From the Guidelines
An elevated Albumin to Creatinine Ratio (ACR) is primarily caused by kidney damage, with key contributors including diabetes mellitus, hypertension, and other kidney diseases, as well as temporary factors like exercise, infection, and marked hypertension, as noted in the 2022 study by Diabetes Care 1. The main causes of an elevated ACR include:
- Diabetes mellitus (diabetic nephropathy)
- Hypertension
- Glomerulonephritis
- Other kidney diseases Other contributors to elevated ACR include:
- Obesity
- Heart failure
- Systemic infections
- Certain medications (NSAIDs, some antibiotics)
- Autoimmune diseases
- Genetic kidney disorders Temporary elevation can occur due to:
- Urinary tract infections
- Vigorous exercise
- Fever
- Dehydration
- Marked hyperglycemia
- Menstruation
- Congestive heart failure, as mentioned in the 2020 study by Diabetes Care 1. ACR is calculated by dividing urinary albumin by urinary creatinine, with normal values below 30 mg/g, as defined in the 2022 study by Diabetes Care 1. It is essential to note that ACR is a continuous measurement, and differences within the normal and abnormal ranges are associated with renal and cardiovascular outcomes, as highlighted in the 2022 study by Diabetes Care 1. Due to the high biological variability of urinary albumin excretion, two of three specimens of UACR collected within a 3- to 6-month period should be abnormal before considering a patient to have high or very high albuminuria, as recommended in the 2022 study by Diabetes Care 1.
From the Research
Causes of Elevated Albumin to Creatinine Ratio (ACR)
- Diabetes: Studies have shown that individuals with diabetes are at a higher risk of developing elevated ACR 2, 3, 4, 5, 6.
- Hypertension: Hypertension is another major cause of elevated ACR, as it can damage the blood vessels in the kidneys and lead to albuminuria 2, 3, 5.
- Kidney disease: Kidney disease, including diabetic nephropathy, can cause elevated ACR 2, 3, 4, 5, 6.
- Cardiovascular disease: Cardiovascular disease is also a risk factor for elevated ACR, as it can increase the pressure on the kidneys and lead to albuminuria 4, 5.
Factors that Contribute to Elevated ACR
- Age: Older adults are more likely to have elevated ACR 4.
- Sex: Women are more likely to have elevated ACR than men 4.
- Race: Certain racial and ethnic groups, such as African Americans, are more likely to have elevated ACR 4.
- Education status: Individuals with lower education status are more likely to have elevated ACR 4.
- Comorbidities: Presence of comorbidities, such as hypertension, diabetes, and cardiovascular disease, can contribute to elevated ACR 2, 3, 4, 5, 6.
Treatment and Management of Elevated ACR
- Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) are commonly used to treat elevated ACR 2, 3, 5, 6.
- Combination therapy with ACEi and ARB may be more effective in reducing ACR than monotherapy 3, 6.
- Lifestyle modifications, such as blood pressure control, diet, and exercise, can also help manage elevated ACR 2, 3, 4, 5, 6.