A 48-year-old woman with type 2 diabetes of eight years' duration has a spot urine albumin-to-creatinine ratio of 85 mg/g on two of three consecutive samples. Her blood pressure is 128/78 mmHg on no antihypertensive drugs, and eGFR is 92 mL/min/1.73 m². What is the most appropriate next step?
- A Start an ACE inhibitor and repeat the albumin-to-creatinine ratio in six months to assess response ✓
- B No drug needed now; repeat annual screening for progression to overt nephropathy
- C Start an ACE inhibitor and repeat testing in three years
- D Perform a renal biopsy to confirm diabetic nephropathy
Correct answer: A. Start an ACE inhibitor and repeat the albumin-to-creatinine ratio in six months to assess response
Explanation
An albumin-to-creatinine ratio of 85 mg/g confirms moderately increased albuminuria (microalbuminuria, defined as 30 to 300 mg/g) on repeated testing. Guidelines recommend an ACE inhibitor or ARB even at this stage because it reduces progression, with follow-up testing within months to confirm a fall in albuminuria. Option B fails to treat early disease, and biopsy is reserved for atypical features such as rapid decline, active urinary sediment, or absence of retinopathy.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.