Microalbumin creatinine ratio- 24 Hours Urine

Kidney

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No Fasting Required

Details

Key marker of kidney filtration function (GFR); elevated in renal impairment.

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Microalbumin Creatinine Ratio - 24 Hours Urine

Why is it done?
- Measures the amount of albumin (a protein) in urine over a 24-hour period to assess kidney function and detect early signs of kidney damage
- Screen for early diabetic nephropathy in patients with type 1 or type 2 diabetes mellitus
- Monitor patients with hypertension to detect subclinical kidney disease
- Evaluate patients with chronic kidney disease (CKD) for disease progression and proteinuria status
- Assess cardiovascular and renal risk in patients with metabolic syndrome or obesity
- Detect albuminuria in patients with autoimmune or glomerular diseases
- Monitor effectiveness of medications such as ACE inhibitors or ARBs in reducing proteinuria
Normal Range
- Normal (Normoalbuminuria): Less than 30 mg/24 hours or less than 30 mg/g creatinine Interpretation: Indicates normal kidney function with no clinically significant proteinuria. Albumin excretion is within physiological limits.
- Microalbuminuria (Early Diabetic Nephropathy): 30-300 mg/24 hours or 30-300 mg/g creatinine Interpretation: Indicates early detection of kidney disease, particularly in diabetic patients. This stage is before overt proteinuria and represents an important intervention window.
- Macroalbuminuria (Overt Proteinuria): Greater than 300 mg/24 hours or greater than 300 mg/g creatinine Interpretation: Indicates significant kidney disease with manifest proteinuria. Associated with advanced nephropathy and increased risk of progression to end-stage renal disease (ESRD).
- Units of Measurement: mg/24 hours or mg/g creatinine (also expressed as mg/mmol creatinine in some laboratories) Alternative Unit: Albumin-to-creatinine ratio (ACR) values above 2.5 mg/mmol (males) or 3.5 mg/mmol (females) suggest microalbuminuria
Interpretation
- Results Less than 30 mg/24 hours:
  - Normal result indicating no albuminuria. Kidneys are functioning appropriately with normal glomerular filtration barrier integrity.
  - In diabetic patients, suggests good glycemic control and effective prevention of kidney disease
- Results 30-300 mg/24 hours:
  - Indicates microalbuminuria, representing subclinical proteinuria. Critical threshold for early intervention in diabetic and hypertensive patients.
  - Strong predictor of future overt nephropathy and increased cardiovascular morbidity and mortality
  - Requires initiation or optimization of renoprotective therapy (ACE inhibitors, ARBs, SGLT2 inhibitors)
  - Warrants increased monitoring frequency and lifestyle modifications
- Results Greater than 300 mg/24 hours:
  - Indicates macroalbuminuria or overt proteinuria. Represents advanced kidney disease with significant glomerular barrier damage.
  - In diabetic patients, suggests progression to diabetic nephropathy stage 3 or later
  - Associated with significantly increased risk of ESRD requiring dialysis or transplantation
  - Requires aggressive management including tight blood pressure control, intensive glucose control, and renoprotective medications
- Factors Affecting Readings:
  - Acute kidney injury or acute glomerulonephritis may cause transient elevation
  - Fever, intense exercise, urinary tract infections, and dehydration can falsely elevate results
  - Menstrual cycle may cause slight variations in some women
  - Medications (NSAIDs, some chemotherapy agents) may alter results
  - Uncontrolled hypertension directly correlates with increased albumin excretion
Associated Organs
- Primary Organ System:
  - Kidneys (Renal System) - specifically the glomeruli (filtering units) and tubules
  - The glomerular filtration barrier is responsible for retaining albumin while filtering waste products
- Medical Conditions Associated with Abnormal Results:
  - Diabetes Mellitus (Type 1 and Type 2) - most common cause of microalbuminuria
  - Hypertension (Essential or Secondary) - increased glomerular pressure damages filtration barrier
  - Chronic Kidney Disease (all stages) - progressive renal dysfunction
  - Glomerulonephritis - primary or secondary immune-mediated kidney disease
  - Systemic Lupus Erythematosus (SLE) and other autoimmune diseases affecting kidneys
