CEA Nursing Practice Exam

When assessing early renal damage in a diabetic, hypertensive patient, which test should be ordered first?

1. BUN/creatinine ratio

2. Urinalysis with micro/macro albumin

3. Renal biopsy

4. Urine sodium

The correct answer is: Urinalysis with micro/macro albumin

When assessing early renal damage in a diabetic and hypertensive patient, the most appropriate initial test to order is a urinalysis that includes micro and macro albumin testing. This is crucial because it specifically evaluates albumin excretion in the urine, which is a key indicator of early kidney damage, particularly in patients with diabetes and hypertension. In the context of diabetic nephropathy, the presence of microalbuminuria (small amounts of albumin in the urine) is one of the earliest signs of renal impairment. Detecting this condition early allows for timely intervention to potentially slow or prevent further progression of kidney disease. Monitoring for microalbuminuria is part of standard clinical practice in managing diabetic patients, especially when they also have hypertension. The other tests listed have different roles and may not be as effective for early detection of renal damage. For instance, the BUN/creatinine ratio is more useful for assessing overall kidney function or for differentiating causes of acute kidney injury rather than early damage. A renal biopsy is more invasive and typically reserved for more advanced evaluation when a definitive diagnosis of renal condition is necessary. Urine sodium levels provide information on sodium homeostasis but are not specific to renal damage assessment related to diabetes or hypertension. This targeted approach