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uACR vs uPCR Relationship — ESENeph MCQ

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EasyChronic Kidney DiseaseuACR vs uPCR RelationshipESENeph

A 55-year-old man with CKD G4 has a urine dipstick showing 2+ protein. His uACR comes back as 85 mg/mmol. His random uPCR is 120 mg/mmol. What is the relationship between uACR and uPCR?

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Correct answer: D — uACR measures albumin specifically (the predominant protein in glomerular proteinuria); uPCR measures total protein (albumin plus tubular proteins, immunoglobulins, and other proteins); in glomerular disease, albumin accounts for >60% of total proteinuria so uACR and uPCR broadly correlate but are not identical

uACR specifically quantifies urinary albumin – the predominant protein in glomerular proteinuria and the preferred KDIGO 2024 measure for CKD staging and monitoring. uPCR measures total urinary protein (albumin plus low molecular weight proteins, Tamm-Horsfall protein, immunoglobulins). In predominantly glomerular disease, albumin comprises >60% of total protein, so uACR and uPCR broadly correlate. However, in tubular proteinuria (e.g. Fanconi syndrome, tubulointerstitial disease), significant non-albumin proteinuria means uPCR will be disproportionately higher than uACR. KDIGO 2024 recommends uACR for CKD classification and uPCR for quantifying total proteinuria in glomerular disease.

Reference: KDIGO 2024 – CKD (Albuminuria Section)