Assess urine albumin excretion yearly to diagnose and monitor kidney damage in patients with type 1 diabetes for five years or more or with type 2 diabetes. [2008, amended 2014] ALBUMIN/CREATININE RATIO (ACR) Definition The Albumin/Creatinine ratio (ACR) test result is a the ratio of measured albumin (a protein) and creatinine (a metabolism by-product) in the urine that has been excreted from the body, at the time of the test (spot sample). ACR: 0 to 30 mg/g. Shrimpton P., “Assessment of Patient Dose in CT” in Bongart G.Z., Golding S.J., Jurik A.G., et al., European Guidelines for Multislice Computed Tomography, 2004. GFR ( ml/min/1.73 m^2) and ACR categories and risk of adverse outcomes: A1 < 3 mg/mol (normal to mildly increased) A2 . [2008, amended 2014] 1.1.19 For the initial detection of proteinuria, if the ACR is between 3 mg/mmol and 70 mg/mmol, this should be confirmed by a subsequent early morning sample. Interpretation of raised urine ACR: Urine ACR 3.0 - 30.0 mg/mmol: Moderately increased. If your results show a small amount of albumin, you may have to repeat the test using a 24-hour urine sample to confirm the results. The two key markers for chronic kidney disease (CKD) are urine albumin and estimated glomerular filtration rate (eGFR). Urine ACR >30.0 mg/mmol: Severely increased* *Including nephrotic syndrome (urine ACR usually >220 mg/mmol) (according to NICE clinical guideline 182) Albuminuria means that there is more albumin in the urine than there should be, which means the kidneys can be damaged. In Evaluating Patients with Diabetes for Kidney Disease. Urine ACR reference range: Less than 3.0 mg/mmol. American College of Radiology, “ACR Practice Guideline for Diagnostic Reference Levels in Medical X-Ray Imaging,” 2002 (revised 2008). Urine albumin (mg/dL) ~ = UACR in mg/g ~ Albumin excretion in mg/day Urine creatinine (g/dL) … The upper limit of normal range for microalbumin is the maximum value for normoalbuminuria. Kidney damage stage is categorised into 3 stages based on urine ACR. Reducing urine albumin to the normal or near-normal range may improve renal and cardiovascular prognoses. Biological reference range or cut off: <3.0 mg/mmol creatinine ... Raised ACR may also be seen with a fever, urinary tract infection, several immune disorders, dehydration, certain drugs and other conditions causing blood in the urine. An ACR between 30-300 means you have moderately increased albuminuria. Albuminuria is the presence of albumin in the urine and a marker of kidney damage. It is normal for individuals to excrete very small amounts of protein in the urine, but the albumin-to-creatinine ratio (ACR) is the first method of preference to detect elevated protein, measuring urinary ACR … If the first positive urine ACR is a random spot (as it may be for opportunistic testing), then repeat tests should ideally be first morning void specimens. An ACR below 30 is considered normal. 3 -30 mg/mol (moderately increased) Results for ACR are given in milligrams per gram (mg/g). Thymus is normal in less than 8% patients. If the initial ACR is 70 mg/mmol or more, a repeat sample need not be tested. Other diseases with positive anti-acetylcholine receptor antibodies are lupus, rheumatoid arthritis, liver disease, autoimmune hepatitis, Lambert-Eaton syndrome, small cell lung cancer, and Graves disease. ACR is calculated by dividing the amount of urine albumin by the amount of urine creatinine. ACR is the recommended method for people with diabetes. 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