{"id":2165,"date":"2018-08-10T10:12:40","date_gmt":"2018-08-10T10:12:40","guid":{"rendered":"http:\/\/papergp.com\/index.php\/data-interpretation\/urine-acr-albumincreatinine-ratio\/"},"modified":"2023-01-24T11:25:25","modified_gmt":"2023-01-24T11:25:25","slug":"urine-acr-albumincreatinine-ratio","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/data-interpretation\/urine\/urine-acr-albumincreatinine-ratio\/","title":{"rendered":"Urine ACR (albumin:creatinine ratio)"},"content":{"rendered":"<div class=\"content-box-blue\">\n<p><strong>Diabetes (or CKD with diabetes)<\/strong><\/p>\n<ul>\n<li>ACR &lt; 3\n<ul>\n<li>no action<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>ACR 3-30 + diabetes\n<ul>\n<li>confirm it is early morning sample<\/li>\n<li>dipstick to check for microscopic haematuria<\/li>\n<li>ask patient to repeat two further early morning ACRs within one month<\/li>\n<li>if at least two out of three are positive\n<ul>\n<li>consider ACE-I (irrespective of BP)<\/li>\n<li>modify CV risk factors &#8211; smoking, diet, lifestyle, statins<\/li>\n<li>improve glycaemic control<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>When to refer\n<ul>\n<li>CKD3b with proteinuria<\/li>\n<li>Deteriorating renal function\n<ul>\n<li>Cr &gt; 150mmol\/L<\/li>\n<li>Cr risen 30% in last twelve months<\/li>\n<li>Progressively falling eGFR (&gt;10ml\/min\/1.73m2) within last twelve months<\/li>\n<\/ul>\n<\/li>\n<li>Microalbuminuria with persistent haematuria<\/li>\n<li>Persistent hypertension<\/li>\n<li>Persistently abnormal potassium, calcium, phosphate<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<p><strong>CKD<\/strong><\/p>\n<ul>\n<li>ACR &lt; 30\n<ul>\n<li>no action<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>ACR 30-70 <strong>without haematuria<\/strong>\n<ul>\n<li>confirm it is early morning sample, dipstick to check for microscopic haematuria, ask patient to repeat two further early morning ACRs within one month\n<ul>\n<li>if confirmed, actively manage in primary care to reduce progression of CKD (NICE CG73)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>ACR 30-70 <strong>with haematuria<\/strong>\n<ul>\n<li>renal referral (urgency depends on suspected cause)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>ACR 70 &#8211; 250\n<ul>\n<li>routine renal referral<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>ACR &gt; 250\n<ul>\n<li>indicates nephrotic syndrome (along with low serum albumin)\n<ul>\n<li>Urgent renal referral<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<div class=\"content-box-blue\"><strong>Notes<\/strong><\/p>\n<ul>\n<li>An early morning sample is used as there is increased risk of false positive results with random samples<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>Causes of increased albumin loss not due to intrinsic renal disease\n<ul>\n<li>Menstrual contamination<\/li>\n<li>Vaginal discharge<\/li>\n<li>Uncontrolled hypertension<\/li>\n<li>Symptomatic UTI<\/li>\n<li>Uncontrolled diabetes<\/li>\n<li>Heart failure<\/li>\n<li>Intercurrent illness<\/li>\n<li>Strenuous exercise<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>both micro- and macroalbuminuria are stronger predictors of cardiovascular mortality than of end-stage renal failure, only a minority of patients with microalbuminuria will progress to end-stage renal failure, because death from a cardiovascular cause commonly occurs before renal failure has developed<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>blood pressure target\n<ul>\n<li>if raised ACR, aim for BP &lt; 130\/80<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Diabetes (or CKD with diabetes) ACR &lt; 3 no action &nbsp; ACR 3-30 + diabetes confirm it is early morning sample dipstick to check for microscopic haematuria ask patient to repeat two further early morning ACRs within one month if at least two out of three are positive consider ACE-I (irrespective of BP) modify CV &hellip; <a href=\"https:\/\/papergp.com\/index.php\/data-interpretation\/urine\/urine-acr-albumincreatinine-ratio\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Urine ACR (albumin:creatinine ratio)<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":2362,"menu_order":40,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2165","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/2165","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=2165"}],"version-history":[{"count":7,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/2165\/revisions"}],"predecessor-version":[{"id":2180,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/2165\/revisions\/2180"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/2362"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=2165"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}