Mr. G is a 65 year old man who has a 15 year history of type 2 diabetes. He has an elevated creatinine level of 3.3mg/dl and evidence of increasing proteinuria. He is currently being managed with 20mgs of lisinopril for his hypertension. Measurement of 24 hour urinary protein has been in the nephrotic range. He has worsening hypertension despite increasing therapy. Your next step would be: 

1.Institute a restricted protein diet. 

2. Increase the dose of the ACE inhibitor. 

3. Referral to a nephrologist. 

4. Add another antihypertensive agent

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