This article originally posted 05 May, 2009 and appeared in Issue 467
Test Your Knowledge Issue 467
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. 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.
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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 for this patient?
A. Calculation of glomerular filtration rate based on serum creatinine level
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