diabetic nephropathy question

[Anonymous]

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A 25-year-old man has had type 1 diabetes mellitus for 5 years. His physician is concerned about the possibility of permanent renal damage. Which of the following is the best early indicator for diabetic nephropathy?

a)Albuminuria
b)Hypertension
c)Rising blood urea nitrogen
d)Rising creatinine
e) Urinary tract infection

[Anonymous]

The correct answer is
A. Permanent renal damage can develop in as little as 5 years after diabetes mellitus. Diabetic nephropathy complicates about one third of cases of type 2 diabetes mellitus, and a smaller proportion of type 2 cases. One of the problems is that diabetic nephropathy tends to be asymptomatic until end-stage disease develops, so there has been considerable interest in identifying early markers for significant renal disease. The spilling of albumin into the urine and, more specifically, the spilling of very small levels of albumin ("microalbuminuria") are the best markers to date for significant diabetic nephropathy.

Hypertension (choice B) often coexists with, and apparently favors the development of, microalbuminuria, but is not a specific marker for renal damage.

Rising blood urea nitrogen (choice C) and rising creatinine (choice D) occur a little later, when there is already a very significant decrease in glomerular filtration rate.
Urinary tract infection (choice E) can permanently damage the kidneys but does not always do so.