Lab result explainedKidneyLast updated November 10, 2026

Urine albumin-to-creatinine ratio (UACR): normal range and what a high microalbumin result means

Urine albumin-to-creatinine ratio (UACR) · Urine albumin-to-creatinine ratio (spot urine); kidney health check · reported in mg albumin per g creatinine (mg/g); outside the US, mg/mmol (1 mg/mmol ≈ 8.84 mg/g). Some labs also report urine albumin concentration in mg/L or mg/dL

The urine albumin-to-creatinine ratio (UACR, often labelled 'microalbumin' on lab reports) measures how much albumin, the main protein in blood, is leaking through the kidney's filters into the urine. Healthy kidneys let through almost none. The result is reported as milligrams of albumin per gram of creatinine (mg/g): under 30 mg/g is normal, 30 to 300 mg/g is moderately increased (the band once called microalbuminuria), and over 300 mg/g is severely increased (macroalbuminuria, or overt proteinuria). The ratio is used rather than a plain albumin concentration because dividing by creatinine corrects for how dilute or concentrated the urine happens to be.

It is the earliest routine signal of kidney damage from diabetes and high blood pressure, usually appearing years before the eGFR falls, and it is checked yearly in everyone with diabetes, most people with hypertension, and anyone with established chronic kidney disease. It also carries information beyond the kidney: even within the 'normal' range, a higher UACR predicts heart attack, stroke and death, and a ratio above 30 mg/g roughly doubles cardiovascular risk independent of eGFR. Together, the eGFR and the UACR define the stage of chronic kidney disease.

A single raised result does not settle the diagnosis. Albumin excretion rises temporarily with exercise in the previous 24 hours, fever, urinary infection, menstruation, very high blood sugar, uncontrolled blood pressure and heart failure, and it varies by 30 to 50 percent from day to day. Persistent albuminuria is defined as two of three samples above 30 mg/g over 3 to 6 months, ideally first-morning samples. The good news is that this marker responds to treatment: blood pressure control, ACE inhibitors or ARBs, SGLT2 inhibitors and lifestyle changes can lower it substantially and slow kidney damage.

UACR at a glance

  • What it is: albumin leaking into the urine, divided by urine creatinine to correct for concentration; the standard test for early kidney damage in diabetes and high blood pressure.
  • Normal (A1): under 30 mg/g (under 3 mg/mmol). Moderately increased (A2, 'microalbuminuria'): 30–300 mg/g (3–30 mg/mmol). Severely increased (A3): over 300 mg/g (over 30 mg/mmol).
  • A single high result is confirmed with two of three samples over 3 to 6 months, avoiding tests after exercise, during infection, fever or menstruation.
  • Causes: diabetes, high blood pressure, obesity and metabolic syndrome, glomerular diseases, heart failure, and temporary rises from exercise, fever and infection.
  • Why it matters: albuminuria predicts kidney decline and roughly doubles heart disease risk; a fall of 30 percent or more on treatment is associated with slower kidney damage.
  • Next step: repeat to confirm, check eGFR and blood pressure, and discuss ACE inhibitor/ARB and SGLT2 inhibitor treatment, salt reduction, glucose control and weight.

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What UACR measures

Albumin is a 66 kDa protein made by the liver that keeps fluid inside blood vessels and carries hormones and drugs. The glomeruli, the kidney's filtering units, are built to hold albumin back: their basement membrane and the slit diaphragms between podocyte cells form a size- and charge-selective barrier, and the small amount that does pass is mostly reabsorbed by the tubules. Normal excretion is under about 10 to 15 mg a day. Damage to the glomerular barrier from high pressure, high glucose, inflammation or immune deposits lets albumin through in proportion to the injury, which is why the ratio tracks kidney damage so closely.

The test uses a spot urine sample, preferably the first void of the morning, which correlates best with 24-hour excretion and avoids the exercise effect. The lab measures albumin by an immunoassay sensitive to a few mg/L (ordinary dipstick protein pads only react above about 15 to 30 mg/dL and miss most moderately increased albuminuria) and creatinine by an enzymatic or Jaffe method, then reports the ratio. Because creatinine excretion is fairly constant across a day, dividing by it converts a concentration into an estimate of daily loss: a UACR of 30 mg/g corresponds roughly to 30 mg of albumin excreted per day.

