Review Question - QID 109276

The patient likely has the early stages of diabetic nephropathy given the microalbuminuria (60mg/24hr). Angiotensin-converting enzyme (ACE) inhibitors can slow progression of diabetic nephropathy.

Diabetic nephropathy is often asymptomatic in the early stages and is therefore diagnosed based on levels of albumin in the urine. Microalbuminuria (30-299mg/24hr) as seen in this patient is suggestive of diabetic nephropathy. ACE inhibitors are effective in slowing progression of diabetic nephropathy even in normotensive patients. ACE inhibitors reduce vasoconstriction in the efferent arteriole and decrease protein leakage from the glomerulus.

Incorrect Answers:
Answer 1: Although the patient is asymptomatic with well controlled blood pressure, ACE inhibitors have been shown to slow progression of nephropathy even at early stages of disease.

Answer 3: The patient is already at goal HbA1c (<7.0%). Further glycemic control is unlikely to prevent nephropathy.

Answer 4: Simvastatin may slow progression of diabetic nephropathy in patients with hyperlipidemia, but given this patient's normal cholesterol levels (<220mg/dL), it is unlikely to provide significant benefit.

Answer 5: Aspirin has not been shown to have a significant benefit to decreasing progression of diabetic nephropathy.

Bullet Summary:
Patients diagnosed with diabetes may develop diabetic nephropathy, which can be treated with ACE inhibitors even if the patient has normal blood pressure.