Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

MKSAP: 45-year-old man with type 2 diabetes mellitus

mksap
Conditions
November 18, 2017
Share
Tweet
Share

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 45-year-old man is evaluated during an annual routine health maintenance visit. History is notable for type 2 diabetes mellitus (diet controlled) diagnosed 3 months ago. Family history is significant for his father who developed end-stage kidney disease due to diabetes at age 68 years. He reports no symptoms and takes no medications.

On physical examination, temperature is 37.0 °C (98.6 °F), blood pressure is 135/78 mm Hg, pulse rate is 70/min, and respiration rate is 12/min. BMI is 31. Cardiac examination reveals no murmur or gallop. The lungs are clear. There is 1+ peripheral edema.

Laboratory studies show a serum creatinine level of 1.0 mg/dL (88.4 µmol/L).

Which of the following is the most appropriate next step in management?

A. Measure urine albumin excretion
B. Order kidney ultrasonography
C. Perform dipstick urinalysis
D. Start an angiotensin receptor blocker

MKSAP Answer and Critique

The correct answer is: A. Measure urine albumin excretion.

Urine albumin excretion measurement is appropriate for this patient with risk factors for chronic kidney disease (CKD). Patients with diabetes mellitus are at a markedly increased risk of CKD, and treatment of patients with diabetes and moderately increased albuminuria (formerly known as microalbuminuria) using angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) can reduce the risk of progression to overt nephropathy. Moreover, determining the level of albuminuria and estimated glomerular filtration rate is important for detecting the presence of CKD and accurately staging CKD if present. CKD staging has important implications with regard to clinical prognosis. Guidelines differ among several medical organizations regarding the optimal approach to CKD screening. Whereas the American College of Physicians guidelines state that there is insufficient evidence to support or discourage screening for CKD in persons with CKD risk factors such as diabetes, the National Kidney Foundation and the American Diabetes Association support screening for kidney disease in all patients with diabetes.

There is no evidence to support the value of kidney ultrasonography in persons who have no clinical evidence of kidney disease and no family history of genetic kidney disease such as autosomal dominant polycystic kidney disease.

Dipstick urinalysis is not sufficiently sensitive to detect the presence of moderately increased albuminuria; the results are semiquantitative, and estimations of proteinuria can be significantly affected by urine concentration.

Although ARBs have been demonstrated to reduce the risk of progression from moderately increased albuminuria to overt diabetic nephropathy, no studies have demonstrated a beneficial effect of these medications in patients who do not have increased urine albumin excretion or existing hypertension. It remains unknown whether ARBs or ACE inhibitors are protective in patients with moderately increased albuminuria due to etiologies other than diabetic nephropathy.

Key Point

  • Patients with risk factors for chronic kidney disease should be screened using laboratory studies, most commonly determining the estimated glomerular filtration rate and urine testing for protein or albumin.

This content is excerpted from MKSAP 17 with permission from the American College of Physicians (ACP). Use is restricted in the same manner as that defined in the MKSAP 16 Digital license agreement. This material should never be used as a substitute for clinical judgment and does not represent an official position of ACP. All content is licensed to KevinMD.com on an “AS IS” basis without any warranty of any nature. The publisher, ACP, shall not be liable for any damage or loss of any kind arising out of or resulting from use of content, regardless of whether such liability is based in tort, contract or otherwise.

Prev

This doctor gave flu vaccines to her patients. You won’t believe what happened next.

November 17, 2017 Kevin 2
…
Next

Got real rights? Not when seeking health care.              

November 18, 2017 Kevin 2
…

ADVERTISEMENT

Tagged as: Diabetes, Endocrinology, Nephrology

Post navigation

< Previous Post
This doctor gave flu vaccines to her patients. You won’t believe what happened next.
Next Post >
Got real rights? Not when seeking health care.              

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by mksap

  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 26-year-old man with back pain

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 36-year-old man with abdominal cramping, diarrhea, malaise, and nausea

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 52-year-old woman with osteoarthritis of the right hip

    mksap

Related Posts

  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 45-year-old woman with type 2 diabetes mellitus

    mksap
  • Type 1 diabetes is no fun

    Ryan Ritchie
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 35-year-old woman with constipation

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 60-year-old woman with persistent constipation

    mksap
  • A Black Panther for diabetics

    Ariel Lawrence
  • Minorities and medical research: Who is still excluded?

    Katie Kinsella and Ximena Verduzco-Villanueva

More in Conditions

  • Financing cancer or fighting it: the real cost of tobacco

    Dr. Bhavin P. Vadodariya
  • 5 cancer myths that could delay your diagnosis or treatment

    Joseph Alvarnas, MD
  • When bleeding disorders meet IVF: Navigating von Willebrand disease in fertility treatment

    Oluyemisi Famuyiwa, MD
  • What one diagnosis can change: the movement to make dining safer

    Lianne Mandelbaum, PT
  • How kindness in disguise is holding women back in academic medicine

    Sylk Sotto, EdD, MPS, MBA
  • Measles is back: Why vaccination is more vital than ever

    American College of Physicians
  • Most Popular

  • Past Week

    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • When errors of nature are treated as medical negligence

      Howard Smith, MD | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • When a doctor becomes the narrator of a patient’s final chapter

      Ryan McCarthy, MD | Physician
    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech
    • Navigating fair market value as an independent or locum tenens physician [PODCAST]

      The Podcast by KevinMD | Podcast
    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician
    • How self-improving AI systems are redefining intelligence and what it means for health care

      Harvey Castro, MD, MBA | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • When errors of nature are treated as medical negligence

      Howard Smith, MD | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • When a doctor becomes the narrator of a patient’s final chapter

      Ryan McCarthy, MD | Physician
    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech
    • Navigating fair market value as an independent or locum tenens physician [PODCAST]

      The Podcast by KevinMD | Podcast
    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician
    • How self-improving AI systems are redefining intelligence and what it means for health care

      Harvey Castro, MD, MBA | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...