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Urine Albumin to Creatinine Ratio (UACR)

In the quest for mechanisms for earlier detection, doctors are more recently finding that the presence of Microalbuminuria may be an early indication of the onset of Renal Insufficiency.  As its name suggests, Microalbuminuria is the Microscopic presence of Albumin in a patient's Urine.  Albumin is a blood protein that is produced by the Liver and enables many nutrients to be carried in the blood to different parts of the body.  Albumin proteins are large and important for the body to retain in the bloodstream.  Because of their size, Kidneys typically cannot pass Albumin proteins into Urine.  Therefore, the presence of even trace amounts of Albumin in the Urine may be an indication that the Kidneys are beginning to not function properly.  Detection of Microalbuminuria is important because it can be determined relatively easily via a Urine sample during routine medical check-ups.  Whereas most patients with Renal disease will seek medical attention after they find blood in their Urine, Microalbuminuria can be found via an easy Urine sample before any more serious symptoms arise.  This provide the doctor and the patient the opportunity to administer treatment prior to the onset of CKD.  

Urine Albumin to Creatinine Ratio (UACR)

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Sources: National Kidney Foundation, Kidney Disease Quality Outcomes Initiative, 2006-2011.


UACR, by Gender

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Sources: National Institutes of Health; National Kidney Education Program; National Kidney Foundation, Kidney Disease Quality Outcomes Initiative, 2006-2011.
Creatinine is chiefly filtered out of the blood by the Kidneys; therefore, If Creatinine levels in the Blood rise then the Kidneys are not filtering them via Urine properly.  As a result, the level of Creatinine in the Blood and Urine can be used to calculate the Creatinine Clearance Rate (CrCl).  This Rate is the volume of Blood that is cleared of Creatinine per unit time (mL/min).  More importantly, CrCl is directly related to the Glomerular Filtration Rate (GFR) within an accuracy of approximately 10% to 20%, which is an acceptable tolerance considering the relative ease of obtaining a Urine sample vs a Blood sample.

With this in mind, doctors will routinely measure a patient's Albumin and Creatinine concentrations during a standard Urinalysis.  In order to improve accuracy of diagnosis further, doctors will use these measurements to calculate a patient's Urine Albumin to Creatinine Ratio (UACR).  If the UACR is found to be higher than 30mg/gram, the patient is considered to have an elevated risk of the future onset of Renal Insufficiency and Chronic Kidney Disease.  Urologists will subsequently highly recommend instituting a process of Active Surveillance for the patient.
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