The creatinine correction introduces its own bias. People with high muscle mass excrete more creatinine, so their ratio reads lower for the same albumin loss, while people with low muscle mass (older adults, women, people with limb loss or wasting) read higher; this is why some older guidelines used sex-specific cut-offs of 17 mg/g for men and 25 mg/g for women. Albumin also degrades in urine left at room temperature for more than a day, and the measurement is not standardised between manufacturers, so values close to 30 mg/g should be interpreted with the lab's own reference range and repeated rather than acted on in isolation.

Normal range for UACR

Reference ranges vary between labs and by age, sex and pregnancy. Use the range printed on your own report.

GroupTypical range (mg albumin per g creatinine (mg/g); outside the US, mg/mmol (1 mg/mmol ≈ 8.84 mg/g). Some labs also report urine albumin concentration in mg/L or mg/dL)Notes
Normal to mildly increased (KDIGO A1)Below 30 mg/g (below 3 mg/mmol)Most healthy adults are under 10 mg/g. Values of 10 to 29 are within range but are associated with slightly higher cardiovascular risk and, in diabetes, a higher chance of progressing. Labs differ slightly; use the printed cut-off.
Moderately increased (KDIGO A2; 'microalbuminuria')30–300 mg/g (3–30 mg/mmol)Confirm on 2 of 3 samples over 3 to 6 months. Marks early diabetic or hypertensive kidney disease and roughly doubles cardiovascular risk. A standard dipstick protein test is usually negative at this level.
Severely increased (KDIGO A3; 'macroalbuminuria')Above 300 mg/g (above 30 mg/mmol)Overt proteinuria; dipstick protein becomes positive. Indicates established kidney disease with a high risk of progression; a kidney specialist referral is usual, particularly if eGFR is also falling.
Nephrotic-range albuminuriaAbove about 2,200 mg/g (roughly 3.5 g of protein a day)Causes low blood albumin, swelling and high cholesterol (nephrotic syndrome). Needs prompt nephrology evaluation, often with a kidney biopsy.
Older sex-specific cut-offs (still printed by some labs)Men below 17 mg/g; women below 25 mg/gReflects lower creatinine excretion in women. KDIGO and the American Diabetes Association now use a single 30 mg/g threshold.
24-hour urine albumin (alternative test)Below 30 mg/24 h normal; 30–300 moderately increased; above 300 severely increasedThe timed collection is the reference standard but is inconvenient and often collected incompletely; the spot ratio has largely replaced it.
PregnancyBelow 30 mg/g; a protein-to-creatinine ratio of 0.3 mg/mg or more supports preeclampsiaAlbumin excretion rises modestly in normal pregnancy. New proteinuria after 20 weeks with high blood pressure is evaluated urgently.
ChildrenBelow 30 mg/g on a first-morning sampleOrthostatic (postural) proteinuria is common in adolescents and is excluded by testing a first-morning sample, which should be normal.

High UACR (albuminuria)

A confirmed ratio above 30 mg/g means the kidney's filtering barrier is leaking albumin. In the 30 to 300 mg/g band the kidneys usually still clear waste normally, the eGFR is often normal, and there are no symptoms; this is the stage at which treatment is most effective. In people with diabetes it is the first sign of diabetic kidney disease, which affects about 20 to 40 percent of people with diabetes over their lifetime, and in people with hypertension it signals that the kidney's small vessels are under strain. Each doubling of albuminuria raises the risk of kidney failure, and a UACR above 300 mg/g with a falling eGFR is the pattern most likely to progress to dialysis without treatment.

The ratio also predicts cardiovascular events more strongly than many cholesterol measures. In the Chronic Kidney Disease Prognosis Consortium analysis of over a million people, a UACR of 30 mg/g carried about 1.6 times the risk of death and a UACR of 300 mg/g about 2.2 times the risk compared with 5 mg/g, at any level of eGFR. Albuminuria is thought to reflect generalised damage to the lining of blood vessels (endothelial dysfunction), which is why it is now listed as a risk-enhancing factor in cardiovascular prevention guidelines and why controlling it matters for the heart as well as the kidneys.

