ALB and diabetic kidney disease: While increasing albuminuria, especially macroalbuminuria, is a major factor in progression of diabetic kidney disease (DKD) and decline in glomerular filtration rate (GFR)7, a subset of patients with DKD show decline in renal function in the absence of elevated urinary albumin excretion rates (AER), so called “normoalbuminuric” decline in renal function8,9.