A 35-year old accountant presented to his physician with a

49-year-old African American female with type 2 diabetes mellitus, hypertension, and hyperlipidemia who returns for a follow-up visit. She has had diabetes for 15 years, and her control has been variable over that time. Now, her glycosylated hemoglobin is 8%. She has developed moderately increased albuminuria and diabetic retinopathy. You tell her that her renal function has progressively declined, which alarms her since her mother is on hemodialysis. Her creatinine was 1.2 mg/dL 3 years ago, and now it is 1.9 mg/dL. Her GFR is 36 mL/min/1.73 m2. She weighs 100 kg, and her blood pressure is 120/76 mm Hg. Describe the pathophysiology of albuminuria in renal disease.

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