Prescribing Safety Assessment (PSA) Practice Exam

What is an early indicator of diabetic nephropathy in diabetic patients?

1. Proteinuria

2. Serum Creatinine

3. Albumin-to-Creatinine Ratio (ACR)

4. Blood Glucose Levels

The correct answer is: Albumin-to-Creatinine Ratio (ACR)

The Albumin-to-Creatinine Ratio (ACR) is an early indicator of diabetic nephropathy in diabetic patients because it reflects the presence of microalbuminuria, which is often one of the first signs of kidney damage in this population. In diabetes, the kidneys may begin to leak small amounts of protein into the urine, specifically albumin, even when conventional proteinuria tests may still appear normal. This can occur long before more significant changes in kidney function are detectable, such as increased serum creatinine levels or overt proteinuria. The ACR provides a more sensitive measurement than simply checking for proteinuria because it accounts for variations in urine concentration. This measurement is important for early detection and intervention as it allows for timely management strategies to prevent the progression of renal impairment in diabetic patients. In contrast, serum creatinine levels are typically used to assess overall renal function and may not change until significant kidney damage has occurred, thus making them less useful as an early indicator. Blood glucose levels, while important to monitor in diabetes management, do not directly indicate kidney damage.