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Nephrology Ask the Experts
UKidney answers your nephrology questions! Feel free to search our previous submissions or create your own today.
I have very low Creatinine in my urine 1.3 mmol/L and my albumin is 14 mg/L. This is creating an elevated ACR of 10.8 mg/mmol. I am diabetic so I am very conscious of this number but is the low Creatinine more of a factor than kidney damage? I am not able to find any information on whether the ACR is accurate with a low creatinine reading. My eGFR is 95.
The issue in some patients with very low body mass is that the creatinine excretion may in fact be so low that it falsely raises the ratio. What is your height and weight?
If there is any doubt about the accuracy of this test, you could always do a 24 hr urine collection. Though in my experience, patients who do not have extremely low body mass (and therefore muscle mass) are accurately diagnosed by the spot urine ACR.
Do you do the test fasting or have you consumed water before? A dilute urine will cause the urine creatinine to appear low - but so will the albumin. This is why the ratio is done, to cancel out the degree of urine dilution or concentration. If you did a fasting urine sample first thing in the morning, this would probably not be the case.
That would probably do it. I generally don't have to fast for my diabetic blood test but I did have a fair amount of water before the test and it is quite conceivable that the urine was diluted. With my ratio elevated but eGFR still normal, is there a way to improve the ACR and my longer term prognosis? I assume losing the weight would be key. I am about 60lbs overweight. Slightly hypertensive but relatively well controlled. Still a bit of work to do on my diabetes.
In general, preservation of kidney function in diabetes requires excellent sugar control (A1C less than 6.5-7) and blood pressure (<130/80), use of ACE inhibitors OR angiotensin receptor blockers, use of SGLT2 inhibitors, avoidance of smoking, minimization of proteinuria, weight loss and control of cholesterol.
Dr. Jordan Weinstein
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