unremarkable. A urine dipstick test is positive for proteinuria.


Step 2: Order all relevant investigations

HbA1c

The HbA1c level is 6.9%

Renal Function Tests

Na+: 139 mmol/l (135 - 145) K+: 4.0 mmol/l (3.5 - 5.0) Cl-: 98 mmol/l (95 - 105) Blood Urea: 14 mg/dl (0 - 50) Serum Creatinine: 1.2 mg/dl (0.5-1.5) eGFR: 62 mL/min/1.73 m2

Urinary Albumin:Creatinine Ratio

100 mg/mmol (normal: < 3.4; microalbuminuria: 3.4 - 34; macroalbuminuria > 34)

Lipid Profile

Total cholesterol: 240mg/dl (< 200) LDL: 120 mg/dl (< 130) Triglycerides: 90 mg/dl (< 150) HDL: 102 mg/dl (> 40)


Step 3: Select appropriate management

ACE inhibitors
Statins
Protein restriction
Add Glipizide


Score: ★★☆