A very high ratio, particularly above 1,000 to 2,200 mg/g, or albuminuria with blood in the urine, a rapidly rising creatinine, rash, joint pain or no diabetes or hypertension to explain it, raises the question of a primary glomerular disease (IgA nephropathy, membranous nephropathy, focal segmental glomerulosclerosis, minimal change disease, lupus nephritis) rather than diabetic or hypertensive damage, and usually leads to nephrology referral and sometimes a kidney biopsy. Before any of this, transient causes must be excluded: a result taken the day after a hard workout, during a fever or urinary infection, with a blood glucose over 300 mg/dL or in menstruating women can read several times higher than the true baseline.

Common causes

  1. Diabetic kidney disease

    Years of high glucose thicken the glomerular basement membrane and injure podocytes. Moderately increased albuminuria typically appears 5 to 15 years after onset of type 1 diabetes and can be present at diagnosis in type 2. Risk is higher with an A1C above 7 percent, high blood pressure, smoking and retinopathy. Annual UACR screening is recommended from diagnosis in type 2 and from 5 years after diagnosis in type 1.

  2. High blood pressure

    Sustained pressure above about 130/80 mmHg transmits to the glomerular capillaries and forces albumin through. Albuminuria is present in roughly 10 to 15 percent of people with untreated hypertension, and lowering blood pressure, particularly with an ACE inhibitor or ARB, reduces it by 20 to 50 percent.

  3. Obesity, metabolic syndrome and insulin resistance

    Excess body weight raises filtration pressure in each glomerulus (hyperfiltration) and promotes inflammation; albuminuria is 2 to 3 times more common in people with obesity and is reversible with weight loss. Sleep apnea adds to the effect through nightly blood pressure surges.

  4. Glomerular diseases

    IgA nephropathy, membranous nephropathy, focal segmental glomerulosclerosis, minimal change disease, lupus nephritis, post-infectious glomerulonephritis and vasculitis damage the filter directly, often producing severe (A3) or nephrotic-range albuminuria, usually with blood in the urine and sometimes with a rapidly falling eGFR.

  5. Heart failure and atherosclerotic vascular disease

    Reduced kidney blood flow and venous congestion increase albumin leak; around 30 percent of people with heart failure have albuminuria, and it predicts worse outcomes. Widespread atherosclerosis produces the same endothelial dysfunction in the kidney as elsewhere.

  6. Transient and physiological rises

    Vigorous exercise within 24 hours, fever, acute illness, urinary tract infection, menstrual contamination, very high blood glucose, a large protein meal, dehydration and prolonged standing (orthostatic proteinuria in adolescents) can all push the ratio above 30 mg/g temporarily. This is why confirmation on repeat first-morning samples is required.

  7. Preeclampsia

    New albuminuria or a protein-to-creatinine ratio of 0.3 or more after 20 weeks of pregnancy, with blood pressure of 140/90 mmHg or higher, defines preeclampsia, which can progress quickly and requires same-day assessment.

  8. Drugs and toxins

    NSAIDs (ibuprofen, naproxen), lithium, gold, penicillamine, some chemotherapy and immunotherapy agents, anabolic steroids and heroin can cause glomerular injury and albuminuria; long-term NSAID use is a common and reversible contributor in older adults.

  9. Low muscle mass (a measurement effect)

    Because the ratio divides by creatinine, people who produce little creatinine (older adults, women, people with amputations, sarcopenia or malnutrition) read higher for the same albumin loss. A borderline ratio in such a person is sometimes checked against a 24-hour collection.

  10. Sickle cell disease, polycystic kidney disease and reflux nephropathy

    Inherited and structural kidney diseases damage glomeruli over time; albuminuria is present in a majority of adults with sickle cell disease and is an early marker of progression in polycystic kidney disease.

