Albuminuria screening — ABIM Board MCQ

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EasyNephrologyAlbuminuria screeningABIM Board

A 59-year-old man with type 2 diabetes mellitus and hypertension has an estimated glomerular filtration rate of 66 mL/min/1.73 m². Routine urine dipstick testing is negative for protein. Which of the following studies should be obtained to screen for albuminuria and complete his kidney risk assessment?

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Correct answer: E — Spot urine albumin-to-creatinine ratio

The correct answer is E. A spot urine albumin-to-creatinine ratio (UACR) is the preferred test for albuminuria screening in type 2 diabetes and should be assessed at least annually along with eGFR. A negative routine dipstick does not exclude moderately increased albuminuria because dipsticks may not detect lower albumin concentrations. A 24-hour urine collection is unnecessarily burdensome, and a protein-to-creatinine ratio is less sensitive for early, albumin-predominant diabetic kidney disease. Cystatin C can refine estimation of filtration when creatinine-based eGFR is uncertain but does not assess albuminuria. Renal ultrasonography evaluates structural disease and is not routine albuminuria screening.

Reference: American Diabetes Association Professional Practice Committee for Diabetes. 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026, Assessment of Albuminuria and Estimated Glomerular Filtration Rate. Diabetes Care. 2026;49(Suppl 1):S246-S260. https://www.niddk.nih.gov/health-information/professionals/advanced-search/quick-reference-uacr-gfr