Which of the following is the earliest manifestation of diabetic nephropathy?
A. proteinuria
B. a progressive decline in the creatinine clearance
C. an elevated serum haptoglobin
D. renal insufficiency
E. microalbuminuria
Answer: E, microalbuminuria
Tiny amounts of albumin (microalbumin) show up first - but need a special test ordered to detect it. Intervention at this point with an ACEI prolongs the length of time before the patient progresses to albuminuria (noted on a typical urine "dip")
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If you are studying for the PANCE or the PANRE I recommend these Review Books.
