Chronic kidney disease is staged by both glomerular filtration rate and albuminuria, and albuminuria independently predicts kidney failure, cardiovascular events and death. A patient with a normal eGFR and raised albuminuria has CKD and is at risk; a patient with a modestly reduced eGFR and no albuminuria may be at much lower risk.
A spot urine albumin-to-creatinine ratio is cheap and widely available. Measure it at diagnosis and at least annually in people with diabetes, hypertension or known CKD, and confirm a raised value on repeat, since exercise, infection and fever can raise it transiently.
- Measure urine albumin-to-creatinine ratio alongside eGFR in every patient at risk of CKD.
- Confirm a raised value with a repeat sample.
- Stage CKD using both eGFR and albuminuria category.
- Use albuminuria to guide intensity of renal and cardiovascular protection.
- Repeat at least yearly in diabetes and hypertension.
Why it matters
Albuminuria is the earliest and most modifiable marker of kidney risk, and it is often not measured.
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