Do I have kidney disease with a normal eGFR (estimated Glomerular Filtration Rate), normal albumin, and normal creatinine levels, but an unable to calculate MA (Microalbumin)/creatinine ratio due to parameters being outside the Clinical Reportable Range?

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No, You Do Not Have Kidney Disease

Based on your laboratory values, you do not have chronic kidney disease. Your eGFR of 77 mL/min/1.73 m² is well above the threshold for CKD (which is <60 mL/min/1.73 m²), your serum albumin is normal at 4.5 g/dL, your serum creatinine is normal at 0.88 mg/dL, and most importantly, your urine microalbumin is <0.5 mg/dL, which is below the normal threshold of <30 mg/g creatinine 1.

Understanding Your Results

Why the MA/Creatinine Ratio Cannot Be Calculated

  • The laboratory cannot calculate your albumin-to-creatinine ratio (ACR) because your urine microalbumin level (<0.5 mg/dL) is below the Clinical Reportable Range—meaning it's too low to measure accurately, not too high 1.

  • Your urine creatinine of 63.34 mg/dL is within normal range, but when the albumin value is below the detectable limit, the ratio calculation becomes mathematically unreliable 2.

  • This is actually a favorable finding—it indicates you have minimal to no albumin in your urine, which is exactly what you want 1.

Your Kidney Function Status

  • eGFR of 77 mL/min/1.73 m²: This places you in the G2 category (mildly reduced GFR: 60-89 mL/min/1.73 m²), but without any evidence of kidney damage, this does not constitute CKD 1.

  • Normal albuminuria (A1 category): Your urine microalbumin <0.5 translates to an ACR well below 30 mg/g creatinine, which is the normal range 1.

  • CKD requires BOTH: Either an eGFR <60 mL/min/1.73 m² OR evidence of kidney damage (such as albuminuria ≥30 mg/g) for at least 3 months 1.

CKD Classification Framework

According to KDIGO (Kidney Disease: Improving Global Outcomes) guidelines, CKD is defined by:

  • Persistent eGFR <60 mL/min/1.73 m² for ≥3 months, OR
  • Evidence of kidney damage (albuminuria ≥30 mg/g, imaging abnormalities, or biopsy-proven disease) regardless of eGFR 1.

You meet neither criterion 1.

Risk Stratification

  • Your combination of G2 (eGFR 60-89) and A1 (ACR <30 mg/g) places you in the low-risk category (green zone on the KDIGO heat map) 1, 3.

  • This risk category indicates you have normal kidney function with no increased risk for CKD progression, cardiovascular disease, or mortality related to kidney disease 1, 3.

Important Caveats

When G2 eGFR Alone Is Not CKD

  • An eGFR of 60-89 mL/min/1.73 m² (G2) is considered "mildly reduced" but is only classified as CKD if accompanied by other markers of kidney damage such as albuminuria, hematuria, structural abnormalities on imaging, or biopsy-proven disease 1.

  • Many healthy individuals, particularly older adults, have eGFR values in the 60-89 range without any kidney disease 1, 4.

  • The American Diabetes Association specifically notes that eGFR alone without albuminuria or other damage markers does not constitute CKD 1.

Age-Related GFR Decline

  • GFR naturally declines with age beginning in the third or fourth decade of life, typically by 1-2 mL/min per year 1.

  • This physiologic decline does not represent disease unless accompanied by evidence of kidney damage 1.

What You Should Do

No Treatment Required

  • You do not need ACE inhibitors or ARBs, as these are only recommended for patients with albuminuria (ACR ≥30 mg/g) or eGFR <60 mL/min/1.73 m² 1, 3.

  • Focus on general cardiovascular health: maintain blood pressure <130/80 mmHg, control blood glucose if diabetic, avoid nephrotoxic medications, and maintain healthy lifestyle habits 1, 3.

Monitoring Recommendations

  • Recheck eGFR and urine albumin annually as part of routine health maintenance, particularly if you have diabetes, hypertension, or cardiovascular disease 1, 3.

  • No need for more frequent monitoring given your low-risk status 1, 3.

No Nephrology Referral Needed

  • Nephrology referral is indicated only when eGFR <30 mL/min/1.73 m² (Stage 4 CKD), ACR ≥300 mg/g, rapid GFR decline (>5 mL/min/1.73 m² per year), or uncertain etiology of kidney disease 1, 3.

  • None of these apply to you 3.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Chronic Kidney Disease Management

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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