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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

Urine albumin (UACR)

In short

Albumin is a protein that healthy kidney filters keep in the blood. When the filters are damaged, albumin leaks into the urine. The UACR (urine albumin-to-creatinine ratio) measures that leak in a small urine sample. Comparing albumin with creatinine corrects for how concentrated your urine is. A UACR under 30 mg/g is in the normal range (KDIGO 2024; NIDDK). The higher it is, the higher the risk of kidney failure and heart disease, so lowering it is a treatment goal (KDIGO 2024).

Your numbers

Category UACR What it means
A1 under 30 mg/g normal to mildly increased
A2 30–300 mg/g moderately increased
A3 over 300 mg/g severely increased
Category UACR What it means
A1 under 3 mg/mmol normal to mildly increased
A2 3–30 mg/mmol moderately increased
A3 over 30 mg/mmol severely increased

Categories from KDIGO 2024. To convert, multiply mg/g by 0.113 to get mg/mmol. Your stage is written with both letters, for example G3a A2. Risk rises with both, so "G3a A3" carries more risk than "G3b A1" (CKD stages).

How often: at least once a year once you have had type 1 diabetes for 5 years or more, and 1–4 times a year once you have CKD (ADA 2026 §11, recommendations 11.1a and 11.1b).

When a change is real: UACR varies by more than 20 % between samples, so two of three samples taken over 3–6 months should be high before you are labeled with raised albuminuria (ADA 2026 §11). Later on, a doubling is bigger than normal variation and should be looked at (KDIGO 2024, practice point 2.1.5).

How to collect the sample

  1. Use the first urine of the morning, when you get up. KDIGO prefers this sample (KDIGO 2024, practice point 1.3.1.1).
  2. Wash your hands. Start to pee into the toilet, then catch the middle part of the stream in the cup ("midstream").
  3. Close the lid, label it, and get it to the lab as the lab tells you, the same day if you can.
  4. If a random sample comes back at 30 mg/g or more, expect a repeat on a first-morning sample (KDIGO 2024, practice point 1.3.1.2).
  5. Reschedule if you have your period, a urine infection or a fever, or did hard exercise in the last day (see below).

What can fool it

These can raise UACR for a short time without new kidney damage:

Cause Source
Hard exercise in the last 24 hours ADA 2026 §11; KDIGO 2024, Table 16
Infection, fever, or a urine infection with symptoms same
Your period, or blood in the urine same
Very high blood glucose ADA 2026 §11
Very high blood pressure, or heart failure ADA 2026 §11

The creatinine half of the ratio matters too. People with low body weight pass less creatinine, so their ratio reads higher; a high-protein diet or exercise raises urine creatinine and lowers the ratio (KDIGO 2024, Table 16). Women pass less creatinine than men, so their UACR reads a little higher for the same albumin.

Why lowering it matters

Most people with kidney disease from diabetes have no symptoms, so tests are the only way to know (NIDDK). A UACR that stays the same or goes down is one sign that treatment is working (NIDDK). Things that lower it:

  • An ACE inhibitor or ARB. KDIGO recommends one for people with diabetes and A2 or A3 (KDIGO 2024, recommendation 3.6.3).
  • Finerenone (Kerendia), approved in the US in 2026 for adults with CKD and type 1 diabetes "to reduce urinary albumin-to-creatinine ratio (UACR)". The approval rests on UACR: the lower UACR is expected to lower the risk of eGFR decline and kidney failure (Kerendia label). In the FINE-ONE trial (242 adults with type 1 diabetes), UACR was 22 % lower than with placebo at 3 months and 28 % lower at 6 months (Kerendia label; FINE-ONE).
  • Less salt. KDIGO suggests under 2,000 mg of sodium a day (recommendation 3.3.2.1) and notes that less salt helps ACE inhibitors and ARBs work fully (KDIGO 2024). KDOQI suggests under 2,300 mg a day to lower urine protein (statement 6.5.2) (KDOQI 2020). See Sodium.
  • Glucose and blood pressure in range, and not smoking (Diabetes and your kidneys).

What to do

  • Ask for your UACR at least once a year, and write it on your lab tracker.
  • Use a first-morning, midstream sample, and reschedule if you are ill or have your period.
  • Skip hard exercise the day before the sample.
  • If your UACR is 30 mg/g or more, ask whether you should take an ACE inhibitor or ARB, and whether finerenone fits you.
  • Keep sodium under 2,000 mg a day (Sodium).
  • Look at the trend: a doubling is worth a call; a small rise is often noise.

In the app

Add a UACR result under Labs in mg/g or mg/mmol. The app shows its A category. UACR does not change your food targets, but it is a reason to keep sodium low; with A3 and low blood albumin, the note says protein may be lost in the urine (design note 05). See Targets and warnings.

Examples

  • A small rise. Ana's UACR went from 80 to 110 mg/g. That is less than a doubling, within normal variation; her team repeats it at the next visit.
  • A real change. Ben's went from 80 to 190 mg/g, more than double. His team checks for a cause, such as a urine infection or high glucose, repeats the test, and reviews his treatment.
  • A day after a hard run. Chris gave a sample the morning after a half-marathon. It read 45 mg/g. A repeat a week later, with no hard exercise the day before, was 18 mg/g.
  • Converting. 300 mg/g × 0.113 = 34 mg/mmol (guidelines round the A3 cut-off to 30).

Ask your care team

  1. What is my A category, and has it changed?
  2. Should I be on an ACE inhibitor or ARB at my dose and blood pressure?
  3. Is finerenone right for me? How will we watch my potassium?
  4. What UACR are we aiming for?
  5. Could anything else be causing albumin in my urine?

Get help now if…

UACR on its own is not an emergency.

Call your care team today

New swelling of your legs, ankles or face, much less urine than usual, or weight gain above the number your team gave you. See Get help now.

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06.