By Dr. Moxit Shah, DM Endocrinology | Vishuddha Diabetes, Thyroid, Weight Loss Clinic, Ahmedabad
Quick answer: Even if you feel well, diabetes can affect your kidneys. Ask about a urine albumin-to-creatinine ratio (ACR/UACR) and a blood test for eGFR. Both are needed because either can be abnormal before symptoms develop.
Why Kidney Testing Matters in Diabetes
Diabetes can gradually damage the kidneys without causing pain or obvious symptoms. Two simple tests—urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR)—can identify problems before swelling or reduced urine output develops. Early detection allows treatment that may slow progression.
What Is a Urine ACR Test?
The urine albumin-to-creatinine ratio measures how much albumin, a blood protein, leaks into urine relative to creatinine. A spot urine sample is usually sufficient; a 24-hour collection is not routinely needed. The result is commonly reported as mg/g or mg/mmol, so always check the units.
Urine ACR: Understanding the Numbers
A1: below 30 mg/g (below 3 mg/mmol): normal to mildly increased.
An abnormal result does not automatically mean permanent kidney disease. A repeat test is usually needed, because fever, urinary infection, strenuous exercise, menstruation or marked hyperglycaemia can temporarily raise urinary albumin.
What Is eGFR?
eGFR estimates how effectively the kidneys filter blood, usually using serum creatinine together with age and sex. An eGFR of 90 or higher may be normal if no other kidney-damage marker is present. Persistent eGFR below 60 mL/min/1.73 m² for at least three months can indicate chronic kidney disease. A normal eGFR does not exclude early diabetic kidney disease if urine albumin is elevated.
When Should People With Diabetes Get Kidney Tests?
For type 2 diabetes, screening with both UACR and eGFR is recommended from diagnosis and at least annually thereafter. For type 1 diabetes, routine screening generally begins five years after diagnosis. People with established kidney disease, hypertension, changing medicines or higher-risk results may need more frequent testing.
Can Kidney Disease Occur Even When Creatinine Is Normal?
Yes. Serum creatinine alone can miss early kidney damage. A person may have preserved eGFR while albumin is already leaking into urine. That is why both UACR and eGFR matter. Conversely, reduced eGFR can occur without increased albuminuria.
What Can Cause a Temporary High ACR?
Exercise shortly before sampling, fever, urinary tract infection, menstruation, dehydration and marked hyperglycaemia can affect the result. Your clinician may recommend a repeat first-morning urine specimen after the temporary issue resolves. Chronic kidney disease generally requires abnormalities persisting for at least three months.
How Can You Protect Your Kidneys?
Manage blood glucose and blood pressure, stop smoking, limit excess salt, maintain physical activity and attend scheduled reviews. Depending on kidney function and other factors, medicines such as ACE inhibitors or ARBs (particularly with hypertension and albuminuria), SGLT2 inhibitors, or other kidney-protective therapies may be appropriate. Do not start these medicines independently. Avoid unnecessary NSAID painkillers and discuss herbal supplements with your doctor.
Does Every Patient Need an Ultrasound?
No. Ultrasound is useful when there are concerns about obstruction, stones, structural disease, atypical findings or another diagnosis. It does not replace UACR and eGFR for routine diabetes kidney screening.
When Should You Seek Specialist Advice?
Seek assessment for persistently increased albuminuria, falling eGFR, blood in urine, difficult-to-control blood pressure or unexpectedly rapid deterioration. Urgent medical evaluation is needed for severe illness, very low urine output, breathlessness or significant swelling.
Frequently Asked Questions
Is urine protein testing the same as urine ACR?
Not exactly. A urine dipstick may miss smaller amounts of albumin; quantitative UACR is preferred for screening.
Can diabetic kidney disease be reversed?
Albuminuria can sometimes improve with treatment, but established scarring may not fully reverse. Early intervention can slow progression.
Do I need a fasting sample?
Fasting is generally not required for UACR; a first-morning specimen may help consistency.
Should I stop metformin if ACR is high?
Not solely because ACR is high. Medication decisions depend particularly on eGFR and the full clinical picture.
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