AKT-3472

AKT-3472

A 63-year-old man attends for diabetic annual review. His current medication consists of metformin 500 mg TDS, pioglitazone 30 mg OD, ramipril 10 mg OD, and atorvastatin 20 mg ON. His latest HbA1c blood test result is 66 mmol/mol. His renal function shows an eGFR of >90 ml/min.

As part of his review his urine is dipstick tested and shows blood+. It is negative for glucose, protein, leucocytes, nitrites and ketones.

The patient feels well and denies any urinary symptoms or frank haematuria. His blood pressure is 126/82 mmHg.

You provide him with two urine containers and ask him to submit further samples in one and two weeks time for repeat testing. You also send a urine sample to the laboratory for microalbuminuria testing.

The repeat tests show persisting blood+ only. His urine albumin:creatinine ratio is 1.9 and there is a leucocytosis on blood testing.

What is the most appropriate approach in managing this patient?