Quick Reference on UACR and GFR

In Evaluating Patients with Diabetes for Kidney Disease

• Urine Albumin-to-Creatinine Ratio
• Estimated GFR

Urine Albumin-to-Creatinine Ratio (UACR)

The two key markers for chronic kidney disease (CKD) are urine albumin and estimated glomerular filtration rate (eGFR).

Assess urine albumin excretion yearly to diagnose and monitor kidney damage in patients with type 1 diabetes for five years or more or with type 2 diabetes.

• More frequent monitoring may be indicated in patients with changing clinical status or after therapeutic interventions.
• Use a spot urine albumin-to-creatinine ratio (UACR). UACR estimates 24-hour urine albumin excretion. Twenty-four-hour collection and timed specimens are not necessary.

Albuminuria is used to diagnose and monitor kidney disease. Change in albuminuria may reflect response to therapy and risk for progression. A decrease in urine albumin may be associated with improved renal and cardiovascular outcomes.

¹ Albuminuria is a term that describes all levels of urine albumin. Microalbuminuria is a term used to describe urine albumin levels not detected by a dipstick test, i.e., 30 mg/g–300 mg/g. Macroalbuminuria is sometimes used to describe albumin levels more than 300mg/g.

Estimated GFR

The two key markers for chronic kidney disease (CKD) are estimated glomerular filtration rate (eGFR) and urine albumin.

Calculate eGFR from stable serum creatinine levels at least once a year in all patients with diabetes.

• eGFR is more accurate than serum creatinine alone. Serum creatinine is affected by muscle mass, and related factors of age, sex, and race.
• eGFR is not reliable for patients with rapidly changing creatinine levels, extremes in muscle mass and body size, or altered diet patterns.

See if your lab reports eGFR routinely. If it does not, ask your lab to do so. You can also calculate can eGFR yourself by using NKDEP's GFR calculators.

If kidney disease is detected, it should be addressed as part of a comprehensive approach to the treatment of diabetes.