A 50 year old Chinese man presents for a routine evaluation. He has had poorly controlled type 2 diabetes mellitus for 10 years, complicated by retinopathy & distal symmetric polyneuropathy.

His labs show an HbA1c of 9.0%, normal electrolytes, and a serum creatinine of 1.6 mg/dl with an eGFR of 46 mL/min/1.73 m2.

Six months ago, the creatinine was 0.8 mg/dl, with no microalbuminuria. There were no urinary symptoms, and there is no family history of renal disease.