A 48-year-old woman with 12 years of type 2 diabetes undergoes annual screening. Two spot urine samples taken three months apart show albumin-to-creatinine ratios of 95 mg/g and 120 mg/g. Estimated GFR is 78 mL/min/1.73 m² and fundoscopy shows moderate nonproliferative retinopathy. How should this result be classified?

• A Normal albuminuria, since the ratio is below 300 mg/g
• B Severely increased albuminuria (macroalbuminuria), requiring renal biopsy
• C Moderately increased albuminuria (microalbuminuria), consistent with early diabetic kidney disease ✓
• D Indeterminate, because spot sampling is invalid and timed 24-hour collection is mandatory

Explanation

An albumin-to-creatinine ratio persistently between 30 and 300 mg/g on two of three specimens defines moderately increased albuminuria, the earliest laboratory evidence of diabetic kidney disease. Ratios above 300 mg/g define severely increased albuminuria. KDIGO accepts confirmed spot samples; timed collections are unnecessary. Retinopathy coexisting with albuminuria further supports a diabetic aetiology and argues against biopsy.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.