Other names: BUN/Creatinine Ratio, BUN:Creatinine Ratio, BUN/Creat Ratio, BUN:Creat Ratio, BUN/Cr Ratio, BUN:Cr Ratio, BUN/Cr, BUN:Cr, BUN/Creat, BUN:Creat, Blood Urea Nitrogen/Creatinine Ratio, Blood Urea Nitrogen to Creatinine Ratio, Urea Nitrogen/Creatinine Ratio, Urea/Creatinine Ratio, Serum BUN/Creatinine Ratio, BUN to Creatinine Ratio
Optimal Result:
10 - 24 :1 ratio.
Updated: January 4, 2026
The BUN/Creatinine ratio is a commonly used clinical marker that helps assess kidney function, hydration status, and underlying causes of abnormal kidney-related lab results. By comparing two waste products filtered by the kidneys, this ratio provides insight that individual BUN or creatinine values alone may miss.
Quick interpretation overview:
High BUN/Creatinine ratio (>20:1):
May indicate dehydration, reduced kidney blood flow (prerenal causes), or upper gastrointestinal bleeding.
Low BUN/Creatinine ratio (<10:1):
May suggest liver disease, malnutrition, low protein intake, or intrinsic kidney disorders.
The BUN/Creatinine ratio compares the amount of Blood Urea Nitrogen (BUN) to creatinine in your blood. Both substances are normal metabolic waste products that are filtered by the kidneys and excreted in urine.
This ratio is used to help clinicians:
Evaluate kidney function
Assess hydration status
Distinguish between different causes of kidney dysfunction
Guide further testing or treatment decisions
BUN reflects the amount of nitrogen in the blood that comes from urea, a waste product formed in the liver during protein metabolism. Healthy kidneys filter urea efficiently, keeping BUN levels within a normal range.
Elevated BUN levels may occur with:
Dehydration
Reduced kidney perfusion
High protein intake
Gastrointestinal bleeding
Kidney dysfunction
Creatinine is a waste product generated from muscle metabolism. Because muscle mass is relatively stable, creatinine production is fairly constant from day to day.
Elevated creatinine levels may indicate:
Impaired kidney filtration
Acute or chronic kidney disease
Reduced glomerular filtration rate (GFR)
The BUN/Creatinine ratio provides important clinical context when evaluating kidney disease (acute and chronic). By assessing the relationship between blood urea nitrogen and creatinine—rather than each value alone—healthcare providers can better distinguish whether abnormal kidney-related results are due to reduced kidney blood flow (prerenal causes), intrinsic kidney damage, or postrenal obstruction.
This ratio is especially useful in the evaluation of acute kidney injury (AKI), where an elevated ratio often suggests prerenal azotemia, such as dehydration or reduced renal perfusion, while lower ratios may point toward intrinsic renal disease or non-renal causes. In chronic kidney disease (CKD), the ratio may remain within normal range even as overall kidney function declines, making it a supportive—rather than standalone—marker.
Learn more about how this marker is used in the evaluation of Kidney Disease (Acute & Chronic).
Important note:
If both BUN and creatinine values are within normal reference ranges, the BUN/Creatinine ratio is often not reported, as it adds little diagnostic value in that context.
In most adults, the normal BUN/Creatinine ratio is:
10:1 to 20:1
Some laboratories may consider values up to 24:1 as normal. Reference ranges can vary slightly depending on lab methodology and patient factors.
A high ratio most commonly suggests prerenal causes, meaning the kidneys themselves may be structurally normal but are receiving reduced blood flow.
Common causes include:
Dehydration
Congestive heart failure (reduced renal perfusion)
Upper gastrointestinal bleeding
High protein intake
Trauma or catabolic states
A ratio greater than 30:1 is particularly suggestive of upper GI bleeding.
The BUN/Creatinine ratio is commonly used to support the diagnosis and classification of acute and chronic kidney disease, particularly when interpreted alongside creatinine, eGFR, hydration status, and clinical symptoms.
