R. C. is a 57-year-old man with type 2 diabetes first diagnosed 2 years ago. Other medical problems include obesity and hypothyroidism. He has a history Mamy Case (8) of heavy alcohol use but quit drinking alcohol 2 years ago. He presents now for routine follow-up and is noted to have a blood pressure of 168/100 mmHg. He is asymptomatic. Physical exam reveals a height of 5 feet, 8 inches, blood pressure of 160/100 mmHg, and a regular pulse of 84 beats/min. There is no retinopathy or thyromegaly. There is no clinical evidence of congestive heart failure or peripheral vascular disease. Laboratory evaluation reveals trace protein on urinalysis, blood urea nitrogen of 14 mg/dl, serum creatinine of 1.2 mg/dl, random serum glucose of 169 mg/dl, normal electrolytes, and normal thyroid-stimulating hormone levels. A 24-h urine collection reveals a urinary albumin excretion rate of 250 mg/day. 1. Explain the previous lab results.
2. What are other helpful investigations to be done?
3. What's the most likely diagnosis?