Albumin Creatinine Ratio (ACR)

Albumin is a protein that circulates in the bloodstream and has many functions like maintaining the blood inside the vessels and preventing blood from leaking out of the vessels. Albumin also helps in carrying substances like medicines in the blood. It is essential for tissue growth and healing of tissue. During the process of filtering substance from the body, the kidneys filter the blood and separate waste products from the healthy substance required by the body such as albumin. 

Albumin itself is a healthy substance and therefore, it is needed by the body. When there is a problem with the kidney, which impairs them from functioning properly, they could filter albumin and release it to the urine together with other waste products. This means that your urine will contain albumin. 

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Moreover, creatinine is a waste product, which is released from the normal activity of breaking down muscle cells in body. Creatinine is produced when there is breakdown of creatine phosphate in muscles. Since there is nearly no tubular reabsorption of creatinine waste product into the body from kidneys, it is filtered out during the formation of urine. 

One aspect with creatinine is that it is one of the substances, which are filtered out by a healthy kidney from the bloodstream. Therefore, in normal circumstances, creatinine is present in urine. However, when the kidneys are not functioning properly, creatinine may not be filtered out from the bloodstream. You will find that there are some amounts of creatinine in blood and fewer amounts in urine. A microalbumin test may be conducted to determine the levels of albumin in urine. 

Albumin Creatinine ratio (ACR)

Albumin creatinine ratio in a urine test used to give an indication of the wellness of your kidneys and how they are functioning. This is so especially if you have diabetes. When the albumin to creatinine ratio (ACR) is less than 30mg/g, this could indicate that the kidneys are filtering wastes and other substances properly. 

When the ACR is more than 30mg/g but less than 300mg/g, this may mean that the kidney is leaking albumin and does not filter out creatinine as desired. This could imply that you are experiencing microalbuminuria. A second test may be required to confirm the first reading results. Moreover, a ratio, which is more than 300gm/g, could indicate that the kidneys are not filtering properly and this is called macroalbuminuria. 

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The ACR levels help in comparing the amount of albumin that passes into urine from kidney in relation to the amount of creatinine that is present in urine following the filtration process. The advantage of using ACR reading is that the ratio is not affected by variations in concentration of urine. The normal ratio of albumin in relation to creatinine in urine is around 30mg/g of creatinine or less. 

The level of albumin to creatinine ratio in men appears to be less than or equal to 17mg/g of creatinine but in women the level is seen to be higher ranging around 25mg/g of creatinine. When the level of ACR increases to around 35-300mg/g of creatinine, a condition known as microalbuminuria, this indicates that the there is small amount of albumin in urine. It is an indication of a slight disease in kidneys. 

A ratio that is more than 300mg/g of creatinine leads to a condition known as macroalbuminuria and it shows a large amount of albumin in urine. This indicates that there is a kidney disease, which is affecting the function of kidneys. If that condition is left untreated, it could result to kidney failure.

One of the earliest indicators of diabetic nephropathy is a microalbuminuria situation. In diagnosing microalbuminuria, proper care should be observed during the sample collection of urine for the test of ACR test. A patient needs to undergo a morning sample and refrain from undertaking strenuous exercise within a period of 24 hours prior to the test. 

A repeat test is needed after about 3 to 6 months following the first positive test of microalbuminuria. Variations in creatinine levels caused by too much or little muscles mass may cause inaccuracies in the ACR test. ACR test is useful in measuring renal function in the case of diabetic renal disease. 

Changes in albuminuria can be used to diagnose and monitor the progress or treatment of kidney disease. During therapy procedures to treat kidney disease, any changes in albuminuria may be used to show positive or negative responses to the treatment. Any risks of progression of the kidney disease may also be shown by use of the test. Moreover, a decrease in urine albumin could be associated with improvement in renal cardiovascular outcomes. 

A person with kidney disease may require another test for glomerular filtration rate (GFR test). During the process of urine formation, the glomerulus structure makes the large molecules such as blood cells and albumin not to pass through in the filtration. However, if an infection of the kidney occurs, it affects or destroys the structure of the glomerulus  thus allowing large protein molecules like albumin to pass through. This is a factor that is important in the diagnosis of kidney disease.

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