What does a high albumin (Albumin)/creatinine (Creatinine) ratio indicate?

Albumin/Creatinine Ratio of 184 mg/g: Clinical Significance

An albumin/creatinine ratio of 184 mg/g indicates moderately increased albuminuria (Stage A2), which signifies kidney damage and substantially increases your risk for both progressive chronic kidney disease and cardiovascular disease. 1

Understanding Your Result

Your UACR of 184 mg/g falls into the moderately increased albuminuria category (30-299 mg/g), previously called "microalbuminuria." 1 This is well above the normal threshold of <30 mg/g and indicates that your kidneys are leaking more albumin (a protein) into your urine than they should. 1

Key point: UACR is a continuous risk marker—meaning that even within the "moderately increased" range, higher values like yours (184 mg/g) carry greater risk than values closer to 30 mg/g. 1, 2

What This Means for Your Health

• Kidney damage marker: This level of albuminuria indicates existing kidney damage and predicts future loss of kidney function. 1
• Cardiovascular risk: At any level of kidney function, your elevated UACR significantly increases your risk for cardiovascular disease, heart attacks, and cardiovascular death. 1, 3
• Progressive disease risk: You are at increased risk for progression to more severe kidney disease stages. 1

Immediate Next Steps: Confirmation Required

Because urinary albumin excretion has high biological variability (>20% between measurements), you must confirm this result before establishing a definitive diagnosis. 1, 2

• Obtain 2 additional urine samples over the next 3-6 months. 1, 2
• If 2 out of 3 total specimens are abnormal (≥30 mg/g), the diagnosis of moderately increased albuminuria is confirmed. 1, 2
• Use first morning void samples when possible, as these have the lowest variability. 2

Important Caveats—Temporary Elevations

Your UACR can be falsely elevated by several factors that should be excluded before confirming chronic kidney disease: 1, 2

• Exercise within 24 hours before testing 1, 2
• Active infection or fever 1, 2
• Congestive heart failure 1
• Marked hyperglycemia (very high blood sugar) 1
• Menstruation 1
• Marked hypertension 1

Essential Additional Testing

Once albuminuria is confirmed, you need: 1

• Serum creatinine to calculate estimated glomerular filtration rate (eGFR) using the CKD-EPI equation 1
• Blood pressure measurement 1
• Hemoglobin A1c if diabetic or at risk 1
• Assessment for diabetic retinopathy if you have diabetes 1

Treatment Recommendations Based on Your Level

For confirmed moderately increased albuminuria (30-299 mg/g), you should receive: 1

• ACE inhibitor or angiotensin receptor blocker (ARB) if you have diabetes and hypertension, or if you have diabetes with modestly elevated UACR like yours. 1
• These medications are strongly recommended if your UACR reaches ≥300 mg/g or if your eGFR drops below 60 mL/min/1.73 m². 1
• Blood pressure control targeting appropriate goals for kidney protection 1
• Optimization of glucose control if diabetic 1

Monitoring Strategy

With confirmed moderately increased albuminuria, you require: 1, 2

• Annual monitoring of both UACR and eGFR at minimum 1, 2
• More frequent monitoring (every 6 months) if eGFR is <60 mL/min/1.73 m² 2
• Monitoring of serum creatinine and potassium when taking ACE inhibitors, ARBs, or diuretics 1

When to See a Kidney Specialist

Prompt referral to a nephrologist is indicated if you have: 1

• Rapidly increasing albuminuria 1
• Rapidly declining eGFR (>25% decline with change in GFR category) 3
• eGFR <30 mL/min/1.73 m² 1
• Active urinary sediment (blood cells or casts in urine) 1
• Uncertainty about the cause of kidney disease 1

Clinical Context

If you have type 2 diabetes, this finding may represent diabetic kidney disease, which can be present at diagnosis even without retinopathy. 1 If you have type 1 diabetes for less than 5 years without retinopathy, alternative causes of kidney disease should be considered. 1

The presence of moderately increased albuminuria places you in a higher-risk category that warrants aggressive cardiovascular risk factor modification and kidney-protective interventions. 1