Urine Albumin to Creatinine Ratio

Kidney Function marker

Albumin/Creatinine Ratio

Urine Albumin to Creatinine Ratio

Category: Kidney Function
Unit: mg/mmol

Ratio of urine albumin to creatinine. The primary screening marker for early kidney damage. Normal: <2.5 mg/mmol (males). Microalbuminuria: 2.5-25. Macroalbuminuria: >25.

PED Notes

CRITICAL kidney health marker for PED users. ACR detects kidney damage earlier than eGFR changes. Trenbolone, high-dose orals (especially anadrol), and chronic NSAID use can impair renal filtration. Heavy training can cause transient elevation — always test on rest days. Serial monitoring is important: a single abnormal result should be confirmed with repeat testing. If persistently elevated alongside declining eGFR, nephrologist referral is warranted.

When high

ACR Staging (males):

  • Normal: <2.5 mg/mmol
  • Microalbuminuria: 2.5-25 mg/mmol (early kidney damage, often reversible)
  • Macroalbuminuria: >25 mg/mmol (established kidney damage, urgent investigation)

If Elevated (>2.5 mg/mmol):

  • Confirm with 2 repeat tests over 3-6 months (single result may be transient)
  • Rule out: recent heavy exercise, fever, UTI, dehydration, menstruation
  • Always use first morning urine sample for accuracy

Supplements:

  • Omega-3 Fish Oil -- 2-4g/day (reduces proteinuria in multiple studies)
  • CoQ10 -- 100-200mg/day (renal antioxidant protection)
  • Astragalus -- 500-1000mg/day (renoprotective)

Pharmacological options (first-line for confirmed persistent ACR elevation):

  • Telmisartan -- 40-80mg/day; ARB; specific evidence for reducing urine albumin and slowing progression of renal damage (RENAAL, IRMA-2 trials); first-line antihypertensive when ACR is elevated; PPAR-gamma activity improves lipids/insulin sensitivity (useful in AAS context)
  • Losartan -- 50-100mg/day; alternative ARB
  • Lisinopril / Ramipril -- ACE inhibitors; 5-10mg and 2.5-10mg/day respectively; equivalent proteinuria reduction via efferent arteriole dilation; monitor for cough and hyperkalaemia
  • Empagliflozin / Dapagliflozin -- 10-25mg/day; SGLT2 inhibitor; EMPA-KIDNEY and DAPA-CKD trials showed renoprotection and significant albuminuria reduction independent of diabetes status; emerging consideration for athletes with persistent ACR elevation
  • Do not combine ACE inhibitor + ARB (additive hyperkalaemia/AKI risk)
  • All require physician oversight; baseline potassium and eGFR before starting

Lifestyle:

  • Blood pressure control is paramount (<130/80) — hypertension is the #1 modifiable risk factor
  • Eliminate or reduce nephrotoxic compounds (trenbolone first, then oral AAS)
  • Reduce AAS dose or discontinue if eGFR declines alongside rising ACR
  • Stop chronic NSAID use — switch to paracetamol or topical anti-inflammatories
  • Hydrate well (3-4L/day)
  • If persistently elevated with declining eGFR → nephrology referral urgently needed

History Chart

Reading History

Frequently Asked Questions

Reference Ranges

Standard Range

Not available

Statistics