We quizzed test takers on the urinary albumin creatinine ratio. 59% of respondents chose the best answer. We want to share this important updated information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: What best describes how to measure urinary albumin creatinine ratio?

Answer Choices:

• Divide blood creatinine results with urinary albumin secretion rate.
• Collect 24-hour urine sample and add alkaline solution to determine albumin ratio quantity.
• Draw a fasting blood sample to determine ratio of creatinine in grams to albumin in milligrams.
• Divide urinary albumin concentration in milligrams by creatinine concentration in grams.

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As shown above, the most common choice was option 4, the second most common answer was option 1, then option 3, and then finally option 2.

Getting to the Best Answer

Answer 1 is incorrect. 16.57% chose this answer, “Divide blood creatinine results with urinary albumin secretion rate.” This is a juicy answer! To calculate UACR, the lab uses albumin and creatinine results from the urine only. And since it is a ratio, they divide the urine albumin levels by the urine creatinine to get the result. Please see our blog From Dipsticks to GFR – How to Evaluate Kidney Function for a detailed explanation.

Answer 2 is incorrect. 12.00%% of you chose this answer, “Collect 24-hour urine sample and add alkaline solution to determine albumin ratio quantity.” In the old days, we would collect a 24 urine samples to evaluate kidney health. However, since the spot urine albumin /creatinine ratio is so accurate, we don’t need to do the cumbersome 24-hour collection to determine UACR. Now we can evaluate UACR using a spot collection (dipstick) or lab evaluation of urine. Please see our blog From Dipsticks to GFR – How to Evaluate Kidney Function for a detailed explanation.

Answer 3 is incorrect. 12.43% of respondents chose this answer, “Draw a fasting blood sample to determine the ratio of creatinine in grams to albumin in milligrams.” To calculate UACR, the lab uses albumin and creatinine results from the urine only. And since it is a ratio, they divide the urine albumin levels by the urine creatinine to get the result. No fasting is required for this test. Please see our blog From Dipsticks to GFR – How to Evaluate Kidney Function for a detailed explanation.

Finally, Answer 4 is correct. 59.00% chose this answer, “Divide urinary albumin concentration in milligrams by creatinine concentration in grams.” GREAT JOB. You chose the best answer. Urinary Albumin Creatinine Ratio (UACR) is the ratio of urine albumin to urine creatinine. The UACR is usually already calculated on the lab report,

To determine the UACR, you divide urine albumin by creatinine, then convert it to mg/g. The reason this value is reported as a ratio as opposed to just urine albumin is to account for the concentration and hydration status of the individual which improves accuracy.

UACR is an important measure of kidney health and the goal is to measure it yearly and if elevated, more frequently.

Testing for UACR is fairly easy. The ADA has approved using a urine dipstick or a urine sample to calculate the UACR, However, according to the standards, two of three tests need to be positive to confirm diagnosis within a 3 to 6 month period before confirming a diagnosis of moderate or severe albuminuria. Exercise within 24 h, infection, fever, congestive heart failure, marked hyperglycemia, menstruation, and marked hypertension may elevate UACR independently of kidney damage. Please see our blog From Dipsticks to GFR – How to Evaluate Kidney Function for a detailed explanation.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this important learning activity!

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