Test Your Knowledge #603: A 66-year-old man has had type 2 diabetes for 12 years....
A 66-year-old man has had type 2 diabetes for 12 years. His diabetes has been treated with oral agents for 5 years, and he now takes insulin and pioglitazone.
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He has hyperlipidemia, hypertension, and mild erectile dysfunction. He also has had low back pain for several years for which he takes ibuprofen as needed. His other medications are a statin and amlodipine.
His body mass index is 31 and blood pressure is 145/85 mm Hg. Nonproliferative diabetic retinopathy is noted in both eyes. Ankle reflexes are absent, and no edema is noted in the legs.
Laboratory Studies
Hemoglobin A1C
8.2%
Urinalysis
No proteinuria; 0–2 erythrocytes/high power field
Urine albumin–creatinine ratio
60 and 90 mg/g (on two occasions)
Blood urea nitrogen
28 mg/dL (10 mmol/L)
Serum sodium
141 meq/L (141 mmol/L)
Serum potassium
4.7 meq/L (4.7 mmol/L)
Serum creatinine
1.3 mg/dL (114.95 µmol/L)
Serum calcium
9.3 mg/dL (2.32 mmol/L)
Serum albumin
3.8 g/dL (38 g/L)
Which of the following is the most appropriate diagnostic test in this patient?
A. Calculation of glomerular filtration rate based on serum creatinine level
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