Albumin:Creatinine Ratio

This is a useful measure of kidney disease in diabetic renal disease.

First morning sample of urine is taken.

(Orthostatic proteinuria can be normal in young people – absent first thing in the morning but happens after walking around)

Microalbuminuria is defined as:

Albumin:Creatinine Ratio > 2.5mg/mmol in men

Albumin:Creatinine Ratio> 3.5mg/mmol in women


urinary albumin> 20mg/l

Urinary Albumin = 30 – 300mg / 24hours

Proteinuria is defined as: 

Albumin:Creatinine Ratio > 30mg/mmol


 Urinary albumin > 200mg/l

Urinary albumin 3.5g/24hours

So proteinuria is roughly 10 times the amount of microalbuminuria

Microalbuminuria preceeds persistent proteinuria which preceeds diabetic nephropathy and end-stage kidney disease.




Diabetic nephropathy


End stage kidney disease

Antihypertensive medication slows this progression!!

There is an even stronger association between cardiovascular mortality and micro- and macro-albuminuria than end stage renal failure. Patients die of cardiovascular disease before renal failure has a chance to occur!!

  • In type I diabetics – use an ACE-inhibitor should be used even if the patient is normotensive
  • Control of blood pressure in these patients is of paramount importance.
  • Tight glycaemic control is also really important – it’s been shown to slow renal disease.
  • Addressing dyslipidemia and smoking are also vitally important.