A 65-year-old woman with a history of type 2 diabetes has a routine urinalysis that is negative for important indicators. What should be the next step?

The recommended next step involves ordering a 24-hour urine for microalbumin in a patient with a history of type 2 diabetes. This is important because individuals with diabetes are at increased risk for developing kidney complications, particularly diabetic nephropathy. The microalbumin test is crucial for detecting early signs of kidney damage caused by diabetes, as it specifically measures the level of albumin in the urine. An elevated albumin concentration indicates that the kidneys may not be filtering properly, which could prompt further evaluation and intervention to prevent progression to more severe kidney disease.

In the context of this patient, who has a negative routine urinalysis for other indicators (such as blood or glucose), the focus should be on assessing renal function and early detection of any microvascular complications. A 24-hour urine collection provides a comprehensive measurement of albumin that is essential for monitoring the patient's renal health and guiding management.

The alternative options, such as ordering a urine culture or declaring that no further tests are necessary, do not directly address the specific risks associated with her diabetes. Also, recommending a screening IVP (intravenous pyelogram) is generally not indicated in this situation, especially when the primary concern is related to kidney function monitoring rather than structural imaging.