15-year Poorly Controlled Type in Medicine / Internal Medicine — 56yo Man | Nephrology | SMLE Q#3328
SMLE Question #3328
Medicine / Internal Medicine
Nephrology
Objective: OBJ-188
Last updated: February 2026
A 56-year-old man with a 15-year history of poorly controlled type 2 diabetes mellitus attends follow-up. He has long-standing hypertension and hyperlipidaemia with intermittent medication nonadherence. An ophthalmology exam last month showed non-proliferative diabetic retinopathy with microaneurysms and dot-blot haemorrhages. Recent testing shows reduced kidney function and nephrotic-range proteinuria. Which of the following is the most likely cause of his renal impairment?
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