Microalbumin Creatinine Ratio - Spot Sample
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Key marker of kidney filtration function (GFR); elevated in renal impairment.
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🧪 What is the Microalbumin/Creatinine Ratio (ACR)?
The ACR (Albumin-to-Creatinine Ratio) is a spot urine test used to detect small amounts of albumin (microalbuminuria), adjusted for urine concentration by comparing it to creatinine levels in the same sample.
- It avoids the need for 24-hour urine collection.
- It’s the preferred test for screening diabetic and hypertensive patients for early kidney disease.
❓ Why is the Test Done?
To:
- Detect early signs of kidney damage in diabetes, hypertension, and CKD
- Monitor renal function progression over time
- Predict cardiovascular events and renal complications
- Guide nephroprotective interventions (e.g., ACE inhibitors, ARBs)
📦 How the Test Works
- A random urine sample (ideally first morning) is collected.
- Albumin (mg) is measured relative to creatinine (g), expressed as mg/g (or mg/mmol).
📊 Normal Range & Interpretation
ACR (mg/g creatinine) | Interpretation |
|---|---|
< 30 mg/g | Normal |
30–300 mg/g | Microalbuminuria (early kidney damage) |
> 300 mg/g | Macroalbuminuria (clinical proteinuria) |
Microalbuminuria must be confirmed on 2 out of 3 samples collected over 3–6 months.
📈 Interpretation of Results
ACR Value | Possible Implication |
|---|---|
< 30 mg/g | Normal kidney filtration |
30–300 mg/g | Early kidney disease, often in diabetes or hypertension |
> 300 mg/g | Overt nephropathy or progressive kidney damage |
🧠 Associated Organs & Conditions
System/Organ | Associated Conditions |
|---|---|
Kidneys | Diabetic nephropathy, hypertensive nephrosclerosis, CKD |
Cardiovascular | Heart disease, endothelial dysfunction |
Endocrine | Type 1 & 2 Diabetes |
Others | Lupus nephritis, glomerulonephritis, preeclampsia |
🔄 Related / Follow-Up Tests
- Serum Creatinine & eGFR – kidney filtration rate
- Urine Routine & Microscopy
- HbA1c – diabetes control
- Blood Pressure Monitoring
- Lipid Profile – CV risk
- Fundus exam – diabetic retinopathy co-evaluation
✅ Fasting Required?
Test | Fasting Requirement |
|---|---|
ACR (Spot Urine Test) | ❌ Not required |
First morning sample is preferred due to low variability.
📝 Summary Table
Parameter | Details |
|---|---|
What | Ratio of albumin (mg) to creatinine (g) in spot urine |
Why | Detect early renal damage, especially in diabetics/hypertensives |
Normal Range | < 30 mg/g creatinine |
Microalbuminuria | 30–300 mg/g – early nephropathy |
Macroalbuminuria | > 300 mg/g – significant protein loss |
Associated Conditions | Diabetes, CKD, hypertension, CV disease |
Follow-up Tests | eGFR, creatinine, HbA1c, BP, lipid profile |
Fasting Required | ❌ No |
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