Some studies have shown that although all individuals with macroalbuminuria in the first urine sample had either macroalbuminuria or microalbuminuria in the second urine sample, approximately one-third of the adults with microalbuminuria would not have increased urine albumin excretion on repeat assessment.[39,40] Furthermore, we might also miss some patients with DN who had improvement of albuminuria or proteinuria after the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. This evidence concerns the gene ALB and liver dysplastic nodule.