Albumin to Creatinine Ratio: All You Should Know

[Nelson Vergel]

This brief article provides information about the albumin to creatinine ratio (ACR), which is found in urine, as well as potential causes of a high ACR and steps that may help improve the lab test result. It is essential to seek the specialized guidance of a healthcare professional.

Table of Contents​

• What is the Albumin to Creatine Ratio?
• What are the Causes for High ACR?
• How Can We Lower a High Albumin to Creatinine Ratio?
  • References:

What is the Albumin to Creatine Ratio?​

The albumin creatinine ratio (ACR) is a frequent test that is used to evaluate kidney function (1). Albumin is a type of protein that can be found in blood, and creatinine is a waste product that is produced as a byproduct of the metabolism of muscle (2). Only minute amounts of albumin are passed out of the body through the urinary tract of healthy people (3). If your ACR is high, it may be a sign that your kidneys are not filtering waste materials and excess chemicals as well as they should be, which allows albumin to be excreted in the urine (4).

What are the Causes for High ACR?​

The following are some of the possible causes of a high ACR:

1. Damage to or disease of the kidneys: Conditions such as diabetic nephropathy (5), glomerulonephritis (6), or polycystic kidney disease (7) are examples of conditions that can affect kidney function and lead to an elevated ACR.
2. Hypertension: High blood pressure can cause damage to the blood vessels in the kidneys, which can then compromise the kidneys' ability to filter blood (8).
3. Diabetes: Prolonged high blood sugar levels can damage the small blood vessels in the kidneys, limiting their ability to filter waste in an effective manner. This can lead to a decrease in kidney function (9).
4. Infections: Infections of the urinary system or other infections might momentarily elevate ACR (10).
5. A number of medications: There are a number of medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) (11), that have the potential to alter renal function and raise ACR.
6. Dehydration: A low fluid intake can lead to concentrated urine, which might cause a transient elevation in ACR (12). If you are dehydrated, you should drink more fluids.

How Can We Lower a High Albumin to Creatinine Ratio?​

It is recommended to do the following actions to try and enhance one's score on the ACR test:

1. If you have diabetes, maintaining tight control of your blood sugar levels is one of the most important things you can do to help prevent further kidney damage (13).
2. Control your blood pressure: Maintaining a blood pressure that is within the normal range by managing your blood pressure will help prevent future damage to your kidneys (14). Modifications to one's way of life, such as eating less salt and working out frequently, might be of assistance. Medication is another option for treating high blood pressure, which may be recommended by a doctor (15).
3. Maintaining an adequate level of water helps the kidneys operate more effectively and facilitates the removal of waste products (16).
4. Reduce your usage of NSAIDs: If at all feasible, you should try to limit your use of nonsteroidal anti-inflammatory drugs (NSAIDs) and discuss other pain relief choices with your primary care physician (17).
5. Ensure that you have a nutritious diet: Adhering to a diet that is abundant in fruits, vegetables, whole grains, and sources of lean protein can help maintain kidney function (18).
6. Treat infections: Seek immediate treatment from your healthcare practitioner if you have an infection of any kind, whether it be a urinary tract infection or another infection (19).
7. Be sure to heed the advice of your medical professional: In order to assist in the protection of kidney function, your healthcare provider can recommend that you take certain medications, such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) (20).
   Keep in mind that it is absolutely necessary to seek the tailored guidance of a trained medical professional and to perform routine checks on the functioning of your kidneys.
   
   

