Integrating uACR Screening Into Routine Care, With Payal Kohli, MD

For many primary care practices, the main challenge is not recognizing the value of uACR but embedding it reliably into daily workflows. Effective integration begins with clear criteria for who should be tested—typically all patients with diabetes, hypertension, established cardiovascular disease, or age older than 60 years with additional risk factors. Once eligibility criteria are defined, delegation becomes essential. Medical assistants or nursing staff can be trained to flag high-risk patients during intake and to ensure that a urine sample is obtained for uACR testing as part of routine laboratory orders.

Leveraging technology can further reduce missed opportunities. EHR-based solutions, such as best practice alerts or care gap reports, can identify patients who have diabetes, hypertension, or a history of cardiovascular disease but lack a documented uACR within the past year. Order sets that bundle uACR with annual laboratory testing—alongside lipid profiles, hemoglobin A1c, and serum creatinine—simplify ordering and standardize care. Periodic audits of practice data can reveal how often uACR is being ordered in eligible patients, helping clinicians and administrators target interventions where they are most needed.

In this video, internationally recognized cardiologist Payal Kohli, MD, adjunct professor at both Johns Hopkins University and Duke University, outlines how she has operationalized uACR screening in her own practice, using a team-based approach and EHR-driven reminders. She describes instructing medical assistants to treat the presence of diabetes, hypertension, or cardiovascular disease as automatic triggers to consider uACR testing and notes that many patients remark they have never previously had a urine test as part of their annual examination. By normalizing uACR as an expected component of high-risk patient care and using artificial intelligence and EHR tools to identify gaps, Kohli illustrates how primary care practices can institutionalize this test rather than rely on individual memory. Her strategies provide a practical roadmap for clinics seeking to move from sporadic to systematic uACR screening.