Leaky 2

Renal & Urinary System

{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"This patient with longstanding type 2 diabetes has presented with overt proteinuria. This is strongly suggestive of diabetic nephropathy.\n\nThe presence of diabetic retinopathy indicates that microvascular disease is already present, further supporting this possibility.\n\nHe needs further investigation to quantify the degree of proteinuria, and determine if his renal functions are impaired.\n\nThe gold standard for quantification of urinary protein excretion is a 24 hour urine collection.\n\nHowever, this is tedious to perform, and can be reliably approximated by estimation of the albumin:creatinine ratio (ACR) in a spot urine sample.\n\nIn this patient, the ACR is over 34 mg\/mmol, confirming the presence of macroalbuminuria, and indicating that ov"}]}

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