Symptoms that can go with it

  • None in the moderately increased range (30 to 300 mg/g); it is found by screening
  • Foamy or frothy urine, which appears once protein loss is substantial (usually well above 300 mg/g)
  • Swelling of the ankles, feet, hands or around the eyes in the morning, as albumin loss lowers blood protein
  • Rising blood pressure or blood pressure that becomes harder to control
  • Fatigue, poor appetite, nausea or itching once kidney function itself declines
  • Blood in the urine, rash, joint pains or fever alongside albuminuria, which point to a glomerular or autoimmune disease
  • Rapid weight gain from fluid, breathlessness lying flat, or reduced urine output in nephrotic syndrome or heart failure

Low or undetectable UACR

There is no lower limit of concern. A ratio under 10 mg/g, or an albumin reported as undetectable, means the glomerular barrier is intact and your risk of kidney and cardiovascular disease from this factor is low. Most healthy adults and most people with well-controlled diabetes or hypertension fall here, and a ratio that falls from the 30 to 300 band into this range on treatment is one of the clearest signs that the kidneys are being protected.

Two caveats. A normal UACR does not exclude kidney disease: some conditions (polycystic kidney disease, hypertensive nephrosclerosis in its early stages, tubulointerstitial disease and many cases of chronic kidney disease in older adults) reduce eGFR with little or no albuminuria, which is why both tests are done. And a low ratio can be artificially produced by a high urine creatinine in very muscular people or by very dilute urine after large fluid intake, which can push true moderately increased albuminuria under the cut-off; a first-morning sample avoids this.

Common causes

  1. Healthy kidneys

    The expected result. An intact glomerular barrier and normal tubular reabsorption keep albumin loss under about 10 to 15 mg a day.

  2. Effective treatment

    ACE inhibitors and ARBs lower albuminuria by 20 to 50 percent, SGLT2 inhibitors by about 30 percent and finerenone by a similar amount; a drop of 30 percent or more from baseline is used as a marker of kidney protection.

  3. High muscle mass or creatine supplements

    More urinary creatinine lowers the ratio for the same albumin loss. Bodybuilders, heavy manual workers and people taking creatine can have a 'normal' ratio despite modest albuminuria; a 24-hour collection resolves this if it matters.

  4. Very dilute urine

    A sample taken after drinking large volumes has little albumin and little creatinine; the ratio is usually still valid, but values near the limit of detection are less precise.

  5. Sample degradation

    Albumin breaks down in urine stored at room temperature for more than 24 hours or frozen and thawed repeatedly, giving a falsely low reading; samples should be refrigerated and tested promptly.

Symptoms that can go with it

  • None; a low or normal UACR does not cause symptoms
  • Swelling, foamy urine or a falling eGFR despite a normal ratio still need evaluation, because not all kidney disease leaks albumin

Read it alongside

  • eGFR (from creatinine or cystatin C) — together they stage chronic kidney disease; a normal eGFR with a high UACR is early disease, a low eGFR with a high UACR is the highest-risk combination.
  • Creatinine — the denominator of the ratio and the basis of eGFR; a rising creatinine with albuminuria means the disease is progressing.
  • Cystatin C — confirms a reduced eGFR when creatinine is unreliable (unusual muscle mass), and refines risk when eGFR is 45 to 59 with a normal UACR.
  • Protein in urine (dipstick or protein-to-creatinine ratio) — the dipstick is negative until roughly 300 mg/g; the protein-to-creatinine ratio captures non-albumin proteins such as light chains in myeloma.
  • A1C and glucose — the main driver of diabetic albuminuria; each 1 percent fall in A1C reduces the risk of new albuminuria by about a quarter to a third.
  • Blood pressure — the other main driver; a target of under 130/80 mmHg is recommended for most people with albuminuria.
  • Potassium and bicarbonate — monitored when ACE inhibitors, ARBs or finerenone are started and as kidney function declines.
  • Blood in urine (RBC and casts) — blood plus albumin points to a glomerular disease rather than diabetic or hypertensive damage and usually prompts nephrology referral.

