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April 9, 2026
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Medically Reviewed by Dr. Andrew Stein MD, Consultant Nephrologist (Hospital Kidney Specialist). Last updated: June 2026
The urinary albumin-creatinine ratio (uACR) measures the amount of albumin (a protein) in the urine; a higher number means more albumin (and proteins).
It is a important diagnostic tool used to detect early signs of chronic kidney disease (CKD).
Whether you are managing diabetes or investigating chronic kidney disease (CKD), understanding your uACR results is key to protecting your long-term health.
Is high or low better? Low – the higher the number, the more protein in the urine, the more strain on the kidneys.
The uACR test measures the relationship between two specific substances in your urine:
Albumin: An important blood protein that healthy kidneys usually keep in the bloodstream.
Creatinine: A waste product that healthy kidneys should filter out.
If your kidneys are under strain or damaged, albumin ‘leaks’ through the filters into your urine. The uACR calculates a ratio by dividing the amount of albumin by the amount of creatinine; providing a more accurate snapshot than a simple protein test.
Clinically, the uACR is considered one of the ‘three pillars’ of kidney disease investigation, alongside the eGFR blood test and a kidney ultrasound.
Early Warning: It can detect kidney strain years before other symptoms appear.
Diabetes & Hypertension: It is a standard monitoring tool for those with high blood pressure or diabetes, as these conditions are the leading causes of Chronic Kidney Disease (CKD).
Cardiovascular Risk: A high uACR is also a marker for increased risk of heart disease and stroke.
In the UK and many other regions, uACR is measured in mg/mmol. The lower the number, the healthier the kidneys.
| Category | uACR Level (mg/mmol) | Description | Clinical Meaning |
| A1 | < 3 | Normal | Healthy kidney function. |
| A2 | 3 – 30 | Moderate (Microalbuminuria) | Early sign of kidney strain or CKD. |
| A3 | > 30 | Severe (Macroalbuminuria) | Significant kidney damage; high risk of progression. |
| Nephrotic | > 220 | Very High | Potential Nephrotic Syndrome; requires urgent specialist care. |
At lower levels (A2), there are often no physical symptoms, which is why regular screening is essential. However, as the ratio climbs (A3 and above), you may notice:
Frothy or Foamy Urine: A telltale sign of high protein levels.
Swelling (Oedema): Specifically in the legs, ankles, or around the eyes.
High Blood Pressure: Often both a cause and a symptom of kidney strain.
A uACR test is not just about a single number. It is combined with your CKD Stage (G1-G5) to determine your kidney outlook. For example, a patient with CKD G2 A1 has a much better prognosis than someone at CKD G2 A3.
If your uACR is elevated, your doctor may suggest lifestyle changes, blood pressure management, or newer medications like SGLT2 inhibitors to slow the progression of kidney disease.
If it is very high (>100 mg/mmol), you need to see a nephrologist (kidney specialist).
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