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Kidney

Urine albumin-to-creatinine ratio (ACR)

Hard training can push albumin into your urine temporarily, with nothing wrong with your kidneys at all. The albumin-to-creatinine ratio corrects for dilution, so you get a baseline to set a later measurement against.

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Reference Ranges

See the value that applies to you:

Choose male or female — this range differs by sex.

Enter your age — this range changes with age.

This range also depends on context such as cycle phase or sample material; the highlighted rows apply to your group.

Male Your group
mg/mmol
Normal < 3 High
Female Your group
mg/mmol
Normal < 3 High

Source: NHG

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

Check your own value

Albumin-to-Creatinine Ratio (ACR): what this test measures

The albumin-to-creatinine ratio compares two things in the same portion of urine: how much albumin it contains and how much creatinine. Albumin is a protein that normally stays in your blood, and healthy kidneys let almost none of it through.

The ratio is not measured separately in the laboratory. It follows from a division: your albumin value divided by your creatinine value, expressed in mg/mmol. No extra sample is needed for it.

That division does real work. Urine is dilute on one occasion and concentrated on another, and an albumin value on its own moves with it. Creatinine moves in exactly the same way, so dividing the two against each other cancels most of the dilution effect out.

Albumin-to-Creatinine Ratio (ACR): why this value matters

Albumin in your urine is one of the earliest signals that your kidneys' filter is not closing as tightly as it should. It often shows before your eGFR changes, which is exactly why this ratio sits alongside eGFR in the guidelines.

The Dutch kidney standard calls a ratio of 3 mg/mmol or above raised. The international KDIGO guideline uses the same boundary and sorts the result into three categories: under 3, between 3 and 30, and above 30 mg/mmol.

A raised result is not a diagnosis on its own. Fever, a bladder infection, hard exercise shortly before the sample and a very high-protein meal can all push the value up temporarily. That is why an abnormal ratio is normally repeated before any conclusions are drawn. Discuss your result with your doctor or GP.

Albumin-to-Creatinine Ratio (ACR): when is testing worthwhile?

The ratio is used mainly in people at raised risk of kidney damage: with diabetes, with high blood pressure, with cardiovascular disease, and where kidney disease runs in the family.

You need two determinations in the same portion of urine for it: albumin and creatinine. If both are on your request, we add the ratio automatically.

Morning urine is preferred, because it is least affected by what you have done that day. Hard training shortly before the sample is better skipped.

Albumin-to-Creatinine Ratio (ACR): symptoms of a high or low value

Low Levels

A low ratio is not an abnormality. The less albumin your kidneys let through the better, so a value under the boundary is the desired result and calls for no action.

High Levels

Early albumin loss usually causes no symptoms at all, which is exactly why it is looked for before there is anything to notice.

With heavier loss you may retain fluid, for instance swollen ankles or eyelids, or see urine that foams noticeably. Rising blood pressure and tiredness can also belong to it. All of these have many possible causes. Take them to your GP rather than interpreting them yourself.

Albumin-to-Creatinine Ratio (ACR): lifestyle and this value

The two things that do most for your kidneys are blood pressure that is well controlled and, if you have diabetes, stable blood sugar. Both help determine how much albumin leaks through the filter.

Beyond that, going easy on salt, drinking enough and not smoking all help. Anti-inflammatory painkillers such as ibuprofen put a load on the kidneys with prolonged use; talk to your GP or pharmacist if you need them often.

Do not schedule your measurement straight after a hard training session. Exertion can push the value up temporarily and that says nothing about your kidneys in the long run.

Albumin-to-Creatinine Ratio (ACR): frequently asked questions

Do I need to order the ratio separately?

No. If albumin (urine) and creatinine (urine) are both on your request, we add the ratio and you will see it on your report.

What counts as a normal value?

Under 3 mg/mmol counts as normal. Between 3 and 30 mg/mmol is called moderately increased albuminuria, and above 30 mg/mmol severely increased albuminuria.

Why not just the albumin on its own?

Because urine is dilute on one occasion and concentrated on another, and an albumin value on its own moves with it. Dividing by creatinine cancels most of that out.

Can a raised result be harmless?

Yes. Fever, a bladder infection, hard exercise shortly before the sample and a very high-protein meal can push the value up temporarily. That is why an abnormal result is usually repeated.

Which urine should I use?

Morning urine is preferred, because it is least affected by what you have done that day.

What should I do with a raised result?

Take it to your GP. They read the ratio alongside your blood pressure, your eGFR and the rest of your picture, and decide whether repeating it or looking further is worthwhile.

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