Preferred Sample Type

Urine Protein:Creatinine ratio (Random urine)

Suitable Specimen Types

  • Plain Spot Urine
2 mL (minimum sample volume 0.5 mL)

Sample Processing in Laboratory


Sample Preparation


Turnaround Time

1 Day

Sample Stability

4 ºC

Urine Protein:Creatinine ratio (Random urine)

General Information

Diabetes is a very common cause of kidney failure. Studies have shown that identifying diabetics in the very early stages of kidney disease by demonstrating an abnormal albumin:creatinine ratio (ACR) helps patients and doctors adjust treatment. With better diabetic control and better control of other complications, such as high blood pressure, the progression of diabetic kidney disease can be slowed down or prevented.

Albumin is the principal component of proteinuria in glomerular disease. Reagent strips in current clinical practice predominantly detect albumin, not total protein, but are not reliably quantitative. ACR has far greater sensitivity than protein:creatinine ratio (PCR) for the detection of low levels of proteinuria and enhances early identification of CKD. However, there may be clinical reasons for a specialist to subsequently use PCR to quantify and monitor significant levels of proteinuria.

To detect and identify proteinuria, use urine albumin:creatinine ratio (ACR) in preference, as it has greater sensitivity than PCR for low levels of proteinuria.

Patient Preparation

Early morning urine sample preferable


The urine protein:creatinine ratio is calculated as follows:

(Urine protein(g/L) X 1000)/Urine creatinine(mmol/L)

Please note, from 22/7/19 analysis performed using Abbott Alinity analyser.   The test is awaiting UKAS accreditation.

Reference Range

  • <15 mg/mmol Creatinine = Normal
  • 15 – 49 mg/mmol Creatinine = Trace Proteinuria. Consider ACEI or ARB in diabetes.
  • 50 – 99 mg/mmol Creatinine = Significant proteinuria. Repeat using early am sample. Consider ACEI or ARB in hypertension.
  • 100 – 300 mg/mmol Creatinine = High proteinuria. If new finding, seek nephrology advice regardless of eGFR.
  • >300 mg/mmol Creatinine = “Nephrotic range” proteinuria. If new finding, seek nephrology advice regardless of eGFR.
Proteinuria is a risk factor for cardiovascular disease and for decline in GFR in CKD
UK CKD Guidelines suggest if PCR is >100 mg/mmol patient should be referred to Nephrologists irrespective of GFR.

Source of Reference Range: NICE guideline CG73 (2008) and UK eCKD guidelines 2009.)


The laboratories at Heartlands Hospital, Good Hope Hospital and Solihull Hospital form part of the services provided by University Hospitals Birmingham and are UKAS (United Kingdom Accreditation Service) accredited to the ISO 15189:2012 standard. For a list of accredited tests and other information please visit the UKAS website using the following link:

  • Heartlands, Good Hope and Solihull Hospital pathology laboratories are a UKAS accredited medical laboratory No.8217
  • United Kingdom Health Security Agency laboratory is a UKAS accredited medical laboratory No.8213

Tests not appearing on the UKAS Schedule of Accreditation currently remain outside of our scope of accreditation. However, these tests have been validated to the same high standard as accredited tests and are performed by the same trained and competent staff.

For further test information, please visit the test database:

Protection of personal information - Laboratory Medicine comply with the Trust Data Protection policy and have procedures in place to allow the Directorate and its employees to comply with the Data Protection act  1998 and associated best practice and guidance.

For further information contact Louise Fallon, Quality Manager, 0121 424 1235