Is a spot urine albumin of 2.2 mg/dL and creatinine of 135.7 mg/dL (albumin‑to‑creatinine ratio ≈16 mg/g) normal in an otherwise healthy adult, and what follow‑up is recommended?

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Interpretation of Your Urine Test Results

Your spot urine albumin-to-creatinine ratio (ACR) of approximately 16 mg/g is normal and does not indicate kidney damage; no specific treatment is required, but annual screening should continue if you have diabetes. 1

Understanding Your Numbers

  • Your urine albumin is 2.2 mg/dL and creatinine is 135.7 mg/dL, which calculates to an ACR of approximately 16 mg/g creatinine. 1
  • Normal ACR is defined as less than 30 mg/g creatinine, and your value falls well within this normal range. 1
  • This result indicates no detectable albuminuria and no evidence of early kidney damage at this time. 1

Clinical Significance

  • ACR is a continuous measurement, meaning that even values within the normal range carry different levels of cardiovascular and renal risk—but your value of 16 mg/g is reassuringly low. 1
  • The threshold for "moderately increased albuminuria" (formerly called microalbuminuria) begins at 30 mg/g, and you are below this cutoff. 1
  • Even though your result is normal, it does not exclude the possibility of future kidney disease, particularly if you have diabetes or hypertension. 1

Recommended Follow-Up

If You Have Diabetes

  • Annual ACR screening is recommended using a first-morning spot urine sample to monitor for the development of diabetic kidney disease. 1
  • Screening should begin at the time of diagnosis for type 2 diabetes, or 5 years after diagnosis for type 1 diabetes. 1
  • First-morning collections are preferred because they minimize diurnal variation in albumin excretion and provide the most reproducible results. 1

If You Do Not Have Diabetes

  • No routine ACR monitoring is necessary unless you develop diabetes, hypertension, or other risk factors for chronic kidney disease. 1
  • If you have hypertension, annual ACR screening may be considered as part of cardiovascular risk assessment. 1

Important Caveats

  • Transient elevations in urinary albumin can occur with vigorous exercise within 24 hours, urinary tract infection, fever, marked hyperglycemia, heart failure, or severe hypertension—none of these conditions would be diagnosed based on a single normal result like yours. 1
  • If a future ACR measurement shows elevation (≥30 mg/g), confirmation with 2 out of 3 specimens collected over a 3–6 month period is required before diagnosing persistent albuminuria, because day-to-day variability in albumin excretion is high. 1
  • Do not rely on urine albumin concentration alone (without creatinine correction), as hydration status can produce misleading results; the ACR method you received is the preferred approach. 1

What This Means for Your Health

  • Your current result provides reassurance that you do not have kidney damage detectable by albuminuria screening at this time. 1
  • Continue routine health maintenance, including blood pressure control, glycemic control if diabetic, and smoking cessation if applicable. 1
  • No pharmacologic intervention (such as ACE inhibitors or ARBs) is indicated for kidney protection when ACR is normal and blood pressure is controlled. 1

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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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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