Table 11.
| Categories | |||
|---|---|---|---|
|
| |||
| Measure | Normal to mildly increased (A1) | Moderately increased (A2) | Severely increased (A3) |
| AER (mg/24 h) | <30 | 30–300 | >300 |
| PER (mg/24 h) | <150 | 150–500 | >500 |
| ACR (mg/mmol) (mg/g) | <3 <30 |
3–30 30–300 |
>30 >300 |
| PCR (mg/mmol) (mg/g) | <15 <150 |
15–50 150–500 |
>50 >500 |
| Protein reagent strip | Negative to trace | Trace to + | + or greater |
Abbreviations: ACR = albumin-to-creatinine ratio; AER = albumin excretion rate; PCR = protein-to-creatinine ratio; PER = protein excretion rate.
Reprinted with permission from Macmillan Publishers Ltd: Kidney Disease: Improving Global Outcomes CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150. [EL 4; NE]
Albuminuria and proteinuria can be measured using excretion rates in timed urine collections, ratio of concentrations to creatinine concentration in spot urine samples and using reagent strips in spot urine samples. Relationships among measurement methods within a category are not exact. For example, the relationships between AER and ACR and between PER and PCR are based on the assumption that average creatinine excretion rate is approximately 1.0 g/d or 10 mmol/d. The conversions are rounded for pragmatic reasons. (For an exact conversion from mg/g of creatinine to mg/mmol of creatinine, multiply by 0.113.) Creatinine excretion varies with age, sex, race, and diet; therefore, the relationship among these categories is approximate only. ACR <10 mg/g (<1 mg/mmol) is considered “normal”; ACR 10 to 30 mg/g (1 to 3 mg/mmol) is considered “high normal.” ACR >2200 mg/g (>220 mg/mmol) is considered “nephrotic range.” The relationship between urine reagent strip results and other measures depends on urine concentration.