“No Kidney Screening Test Is Complete Without uACR,” Payal Kohli, MD, Says

Relying on estimated glomerular filtration rate (eGFR) alone may leave early kidney damage and cardiovascular risk undetected. While eGFR reflects filtration capacity, it often declines only after substantial nephron injury has occurred. As a result, clinicians may miss earlier stages of kidney stress if albuminuria is not assessed concurrently.

Urine albumin-to-creatinine ratio (uACR) provides complementary information by identifying increased glomerular permeability that can precede measurable declines in eGFR. Even modest elevations in albuminuria have been associated with higher risks of cardiovascular events and mortality, independent of kidney function. For patients with diabetes, hypertension, or established cardiovascular disease, this earlier signal may offer a window for risk modification.

In this video, internationally recognized cardiologist Payal Kohli, MD, adjunct professor at both Johns Hopkins University and Duke University, emphasizes that kidney screening is incomplete without uACR measurement. She argues that the test should not be viewed solely as a nephrology tool, but rather as part of a broader cardiometabolic risk assessment strategy relevant to primary care and cardiovascular practice.