Which of the following is the earliest manifestation of diabetic nephropathy?
- a progressive decline in the creatinine clearance
- an elevated serum haptoglobin
- renal insufficiency
Tiny amounts of albumin (microalbumin) show up first - but need a special test ordered to detect it. Intervention at this point with an ACEI prolongs the length of time before the patient progresses to albuminuria (noted on a typical urine "dip")