Albumin, Random Urine with Creatinine

Test Code

CPT Codes

Preferred Specimen
10 mL random urine - no preservative

Minimum Volume
2 mL

Other Acceptable Specimens
Urinalysis transport tube (yellow-top, blue fill line, preservative tube)

Mix well if aliquoting

Note: Exercise within 24 hours, infection, fever, congestive heart failure, marked hyperglycemia, and marked hypertension may elevate urinary albumin excretion over baseline values.

Transport Container

Plastic urine container

Transport Temperature
Room temperature

Specimen Stability
Room temperature: 7 days
Refrigerated: 7 days
Frozen: 28 days

Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Acid preserved urine


Reference Range
Albumin, Urine Not established
Albumin/Creat Ratio, Random Urine <30 mcg/mg creat

Creatinine, Random Urine
≤6 Months 2-28 mg/dL
7-11 Months 2-31 mg/dL
1-2 Years 2-110 mg/dL
3-8 Years 2-130 mg/dL
9-12 Years 2-160 mg/dL
>12 Years Male 20-320 mg/dL
>12 Years Female 20-275 mg/dL

Clinical Significance

This test is used to detect albuminuria by measuring albumin and creatine concentrations in a random (spot) urine sample and calculating the albumin-creatinine ratio (ACR). This test is useful for assessing kidney damage, especially at an early stage, and informing management and prognosis of chronic kidney disease (CKD) [1].

Albuminuria, as a marker of kidney damage, provides a more specific and sensitive measurement of glomerular permeability than does proteinuria. An ACR measured from a spot urine sample acquired in the early morning is preferred for initial evaluation of albuminuria. This test can also be used to confirm a positive reagent strip urinalysis result. A moderately increased ACR (≥30 mg/g) for more than 3 months is diagnostic of CKD. The severity of albuminuria is also used for staging and prognosis of CKD [1,2].

Albuminuria generally appears before the reduction of glomerular filtration rate in people with diabetic glomerulosclerosis but may appear later in people with hypertensive nephrosclerosis. Albuminuria is independently associated with an increased risk of cardiovascular events and mortality. In individuals with diabetes and/or hypertension, early identification of albuminuria that prompts blood pressure and glycemic control may subsequently reduce the risk of cardiovascular events and CKD progressing to end-stage renal disease. Referral to specialist kidney care services is recommended in individuals with a consistent finding of severely increased ACR (≥300 mg/g) [1-4].

Factors that affect urinary ACR include menstrual blood contamination, symptomatic urinary tract infections, exercise, upright posture (orthostatic proteinuria), and other conditions that increase vascular permeability (eg, septicemia). Given the pathological and physiological causes of transient albuminuria, repeating ACR tests twice with early morning urine samples in the next 2 months is recommended. ACR from a timed urine sample can provide a more accurate estimate of albuminuria [1].

The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.

1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3(1):1-150.
2. Inker LA, et al. Am J Kidney Dis. 2014;63(5):713-735.
3. American Diabetes Association. Standards of medical care in diabetes-2020. Diabetes Care. 2020;43(suppl 1):S135-S151.
4. Shin JI, et al. Hypertension. 2021;78(4):1042-1052.

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.