Albumin-to-Creatinine Ratio and Kidney Disease

Understanding Albuminuria

An Albumin-to-Creatinine Ratio (ACR) of 62 mg/g indicates moderately increased albuminuria, signifying kidney damage and increasing the risk for progressive kidney disease and cardiovascular events, according to the American Journal of Kidney Diseases and Kidney International 1, 2
The moderately increased albuminuria category (30-299 mg/g) represents stage A2 kidney disease, with the normal range defined as less than 30 mg/g creatinine, as stated by the American Journal of Kidney Diseases and Diabetes Care 3, 4

An ACR of 62 mg/g is a marker of early kidney damage, even with normal kidney function (GFR), as indicated by the American Journal of Kidney Diseases and Anaesthesia 3, 5
Moderately elevated ACR is associated with heightened cardiovascular disease risk, independent of kidney function, according to the American Journal of Kidney Diseases 5
Increased ACR is associated with higher risk for adverse outcomes, with this risk increasing as ACR rises, as stated by the American Journal of Kidney Diseases 5

Persistent albuminuria cannot be diagnosed based on a single test; 2 out of 3 specimens must be abnormal over a 3-6 month period to confirm true albuminuria, as recommended by Diabetes Care and the American Journal of Kidney Diseases 4, 5

Temporary elevations in ACR can be caused by exercise, active infection, fever, congestive heart failure, marked hyperglycemia, menstruation, and marked hypertension, as indicated by the American Journal of Kidney Diseases and Diabetes Care 4, 5, 6

If confirmed, treatment is indicated, including blood pressure control, ACE inhibitor or ARB therapy, and glycemic control, as recommended by the American Journal of Kidney Diseases and Diabetes Care 5, 6
Target blood pressure should be optimized to <130/80 mmHg in the presence of kidney disease, as stated by the American Journal of Kidney Diseases 5
ACE inhibitors and ARBs should be titrated to normalize albumin excretion, but avoided in women of childbearing age without reliable contraception due to teratogenic effects, as indicated by Diabetes Care 6

ACR and eGFR should be monitored at least every 6 months, or more frequently depending on the overall risk profile and response to treatment, as recommended by the American Journal of Kidney Diseases and Kidney International 1, 2
Annual monitoring is recommended for anyone with confirmed kidney disease, as stated by Kidney International 1