A 45-Year-Old Man Comes to the Office for an Annual

A 45-year-old man comes to the office for an annual medical visit.  The patient has had prediabetes for the last 2 years.  He feels well and takes no medications but has gained weight since his last visit a year ago.  The patient has a strong family history of type 2 diabetes mellitus.  Blood pressure is 124/78 mm Hg and BMI is 32 kg/m².  Laboratory results show a fasting blood glucose of 157 mg/dL and serum creatinine of 0.7 mg/dL.  Hemoglobin A1c is 7.4%.  Urine assay shows no detectable albuminuria.  Which of the following renal changes is most likely present in this patient at this time?

A) Decreased peritubular capillary oncotic pressure
B) Decreased intraglomerular capillary pressure
C) Glomerular atrophy
D) Increased glomerular filtration rate
E) Increased oncotic pressure in Bowman's space

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