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 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.