  - IgA Nephropathy and other primary glomerulonephropathies
  - Polycystic Kidney Disease - genetic condition affecting renal function
  - Membranous Nephropathy - primary or secondary glomerular disease
  - Focal Segmental Glomerulosclerosis (FSGS) - progressive kidney disease
  - Alport Syndrome - hereditary nephritis affecting basement membrane
  - Preeclampsia and Gestational Hypertension - pregnancy-related kidney dysfunction
  - Metabolic Syndrome and Obesity - associated with increased renal disease risk
- Potential Complications Associated with Abnormal Results:
  - Progression to End-Stage Renal Disease (ESRD) requiring dialysis or transplantation
  - Increased cardiovascular morbidity and mortality - albuminuria is independent cardiovascular risk factor
  - Hypertension progression - proteinuria worsens blood pressure control
  - Acute kidney injury (AKI) - acute deterioration of renal function
  - Nephrotic syndrome - in cases of macroalbuminuria with very high protein loss
  - Electrolyte abnormalities and fluid retention - secondary to progressive kidney disease
  - Anemia from decreased erythropoietin production - common in CKD
Follow-up Tests
- Recommended Follow-up Tests Based on Results:
  - Serum Creatinine and Estimated Glomerular Filtration Rate (eGFR) - assess overall kidney function and CKD stage
  - Blood Urea Nitrogen (BUN) - evaluate nitrogen metabolism and kidney function
  - Serum Electrolytes (Sodium, Potassium, Chloride, Bicarbonate) - monitor for abnormalities
  - Lipid Panel - assess cardiovascular risk; dyslipidemia often accompanies proteinuria
  - Fasting Glucose and Hemoglobin A1C - evaluate glycemic control in diabetic patients
  - Spot Urine Albumin-to-Creatinine Ratio (ACR) - alternative to 24-hour urine collection for ongoing monitoring
  - Urinalysis - detect other abnormalities such as casts, crystals, or pyuria
  - Renal Ultrasound - assess kidney size, echotexture, and exclude structural abnormalities
  - Blood Pressure Monitoring (24-hour ambulatory BP) - assess adequacy of BP control
  - Immunology Tests (ANA, ANCA, complement levels) - if autoimmune disease suspected
  - Renal Biopsy - considered in atypical presentations or rapidly progressive disease
- Monitoring Frequency:
  - Normal Results (<30 mg/24h): Annually or as clinically indicated for diabetic or hypertensive patients
  - Microalbuminuria (30-300 mg/24h): Every 3-6 months to assess treatment response and disease progression
  - Macroalbuminuria (>300 mg/24h): Every 3 months or more frequently depending on clinical status
  - Rapidly Progressive Disease: May require monitoring every 1-4 weeks
- Related Complementary Tests:
  - 24-Hour Total Protein Excretion - comprehensive assessment of proteinuria severity
  - Serum Albumin - assess nutritional status in patients with significant proteinuria
  - Urine Calcium and Phosphorus - monitor mineral metabolism in CKD patients
  - Bone-Specific Alkaline Phosphatase and PTH - assess bone health in advanced CKD
  - Urine Osmolality - evaluate concentrating ability of kidneys
Fasting Required?
- NO - Fasting is not required for this test. This is a 24-hour urine collection, not a blood test, so dietary intake does not interfere with results.
- Patient Preparation Instructions:
  - Begin collection at 8:00 AM - Empty bladder and discard this first urine (do not collect it)
  - Collect all subsequent urine passed during the next 24 hours in the provided sterile container
  - End collection the following morning at 8:00 AM - collect the first urine void of that morning
  - Keep the collection container cool - refrigerate throughout collection period or use ice pack
  - Record total volume of urine collected (usually noted on container label)
  - Return specimen to laboratory within 24 hours of collection completion
  - Maintain normal diet and hydration - no specific dietary restrictions
- Medications and Substances to Consider:
  - Continue taking regular medications unless specifically instructed otherwise
  - Inform laboratory if taking NSAIDs, antibiotics, or chemotherapy - these may affect results
  - Avoid excessive exercise or strenuous activity during collection period - may artificially elevate albumin
  - Avoid collection during menstruation or for 2-3 days after in women - can cause false elevation
  - Postpone collection if experiencing acute illness, fever, or urinary tract infection - causes transient elevation

How our test process works!