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The two kidneys filter approximately 650 mL of plasma every minute. This means that 37,000 grams of albumin pass through the glomeruli each day. Only 1.3 grams, or 0.004%, of the total albumin leaks through the glomeruli, which is an amazing efficiency for any filtration system. Ninety nine percent of the leaked albumin is degraded to fragments by the renal proximal tubules, resulting in a daily urinary excretion of only ~15 mg of albumin.

Diabetic renal disease is the single most common cause of end stage renal disease in the United States. Approximately 40% of patients with type 1 and 20% with type 2 diabetes develop nephropathy. The earliest clinical evidence of nephropathy is the appearance of microalbuminuria. In healthy individuals, urinary protein excretion is less than 150 mg per day and albumin excretion is less than 30 mg per day. Microalbuminuria is defined as an increase in urinary albumin excretion at a level below that reliably detected by urine dipsticks (30 -

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