A 62-year-old woman presents to her primary care provider (PCP) for a routine annual visit. Her medical history includes hypertension (HTN) treated with lisinopril 20 mg daily, diabetes mellitus (DM) treated with metformin, and chronic kidney disease (CKD).
Laboratory study results include serum creatinine level 1.2 mg/dL and estimated glomerular filtration rate (eGFR) 50 mL/min/1.73 m2.
The PCP is considering whether to order a spot urinary albumin-to-creatinine ratio (UACR).
The correct answer is: D. DM, HTN, and established CKD.
The 2025 multisociety Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults includes a Class 1 recommendation for UACR measurement in all patients with HTN. The American Diabetes Association (ADA) Standards of Care–2026 recommends at least annual UACR and eGFR screening in all adults with type 2 DM (starting at diagnosis) and in those with type 1 DM with duration ≥5 years. For patients with established CKD, the Kidney Disease: Improving Global Outcomes (KDIGO) 2024 Clinical Practice Guideline for the Evaluation and Management of CKD recommends monitoring UACR and eGFR one to two times per year depending on CKD stage.
This patient case quiz is part of The Increasing Role of UACR in Cardiovascular Care educational grant program supported by Boehringer Ingelheim. Visit the program page to learn more about the role of UACR in Cardiovascular Care.
References
- Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2025;86(18):1567-1678. doi:10.1016/j.jacc.2025.05.007
- American Diabetes Association Professional Practice Committee for Diabetes. 11. Chronic kidney disease and risk management: Standards of Care in Diabetes-2026. Diabetes Care. 2026;49(Supplement_1):S246-S260. doi:10.2337/dc26-S011
- Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2024;105(4S):S117-S314. doi:10.1016/j.kint.2023.10.018