What usually happens next

  1. A first result of 30 mg/g or more is repeated, ideally on a first-morning sample, with two of three samples over 3 to 6 months needed to confirm persistent albuminuria. Avoid testing within 24 hours of hard exercise, during a fever, urinary infection or period, or when blood sugar is very high.
  2. Once confirmed, the eGFR, blood pressure, A1C, lipids and a urine microscopy for blood are reviewed, and the chronic kidney disease stage (G1 to G5 with A1 to A3) is recorded; this determines how often you are monitored, from yearly to every 3 months.
  3. For people with diabetes or hypertension and a UACR above 30 mg/g, guidelines recommend an ACE inhibitor or ARB at the highest tolerated dose, and for type 2 diabetes or chronic kidney disease an SGLT2 inhibitor; finerenone and GLP-1 receptor agonists are added in some cases. Each of these lowers albuminuria by roughly 20 to 40 percent and slows kidney decline.
  4. The ratio is rechecked 3 to 6 months after any treatment change; a fall of 30 percent or more from baseline is the target used in trials and is associated with slower progression. Potassium and creatinine are checked 1 to 2 weeks after starting an ACE inhibitor, ARB or finerenone.
  5. A UACR above 300 mg/g, a ratio that keeps rising despite treatment, albuminuria with blood in the urine, an eGFR under 30, or albuminuria without diabetes or hypertension to explain it are the usual triggers for nephrology referral.
  6. Questions to ask: was this a first-morning sample, what is my CKD stage, am I on an ACE inhibitor or ARB and an SGLT2 inhibitor, what is my blood pressure target, and when is the next recheck.

Diet, lifestyle and natural levers with evidence

What can move UACR once the cause is known. Nothing here replaces finding the cause.

Cutting sodium to under 2,300 mg a day

Strong evidence

Salt raises glomerular pressure and blunts the effect of ACE inhibitors and ARBs. A Cochrane review of 21 trials in chronic kidney disease found that reducing salt intake lowered albuminuria and proteinuria by roughly a third as well as lowering blood pressure by about 7/3 mmHg, and in a crossover trial of people already taking lisinopril, cutting sodium from about 4,500 to 2,300 mg a day reduced proteinuria more than adding a second blood-pressure drug. Most sodium comes from bread, processed meat, cheese, sauces and restaurant food rather than the salt shaker.

Weight loss if overweight

Moderate evidence

Excess weight causes hyperfiltration in each glomerulus, and albuminuria falls as weight does. A systematic review of weight-loss studies found proteinuria fell by about 110 mg a day for every kilogram lost, with intentional loss of 5 to 10 percent of body weight reducing albuminuria by roughly 30 percent in people with diabetes or obesity-related kidney disease; after bariatric surgery, albuminuria resolves in around half of patients who had it. GLP-1 receptor agonists, which produce similar weight loss, also lower albuminuria in trials.

Blood glucose control (A1C under about 7 percent)

Strong evidence

In the Diabetes Control and Complications Trial, intensive glucose control in type 1 diabetes reduced the development of moderately increased albuminuria by 39 percent and severe albuminuria by 54 percent over 6.5 years, with benefits persisting for decades afterwards. In the UK Prospective Diabetes Study in type 2 diabetes, intensive control reduced new albuminuria by about a third. The components with the best kidney evidence are diet, exercise and weight loss alongside medication; very tight control (A1C under 6.5 percent) adds little kidney benefit and more hypoglycaemia.

Stopping smoking

Moderate evidence

Smoking roughly doubles the risk of albuminuria in the general population and in people with diabetes, through vascular damage, higher blood pressure and direct toxicity to glomerular cells, and smokers with diabetic kidney disease progress faster. Observational studies show albuminuria falls and progression slows after quitting; in one study of people with type 2 diabetes, stopping smoking for a year lowered UACR by about a third compared with continuing.