A low ratio may indicate:
Liver disease (reduced urea production)
Malnutrition or low protein intake
Muscle breakdown
Certain intrinsic kidney disorders
Low ratios are less common but can provide valuable diagnostic clues when interpreted alongside other labs and clinical findings.
The BUN/Creatinine ratio is used to:
Assess overall kidney function
Help diagnose acute or chronic kidney disease
Monitor kidney disease progression
Evaluate response to treatment or medications
Aid in the differential diagnosis of acute kidney injury (AKI)
Acute kidney injury (also called acute renal failure) is a sudden decline in kidney function occurring over hours to days.
AKI is commonly classified into three categories:
Reduced blood flow to the kidneys
Often associated with high BUN/Creatinine ratios (>20)
Direct damage to kidney tissue
Ratio may be low or normal (<10)
Obstruction of urine flow
Ratio often remains within the normal range
Symptoms vary depending on cause and severity and may include:
Reduced urine output
Swelling in legs, ankles, or around the eyes
Fatigue
Shortness of breath
Confusion
Nausea
Chest pain or pressure
In some cases, AKI causes no symptoms and is detected only through lab testing.
Each kidney contains approximately one million nephrons, which are the functional filtering units.
BUN is filtered by the glomerulus and partially reabsorbed in the renal tubules.
Creatinine is filtered and then actively secreted into the tubules, making it a more stable marker of filtration.
Differences in how these substances are handled explain why their ratio changes in different disease states.
Clinicians use the ratio to:
Distinguish dehydration from intrinsic kidney damage
Identify reduced kidney perfusion
Detect possible GI bleeding
Evaluate chronic vs acute kidney disease patterns
In chronic kidney disease, the ratio often remains relatively normal despite elevated absolute values.
In most adults, a normal ratio is 10:1 to 20:1, though some labs extend the upper limit to 24:1.
It often indicates dehydration, reduced blood flow to the kidneys, or increased urea production, such as from GI bleeding or high protein intake.
Low ratios may be associated with liver disease, malnutrition, low protein intake, or intrinsic kidney disorders.
Yes. High protein intake can raise BUN levels, increasing the ratio, while low protein intake can lower it.
No. The ratio is a clinical interpretation tool and must be evaluated alongside symptoms, medical history, and other lab values such as eGFR.
National Kidney Foundation — Acute Kidney Injury
Uchino S, et al. Clin Kidney J. 2012
Salvador LG, et al. BMC Nephrology. 2023
Matsue Y, et al. Heart. 2017
Hosten AO. Clinical Methods. 1990
A high BUN/Creatinine ratio occurs when blood urea nitrogen (BUN) rises disproportionately compared to creatinine. This pattern most commonly reflects reduced blood flow to the kidneys (prerenal causes), increased urea production, or altered kidney handling of urea and creatinine.
A ratio above 20:1 is generally considered elevated and warrants clinical interpretation in context.
One of the most common causes. Reduced fluid volume decreases kidney perfusion, leading to increased urea reabsorption while creatinine remains relatively stable.
Reduced cardiac output lowers renal blood flow, increasing urea reabsorption and raising the ratio. Elevated ratios in heart failure are associated with worse outcomes.
Any condition that decreases effective blood flow to the kidneys—such as shock, blood loss, or severe hypotension—can increase the ratio.
Blockages from stones, tumors, or prostate enlargement may impair waste excretion. BUN often rises more rapidly than creatinine.
Increased protein breakdown raises urea production, disproportionately increasing BUN.
Digested blood proteins increase urea production. Volume loss from bleeding further reduces renal perfusion.
Clinical insight:
A BUN/Creatinine ratio ≥30 (and especially ≥36) is highly suggestive of upper gastrointestinal bleeding, particularly in pediatric and hospitalized patients.
Corticosteroids, certain antibiotics, and other drugs may increase protein catabolism or alter renal hemodynamics, raising the ratio.
