A 68-year-old Portuguese woman with a long-standing history of hypertension and diabetes was referred for a urine albumin–creatinine ratio of 5568 mg/g with serum albumin 3.5 g/dl, serum creatinine 1.25 mg/dl, and eGFR CKD Epidemiology Collaboration creatinine–cystatin C 32 ml/min per 1.73 m2. The gene discussed is ALB; the disease is diabetes mellitus.