Abstract
Diabetes is the leading cause of end-stage renal disease (ESRD) in the USA [1]. The prevalence of diabetic kidney disease has increased steadily in proportion to the prevalence of diabetes [2]. Most patients with advanced diabetic kidney disease are overtly proteinuric. Still, clinicians are encountering diabetic patients without proteinuria, and at times even without microalbuminuria, who suffer from advanced chronic kidney disease (CKD) that seems out of proportion to nondiabetic patients with similar co-morbidities.
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