   References:​

   1. American Association for Clinical Chemistry. (2021). Albumin/Creatinine Ratio. Retrieved from https://labtestsonline.org/tests/albumincreatinine-ratio
   2. Inker, L. A., & Okparavero, A. (2011). Cystatin C as a marker of glomerular filtration rate: prospects and limitations. Current Opinion in Nephrology and Hypertension, 20(6), 631-639.
   3. Levey, A. S., & Coresh, J. (2012). Chronic kidney disease. The Lancet, 379(9811), 165-180.
   4. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. (2013). KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International Supplements, 3(1), 1-150.
   5. Alicic, R. Z., Rooney, M. T., & Tuttle, K. R. (2017). Diabetic kidney disease: Challenges, progress, and possibilities. Clinical Journal of the American Society of Nephrology, 12(12), 2032-2045.
   6. Couser, W. G. (2017). Primary glomerulonephritis. The Lancet, 389(10081), 2072-2081.
   7. Torres, V. E., & Harris, P. C. (2014). Autosomal dominant polycystic kidney disease: the last 3 years. Kidney International, 86(2), 243-249.
   8. Taler, S. J., Agarwal, R., Bakris, G. L., Flynn, J. T., Nilsson, P. M., Rahman, M., ... & Townsend, R. R. (2013). KDOQI US commentary on the 2012 KDIGO clinical practice guideline for management of blood pressure in CKD. American Journal of Kidney Diseases, 62(2), 201-213.
   9. Molitch, M. E., DeFronzo, R. A., Franz, M. J., Keane, W. F., Mogensen, C. E., Parving, H. H., & Steffes, M. W. (2004). Diabetic nephropathy. Diabetes Care, 27(suppl 1), s79-s83.
   10. Sabanayagam, C., & Shankar, A. (2010). Association between plasma homocysteine and microalbuminuria in persons without hypertension, diabetes mellitus, and cardiovascular disease. Clinical Chemistry and Laboratory Medicine (CCLM), 48(12), 1735-1740.
   11. Plantinga, L., Grubbs, V., Sarkar, U., Hsu, C. Y., Hedgeman, E., Robinson, B., ... & Powe, N. R. (2011). Nonsteroidal anti-inflammatory drug use among persons with chronic kidney disease in the United States. Annals of Family Medicine, 9(5), 423-430.
   12. Clark, W. F., Sontrop, J. M., Macnab, J. J., Suri, R. S., Moist, L., Salvadori, M., & Garg, A. X. (2011). Urine volume and change in estimated GFR in a community-based cohort study. Clinical Journal of the American Society of Nephrology, 6(11), 2634-2641.
   13. 
       De Boer, I. H., Rue, T. C., Hall, Y. N., Heagerty, P. J., Weiss, N. S., & Himmelfarb, J. (2011). Temporal trends in the prevalence of diabetic kidney disease in the United States. JAMA, 305(24), 2532-2539.
       
       
   14. 
       Muntner, P., Anderson, A., Charleston, J., Chen, Z., Ford, V., Makos, G., ... & Rahman, M. (2010). Hypertension awareness, treatment, and control in adults with CKD: results from the Chronic Renal Insufficiency Cohort (CRIC) study. American Journal of Kidney Diseases, 55(3), 441-451.
       
       
   15. 
       Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., ... & MacLaughlin, E. J. (2018). 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 138(17), e426-e483.
       
       
   16. 
       Perazella, M. A. (2012). Drug-induced acute kidney injury: diverse mechanisms of tubular injury. Current Opinion in Critical Care, 18(6), 555-561.
       
       
   17. 
       Harirforoosh, S., Asghar, W., & Jamali, F. (2014). Adverse effects of nonsteroidal anti-inflammatory drugs: an update of gastrointestinal, cardiovascular, and renal complications. Journal of Pharmacy & Pharmaceutical Sciences, 16(5), 821-847.
       
       
   18. 
       Lin, J., Fung, T. T., Hu, F. B., & Curhan, G. C. (2011). Association of dietary patterns with albuminuria and kidney function decline in older white women: a subgroup analysis from the Nurses' Health Study. American Journal of Kidney Diseases, 57(2), 245-254.
       
       
   19. 
       Foxman, B. (2014). Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infectious Disease Clinics, 28(1), 1-13.
       
       
   20. 
       Fried, L. F., Emanuele, N., Zhang, J. H., Brophy, M., Conner, T. A., Duckworth, W., ... & Palevsky, P. M. (2013). Combined angiotensin inhibition for the treatment of diabetic nephropathy. New England Journal of Medicine, 369(20), 1892-1903
       

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[jonezee2014]

Anyone know what ideal levels / ratio should be?