ACR

Understanding Your ACR (Albumin-to-Creatinine Ratio) Urine Test

The Albumin-to-Creatinine Ratio (ACR) test measures the amount of albumin (a protein) in your urine compared to the level of creatinine (a waste product from muscles). This test helps detect early signs of kidney damage, often related to conditions such as diabetes or high blood pressure.

What Does the ACR Test Measure?

• Albumin is a protein that normally stays in the bloodstream. If it is found in your urine, it may indicate that your kidneys are not filtering properly.
• Creatinine is a byproduct of muscle metabolism and is generally constant in urine. Measuring albumin relative to creatinine helps assess if your kidneys are leaking albumin.

Normal and High ACR Levels:

• Normal ACR: Less than 3 mg/mmol
• High ACR: Above 3 mg/mmol. This can indicate early kidney damage (often called “microalbuminuria” for slight increases or “macroalbuminuria” for higher levels).

A higher ACR level can be an early sign of kidney damage, particularly if you have diabetes or high blood pressure. The higher the ACR, the more significant the kidney impairment may be.

Lifestyle and Condition Management to Help Improve ACR Levels

Improving your ACR levels often involves managing underlying conditions and making lifestyle changes:

1. Control Blood Sugar Levels (for those with diabetes):

   • Keeping blood glucose levels within the target range can reduce stress on your kidneys.
   • Regular monitoring and working with your healthcare provider to adjust medications can help improve blood sugar control.

2. Manage Blood Pressure:

   • High blood pressure is a significant risk factor for kidney disease. Maintaining healthy blood pressure through lifestyle changes or medication can protect kidney function.
   • Aim for a blood pressure level recommended by your doctor, typically below 130/80 mmHg.

3. Adopt a Kidney-Friendly Diet:

   • Reduce sodium intake: Excess salt can increase blood pressure and strain the kidneys. Aim for less than 6g of salt per day.
   • Limit protein intake: High protein intake may increase the amount of albumin your kidneys have to filter. Speak with a dietitian for guidance on an appropriate protein level.
   • Stay Hydrated: Drink adequate fluids, but avoid excessive intake as it can strain kidneys.

4. Exercise Regularly:

   • Regular physical activity can help control blood sugar, reduce blood pressure, and improve overall kidney health. Aim for at least 150 minutes of moderate activity per week, such as brisk walking or cycling.

5. Avoid Smoking and Limit Alcohol:

   • Smoking can worsen kidney function and damage blood vessels, while excessive alcohol can increase blood pressure. Quitting smoking and reducing alcohol intake can have a positive impact on kidney health.

Medications That Can Help Improve ACR

If lifestyle changes alone are not enough to lower ACR, your doctor may prescribe medications known to help protect your kidneys:

1. ACE Inhibitors and ARBs:

   • ACE Inhibitors (e.g., ramipril, lisinopril) and ARBs (e.g., losartan, candesartan) are often prescribed to reduce blood pressure and protect the kidneys. They help reduce protein leakage into the urine and can improve ACR levels.
   • These medications are commonly used for people with diabetes or high blood pressure and are effective in reducing kidney damage.

2. SGLT2 Inhibitors:

   • SGLT2 inhibitors, such as dapagliflozin and empagliflozin, are newer medications used to manage diabetes and protect kidney function. They help the body excrete excess sugar through urine, which can also reduce kidney damage.
   • These medications may be recommended for people with diabetes who have a high ACR level.

3. Statins:

   • If you have high cholesterol, statins may be prescribed to lower cholesterol levels and protect blood vessels, indirectly benefiting kidney function.

4. Blood Pressure Medications:

   • Other blood pressure medications, such as beta-blockers or calcium channel blockers, may also be prescribed if you need additional blood pressure control.

When to Follow Up

Your doctor will monitor your ACR levels periodically to assess how well your kidneys are functioning and to determine if your current treatment plan is effective. If ACR levels remain high or increase, further tests or medication adjustments may be needed.

By following these lifestyle and treatment guidelines, you can help improve your ACR levels and protect your kidney health.

If you have any concerns or questions about your ACR test results, speak with your GP or kidney specialist.