Is an Albumin-to-Creatinine Ratio of 62 mg/g Concerning?
Yes, an ACR of 62 mg/g is concerning as it indicates moderately increased albuminuria (formerly called microalbuminuria), which signifies kidney damage and substantially increases your risk for both progressive kidney disease and cardiovascular events. 1, 2
Understanding Your Result
Your ACR of 62 mg/g falls into the moderately increased albuminuria category (30-299 mg/g), which represents stage A2 kidney disease. 1 This is not normal—the normal range is defined as less than 30 mg/g creatinine. 1, 2
Clinical Significance
- Kidney damage marker: This level indicates early kidney damage, even if your kidney function (GFR) appears normal. 1
- Cardiovascular risk: Even moderately elevated ACR is associated with heightened cardiovascular disease risk, independent of kidney function. 1
- Progressive risk: At any level of kidney function, increased ACR is associated with higher risk for adverse outcomes, and this risk increases as ACR rises. 2
Confirmation Required Before Diagnosis
You cannot be diagnosed with persistent albuminuria based on a single test. Due to high day-to-day biological variability in urinary albumin excretion, you need 2 out of 3 specimens to be abnormal over a 3-6 month period to confirm true albuminuria. 1, 2
Factors That Can Falsely Elevate ACR
Your result may be temporarily elevated due to: 1
- Exercise within 24 hours before testing
- Active infection or fever
- Congestive heart failure
- Marked hyperglycemia (very high blood sugar)
- Menstruation
- Marked hypertension (very high blood pressure)
Immediate Next Steps
Repeat testing: Obtain 2 additional first morning urine samples for ACR over the next 3-6 months. 2 First morning samples have the lowest variability (31% coefficient of variation). 2
Assess kidney function: If not already done, measure serum creatinine to calculate estimated GFR (eGFR) to determine your kidney function stage. 1
Screen for underlying causes: 1
- Check blood pressure (hypertension is both a cause and consequence)
- Screen for diabetes if not already diagnosed
- Review medications that may affect kidney function
If Confirmed: Treatment Implications
If 2 out of 3 tests over 3-6 months confirm ACR ≥30 mg/g, treatment is indicated: 1
- Blood pressure control: Target blood pressure should be optimized, typically <130/80 mmHg in the presence of kidney disease. 1
- ACE inhibitor or ARB therapy: These medications are associated with treatment benefits in adults with increased albuminuria, particularly in the setting of diabetes or cardiovascular disease. 1 They should be titrated to normalize albumin excretion. 1
- Glycemic control: If diabetic, improved glucose control is essential. 1
Important Caveat for Women of Childbearing Age
ACE inhibitors and ARBs are teratogenic and should be avoided if you are of childbearing age without reliable contraception. 1 Reproductive counseling is essential before starting these medications. 1
Monitoring Frequency
- If confirmed: ACR and eGFR should be monitored at least every 6 months, or more frequently depending on your overall risk profile and response to treatment. 2
- Annual monitoring minimum: Even with treatment, annual assessment is recommended for anyone with confirmed kidney disease. 1
Risk Stratification
Your ACR of 62 mg/g, combined with your kidney function (GFR), determines your overall risk for progression to kidney failure. 1 The combination of these two parameters guides the intensity of monitoring and treatment. Even if your GFR is currently normal (≥90 mL/min/1.73 m²), the presence of moderately increased albuminuria moves you from stable disease (A1/G1) to a higher risk category requiring closer follow-up. 1