Which statement best describes the progression of diabetic nephropathy?

• A. Immediate macroalbuminuria with preserved GFR
• B. No albuminuria with stable eGFR
• C. Microalbuminuria progressing to macroalbuminuria with declining eGFR
• D. Hyperfiltration with increased eGFR

Answer: (C)

Diabetic nephropathy typically starts with leakage of smaller amounts of albumin into the urine, known as microalbuminuria, signaling glomerular injury. As damage advances, albuminuria worsens to macroalbuminuria, and meanwhile more nephrons are lost, causing the kidneys’ filtering capacity to decline. So the pattern described as microalbuminuria progressing to macroalbuminuria with a falling eGFR best fits the usual progression. The other scenarios don’t match this sequence: macroalbuminuria with preserved GFR would not show the expected functional decline; no albuminuria with stable eGFR suggests the absence of nephropathy progression; hyperfiltration with increased GFR is an early change before albuminuria develops, not the later progression to declining kidney function.