Avoiding Common Ordering Errors in UACR Testing, With Holly Kramer, MD

Confusing test nomenclature and inconsistent laboratory order sets continue to undermine effective use of urine albumin-to-creatinine ratio testing in primary care. Speaking with Patient Care Online, Holly Kramer, MD, MPH, a professor of public health sciences and medicine at Loyola University Chicago who specializes in nephrology, explains that ordering urine albumin alone—sometimes labeled as “microalbumin” or “urine albumin screen”—does not provide the clinically actionable ratio needed to assess kidney and cardiovascular risk. Instead, clinicians must ensure that both urine albumin and urine creatinine are measured together to generate a true UACR value.

This distinction has important implications for patient outcomes. Albuminuria affects approximately 30% to 40% of adults with type 2 diabetes, yet fewer than 1 in 3 patients with elevated UACR receive appropriate follow-up or treatment intensification in routine practice.¹ When UACR exceeds 30 mg/g, patients face a 5-fold higher risk of heart failure, a 4-fold higher risk of cardiovascular mortality, and a 3-fold higher risk of myocardial infarction compared with those without albuminuria. Despite this, testing gaps remain common, with research showing that annual UACR screening rates in diabetes range from only 40% to 60% in the US.

Above, Kramer emphasizes that many laboratories now offer simplified “kidney panels” that automatically include both estimated glomerular filtration rate and UACR, reducing ordering errors and workflow burden. Ensuring the correct test is ordered is a low-effort intervention that can substantially improve early detection of kidney disease, refine cardiovascular risk stratification, and prompt timely initiation of guideline-recommended therapies.

References:

1. American Diabetes Association. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47:S219-S230. doi:10.2337/dc24-S011