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Proteinuria and ACR

ACR is the Albumin Creatinine Ratio - this is a sensitive method to detect small amounts of albumin (protein) in the urine. Proteinuria and microalbuminuria are both signs of renal involvement in the disease process, and risk factors for cardiovascular morbidity and mortality.

It is also used in diabetes monitoring. Initial confirmation of microalbuminuria based on at least 2 of 3 specimens with ACR   3.0 - 30.0 - Moderately increased (mg/mmol) > 30.0 - Severely increased*

*Including nephrotic syndrome (ACR usually >220.0 mg/mmol)
(According to NICE clinical guideline 182)

Also send MSU for culture to exclude infection and stick test the urine for haematuria


What does it mean?

An ACR > 30 mg/mmol is a positive value for proteinuria and > 70 usually requires investigation.

A value of 30 - 70 should be confirmed using an early morning sample of urine


What should I do now about a positive result?


If suspect Nephrotic syndrome (ACR > 250 and low serum albumin) - urgent referral

New finding of eGFR 30 - 59

 New finding eGFR < 30

Diabetic microalbuminuria guidelines