Moderate protein intake (about 0.8 g/kg a day) with more plant protein

Moderate evidence

High protein intake, especially from red and processed meat, increases glomerular pressure and albumin excretion. KDIGO guidelines recommend about 0.8 g of protein per kilogram of body weight for adults with chronic kidney disease, and a meta-analysis of randomised trials found that restricting protein modestly reduced proteinuria and slowed eGFR decline in diabetic kidney disease. Replacing some animal protein with plant sources (beans, lentils, nuts, whole grains) and following a Mediterranean- or DASH-style pattern is associated with 20 to 30 percent lower risk of albuminuria in cohort studies.

Very low protein diets (under 0.6 g/kg) risk malnutrition and are only used under dietitian supervision; people on dialysis need more protein, not less.

Curcumin

Preliminary evidence

Small randomised trials in diabetic nephropathy and lupus nephritis report that turmeric or curcumin (about 500 mg to 1.5 g a day for 2 to 3 months) reduced proteinuria by around 20 to 40 percent compared with placebo, alongside lower inflammatory markers, but the trials were short and involved fewer than 50 participants each, and a 2021 meta-analysis found inconsistent effects on albuminuria. It is not a substitute for ACE inhibitor, ARB or SGLT2 inhibitor treatment.

Turmeric is high in oxalate and curcumin supplements can increase bleeding with anticoagulants; rare cases of liver injury have been reported with concentrated supplements. Discuss before use if you have kidney stones or take blood thinners.

When to see a clinician promptly

  • Albuminuria with sudden swelling of the legs, face or abdomen, foamy urine and rapid weight gain: possible nephrotic syndrome, which needs prompt nephrology assessment.
  • A high UACR with blood pressure of 180/120 mmHg or higher, severe headache, chest pain, breathlessness or confusion: a hypertensive emergency.
  • New protein in the urine after 20 weeks of pregnancy, with high blood pressure, headache, visual disturbance or pain under the right ribs: possible preeclampsia, same-day assessment.
  • Albuminuria with blood in the urine, rash, joint pain, fever or a creatinine that has risen quickly over days to weeks: possible glomerulonephritis or vasculitis, which can damage the kidneys rapidly.
  • A UACR above 300 mg/g, or a ratio that keeps rising on two or more checks despite treatment, to review medication and consider kidney specialist referral.
  • Any confirmed UACR of 30 mg/g or more if you are not yet on an ACE inhibitor or ARB, or have not had your eGFR, blood pressure and A1C reviewed in the last year.

Frequently asked questions

What is a normal urine albumin-to-creatinine ratio?

Under 30 mg of albumin per gram of creatinine (under 3 mg/mmol in countries using SI units) is normal; most healthy people are under 10 mg/g. A ratio of 30 to 300 mg/g is moderately increased, the range that used to be called microalbuminuria, and above 300 mg/g is severely increased. Some labs still print sex-specific limits of 17 mg/g for men and 25 mg/g for women, but current guidelines use 30 mg/g for everyone. Laboratories differ slightly, so use the reference range on your own report.

What is the microalbumin normal range?

'Microalbumin' is the older name for the same test. When reported as a ratio, normal is under 30 mg/g; when reported as a concentration, normal is usually under 20 to 30 mg/L, and when reported from a 24-hour collection, under 30 mg a day. The word does not mean a small kind of albumin; it refers to amounts too small for a standard dipstick to detect. Most labs now label the test 'urine albumin' or 'UACR'.

Is a UACR of 35, 50 or 100 bad?

All three fall in the moderately increased band (30 to 300 mg/g) and, if confirmed on repeat samples, indicate early kidney damage and raised cardiovascular risk; the higher the number, the greater the risk. A single value of 35 could easily be a normal day-to-day fluctuation or a post-exercise reading and should simply be repeated. A confirmed 50 or 100 in someone with diabetes or hypertension is the point at which an ACE inhibitor or ARB and, in type 2 diabetes, an SGLT2 inhibitor are recommended, and the number is expected to fall by 30 percent or more with treatment.

Can a high albumin-creatinine ratio be reversed?

Often, yes, particularly in the 30 to 300 mg/g range. Blood pressure control with an ACE inhibitor or ARB lowers albuminuria by 20 to 50 percent, SGLT2 inhibitors by about 30 percent, and salt reduction, weight loss and glucose control each add to the effect; in trials, a third or more of people with moderately increased albuminuria return to normal within a few years of treatment. Severe albuminuria (above 300 mg/g) and established scarring are less likely to normalize, but the same measures slow the loss of kidney function.

