From the Guidelines
The albumin/creatinine ratio (ACR) of 33 mg/g in a random urine sample indicates microalbuminuria, which is an early sign of kidney damage and requires prompt follow-up and management. This result falls in the moderately increased albuminuria range (30-300 mg/g) and is associated with an increased risk of renal and cardiovascular outcomes 1.
Key Considerations
- The patient should undergo confirmation of this result with at least one additional urine sample, as variability can occur 1.
- If confirmed, lifestyle modifications should be implemented immediately, including:
- Blood pressure control (target <130/80 mmHg)
- Diabetes management if applicable (target HbA1c <7%)
- Dietary sodium restriction (<2.3g/day)
- Regular exercise
- Medication therapy with an ACE inhibitor (like lisinopril 10-40 mg daily) or an ARB (such as losartan 50-100 mg daily) should be considered, especially if the patient has hypertension or diabetes 1.
Monitoring and Follow-up
- Regular monitoring of kidney function with eGFR and repeat ACR measurements every 3-6 months is essential to assess response to therapy and progression of disease 1.
- The patient should be referred to a physician experienced in the care of kidney disease if there is uncertainty about the etiology of kidney disease, difficult management issues, or rapidly progressing kidney disease 1.
Conclusion Not Applicable - Outcome Based Answer Only
This level of albuminuria indicates that kidney damage is occurring, likely due to increased glomerular pressure or inflammation, and early intervention can significantly slow progression to more severe kidney disease and reduce cardiovascular risk 1.
From the Research
Albumin/Creatinine Ratio
- The albumin/creatinine ratio (ACR) is a test used to detect kidney damage and is also a risk factor for cardiovascular disease and mortality 2, 3.
- A random urinary ACR based on a random urine sample correlates well with 24-hour urinary albumin excretion measurement 2.
- The ACR can be used as a screening test for microalbuminuria, but it has limitations, particularly in older adults, where the false-positive rate increases with age 4.
Interpretation of ACR Results
- An ACR of 30 mg/g or greater is considered abnormal and may indicate kidney damage 5, 4.
- The ACR can be influenced by various factors, including age, sex, and blood pressure 4.
- Point-of-care testing devices, such as the CLINITEK Microalbumin and DCA 2000+, can be used to measure ACR and rule out increased urinary albumin excretion 2.
Clinical Significance
- The ACR is an important marker for kidney disease and cardiovascular risk 3, 6.
- Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) can decrease albuminuria and slow the progression of kidney disease 6.
- The use of ACEIs and ARBs has increased over time, particularly in patients with chronic kidney disease (CKD) 5.