Albumin to Creatinine ratio (ACR)

£15.00+ visit fee (from £24.00)


2 tests included

Same day


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To screen for and detect early kidney disease in people with diabetes or other risk factors, such as high blood pressure (hypertension).


Albumin is a major protein normally present in the blood, but virtually no albumin is present in the urine when the kidneys are functioning properly. However, albumin may be detected in the urine even in the early stages of kidney disease. The urine albumin test (formerly called microalbumin) detects and measures the amount of albumin in the urine to screen for kidney disease.

Most of the time, tests for albumin and creatinine are done on a urine sample collected randomly (not timed) and an albumin-to-creatinine ratio (ACR) is calculated. This is done to provide a more accurate indication of how much albumin is being released into the urine. Creatinine, a byproduct of muscle metabolism, is normally released into the urine at a constant rate and its level in the urine is an indication of the urine concentration. This property of creatinine allows its measurement to be used to correct for urine concentration when measuring albumin in a random urine sample.

The presence of a small amount of albumin in the urine may be an early indicator of kidney disease. A small amount of albumin in the urine is sometimes referred to as urine microalbumin or microalbuminuria. “Microalbuminuria” is slowly being replaced with the term “albuminuria,” which refers to any elevation of albumin in the urine.

Plasma, the liquid portion of blood, contains many different proteins, including albumin. One of the many functions of the kidneys is to conserve plasma proteins so that they are not released along with waste products when urine is produced. There are two mechanisms that normally prevent protein from passing into urine:

  • Specialized structures in the kidney called glomeruli are composed of loops of specialized capillaries that filter the blood, allowing small substances to pass through towards the urine, but provide a barrier that keeps most large plasma proteins inside the blood vessels.
  • The smaller proteins that do get through are almost entirely reabsorbed by tubes (tubules) that have a number of sections that collect the fluid and molecules that pass through the glomeruli.
Protein in the urine (proteinuria) most often occurs when either the glomeruli or tubules in the kidney are damaged. Inflammation and/or scarring of the glomeruli can allow increasing amounts of protein to leak into the urine. Damage to the tubules can prevent protein from being reabsorbed.

If a person’s kidneys become damaged or diseased, they begin to lose their ability to conserve albumin and other proteins. This is frequently seen in chronic diseases, such as diabetes and hypertension, with increasing amounts of protein in the urine reflecting increasing kidney dysfunction.

Albumin is one of the first proteins to be detected in the urine with kidney damage. People who have consistently detectable small amounts of albumin in their urine (albuminuria) have an increased risk of developing progressive kidney failure and cardiovascular disease in the future.


We are using the CLINITEK Microalbumin 2 Reagent Strips to provide semi-quantitative results with a hard-copy report on the CLINITEK Status family of analyzers, making them ideal for the same-day testing. The strips are also convenient for testing random urine samples, eliminating the need to collect a timed sample.


Urine for a CKD screening or ACR can be collected over 4 hours, or overnight. The first-morning sample is the most valuable because it is more concentrated and more likely to yield abnormal results. As you start to urinate, let some urine fall into the toilet, then collect a sample of urine in the container provided. Before a test, tell VisitHealth’s medic about any health condition you have.


Although kidney disease is a long term illness once detected there is a range of treatment to manage the condition. Regular testing is recommended for anyone who has one of the following risk factors as symptoms often don’t appear straight away:
  • High blood pressure
  • Diabetes
  • Cardiovascular disease
  • Acute kidney injury
  • Kidney stones
  • Enlarged prostate
  • Lupus
  • A family history of chronic kidney disease
  • High Cholesterol
  • If you are elderly
  • You are black or from the south asian origin
You should also consider a CKD screening if you have had any symptoms, such as weight loss, poor appetite, swollen ankles, shortness of breath, blood in your urine tiredness or urinating more than usual.


If albumin is undetectable in the urine, it is an indication that kidney function is normal.

Moderately increased albumin levels found in both initial and repeat urine tests indicate that a person is likely to have early kidney disease. Very high levels are an indication that kidney disease is present in a more severe form.

The presence of blood in the urine, a urinary tract infection, vigorous exercise, and other acute illnesses may cause a positive test result that is not related to kidney disease. Testing should be repeated after these conditions have resolved.

If albumin is detected in a urine sample collected at random, over 4 hours, or overnight, the test may be repeated and/or confirmed with urine that is collected over a 24-hour period (a 24-hour urine).


The laboratory test results are NOT to be interpreted as results of a "stand-alone" test. The test results have to be interpreted after correlating with suitable clinical findings and additional supplemental tests/information. Your healthcare providers will explain the meaning of your tests results, based on the overall clinical scenario. Certain medications that you may be currently taking may influence the outcome of the test. Hence, it is important to inform your healthcare provider of the complete list of medications (including any herbal supplements) you are currently taking. This will help the healthcare provider interpret your test results more accurately and avoid unnecessary chances of a misdiagnosis.

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