Why is my albumin-creatinine ratio high but my eGFR normal?

Because albumin leak appears before filtering capacity falls. In diabetic and hypertensive kidney disease, the glomerular barrier is damaged years before enough filtering units are lost to lower the eGFR, so a normal eGFR with a high UACR is the typical picture of early, treatable disease (stage G1 or G2 with A2). It is still classified as chronic kidney disease if it persists for 3 months, and it still raises cardiovascular risk, which is why treatment is started at this stage rather than waiting for the eGFR to drop.

Can exercise or dehydration raise the albumin-creatinine ratio?

Exercise can. Vigorous activity in the previous 24 hours increases albumin leak several-fold, and guidelines advise against testing after hard workouts. Dehydration concentrates both albumin and creatinine, so the ratio is largely unaffected, though a very concentrated sample can read slightly high. Fever, urinary infection, menstruation, a large protein meal and very high blood sugar also raise it temporarily. A first-morning sample on a normal day is the most reliable, and persistent albuminuria is only diagnosed on two of three samples.

Is UACR the same as the urine protein-creatinine ratio?

No. The UACR measures only albumin and is far more sensitive at low levels, which makes it the right test for screening in diabetes and hypertension. The protein-to-creatinine ratio (UPCR) measures all urinary proteins, including immunoglobulin light chains and tubular proteins, and is used for established kidney disease, myeloma and pregnancy. Roughly, a UACR of 30 mg/g corresponds to a UPCR of about 0.15 mg/mg (150 mg/g), and a UACR of 300 mg/g to a UPCR of about 0.5 mg/mg.

How often should the urine albumin-creatinine ratio be checked?

At least once a year in everyone with type 2 diabetes from diagnosis, in type 1 diabetes from 5 years after diagnosis, and in people with hypertension or known chronic kidney disease. Once albuminuria is found, it is rechecked 1 to 4 times a year depending on the stage: yearly for a UACR of 30 to 300 mg/g with a normal eGFR, every 3 to 6 months for severely increased albuminuria or a reduced eGFR, and 3 to 6 months after any change in treatment to see whether the ratio has fallen.

References

  1. Microalbumin creatinine ratio. MedlinePlus, US National Library of Medicine (2022)View source
  2. Albuminuria: albumin in the urine. National Kidney Foundation (2023)View source
  3. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International (2024)
  4. American Diabetes Association Professional Practice Committee. Standards of Care in Diabetes 2025: chronic kidney disease and risk management. Diabetes Care (2025)
  5. Diabetic kidney disease. National Institute of Diabetes and Digestive and Kidney Diseases (2017)View source
  6. Microalbumin test. Mayo Clinic (2024)View source
  7. Chronic Kidney Disease Prognosis Consortium; Matsushita K, van der Velde M, Astor BC, et al.. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. The Lancet (2010)
  8. Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New England Journal of Medicine (1993)
  9. McMahon EJ, Campbell KL, Bauer JD, Mudge DW, Kelly JT. Altered dietary salt intake for people with chronic kidney disease. Cochrane Database of Systematic Reviews (2021)
  10. Slagman MC, Waanders F, Hemmelder MH, et al.. Moderate dietary sodium restriction added to angiotensin converting enzyme inhibition compared with dual blockade in lowering proteinuria and blood pressure: randomised controlled trial. BMJ (2011)
  11. Afshinnia F, Wilt TJ, Duval S, Esmaeili A, Ibrahim HN. Weight loss and proteinuria: systematic review of clinical trials and comparative cohorts. Nephrology Dialysis Transplantation (2010)
  12. Khajehdehi P, Pakfetrat M, Javidnia K, et al.. Oral supplementation of turmeric attenuates proteinuria, transforming growth factor-β and interleukin-8 levels in patients with overt type 2 diabetic nephropathy: a randomized, double-blind and placebo-controlled study. Scandinavian Journal of Urology and Nephrology (2011)

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