Urine Albumin-to-Creatinine Ratio (ACR)

Overview

The urine albumin-to-creatinine ratio (ACR) is a simple, painless urine test that measures how much albumin (a protein) is leaking into the urine. Even tiny amounts — too small to be picked up by ordinary urine tests — can be the earliest sign that diabetes is beginning to affect the kidneys, often years before blood tests of kidney function change.

This page is the dedicated guide to the ACR test itself. For what an abnormal result means as a condition, see Albuminuria / Microalbuminuria, and for the wider disease picture see Diabetic Kidney Disease.

What the test measures

ACR compares the amount of albumin to the amount of creatinine in a single urine sample, usually the first urine of the morning. Because it is a ratio, it corrects for how concentrated the urine is, giving a reliable result from one sample without needing a 24-hour collection. The result is reported in mg/g and categorised as normal, mildly increased (microalbuminuria) or clearly raised.

Why it matters

• It detects kidney involvement at the earliest, most reversible stage.
• A normal ACR is reassuring; a raised ACR prompts protective treatment.
• It should be checked at least once a year in people with diabetes.
• Trends over time matter more than any single reading.

Understanding your result

• Normal — typically below 30 mg/g; kidney leak is not present.
• Mildly raised (microalbuminuria) — 30–300 mg/g; the earliest warning sign.
• Clearly raised (macroalbuminuria) — above 300 mg/g; more established leak.
• A single raised result may be due to fever, exercise or infection and should be confirmed with a repeat test.

How often to test

For most people with diabetes, ACR is checked at least once a year alongside kidney function blood tests. If a result is raised, it is repeated within a few weeks to confirm the trend before deciding on treatment. Once protective treatment is started, ACR is monitored regularly to check whether the leak is improving.

How we help

Dr. Nayak orders ACR testing as part of routine diabetes review, interprets the result alongside your kidney function and blood pressure, and explains clearly what it means for you. If the result is raised, protective treatment is started early to safeguard your kidneys, and follow-up testing confirms the trend. Consultations are available in-clinic in Bhubaneswar and over teleconsultation.

Related conditions and patient concerns

The ACR test is the gateway to detecting and managing diabetic kidney disease. These related pages explain what the results mean and how kidney health is protected.

• Albuminuria / Microalbuminuria
• Diabetic Kidney Disease
• Diabetes Complications
• HbA1c Management
• Kidney Health
• Hypertension & Cardiovascular Risk