>20:1: Often indicates prerenal causes (e.g., dehydration, heart failure)
<12:1: More suggestive of intrinsic renal disease or liver-related causes
A BUN/Creatinine ratio above ~22–25 is associated with significantly higher short- and long-term mortality in heart failure and acute myocardial infarction.
≥30: Strongly suggests upper GI bleeding
≥36: Very high specificity for upper GI sources over lower GI bleeding
A high ratio does not automatically mean intrinsic kidney damage. In many cases, kidney structure is intact, but perfusion or metabolic factors are impaired.
Because of this, the ratio should always be interpreted alongside:
Absolute BUN and creatinine values
eGFR
Hydration status
Blood pressure and cardiac function
Medications and dietary intake
Clinical symptoms
Management depends on the underlying cause and should be guided by a healthcare provider.
Maintain adequate fluid intake unless medically restricted. Light-colored urine is often a practical hydration indicator.
Moderate protein intake, reduce excess sodium, and support overall kidney-friendly nutrition.
Regular physical activity, stress management, and adequate sleep support cardiovascular and renal health.
Certain medications may need adjustment if they contribute to altered kidney perfusion or increased urea production.
Yes. Dehydration is one of the most common causes because it reduces kidney blood flow and increases urea reabsorption.
No. High ratios often reflect prerenal conditions, such as dehydration, heart failure, GI bleeding, or high protein intake, rather than direct kidney damage.
A ratio above 20:1 is elevated. Ratios ≥30 are strongly suggestive of upper GI bleeding in the appropriate clinical context.
Ratios above approximately 22–25 are associated with increased short- and long-term mortality.
A BUN/Creatinine ratio ≥30, and especially ≥36, strongly points toward upper GI bleeding rather than lower sources.
Note:
In contrast, a low BUN/Creatinine ratio may indicate liver disease, malnutrition, hypothyroidism, or increased creatinine production. See the Low BUN/Creatinine Ratio section for details.
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A low BUN/Creatinine ratio occurs when blood urea nitrogen (BUN) is disproportionately low relative to creatinine. This pattern can reflect reduced urea production, altered protein metabolism, or conditions that increase creatinine levels, rather than dehydration.
Common and clinically relevant causes include:
Insufficient dietary protein reduces urea production in the liver, leading to lower BUN levels and a reduced ratio. This may be seen with restrictive diets, malnutrition, or prolonged fasting.
Because urea is produced in the liver, impaired liver function can significantly reduce BUN production, resulting in a low BUN/Creatinine ratio.
Low thyroid hormone levels can decrease renal clearance of creatinine or increase creatinine production, lowering the ratio even when BUN is normal.
Increased muscle breakdown raises creatinine levels, which can lower the ratio even if kidney filtration is otherwise normal.
Certain kidney-related changes in sickle cell disease may reduce urea reabsorption, contributing to a lower ratio.
Some forms of intrinsic renal damage may reduce the ratio, particularly when creatinine rises disproportionately.
Certain drugs, such as acetazolamide, can alter renal handling of urea or creatinine and affect the ratio.
A low ratio does not automatically indicate kidney failure. Instead, it often points toward non-renal factors, such as liver function, nutrition, muscle metabolism, or hormonal influences.
Because the ratio is a contextual marker, it should always be interpreted alongside:
Absolute BUN and creatinine values
Clinical symptoms and medical history
Further evaluation may be appropriate if a low BUN/Creatinine ratio is accompanied by:
Symptoms of liver disease (fatigue, jaundice, abdominal swelling)
Signs of malnutrition or unintended weight loss
Muscle pain, weakness, or dark urine
Abnormal thyroid or kidney markers
Your healthcare provider may recommend additional testing to clarify the underlying cause.
Yes. Temporary changes in diet, fluid status, medications, or short-term illness can lower the ratio without indicating chronic disease.
No. While liver disease is a known cause, low protein intake, hypothyroidism, muscle breakdown, and certain kidney conditions can also lower the ratio.
Not necessarily. Mildly low values are often benign, especially if other lab results are normal. Interpretation depends on the full clinical picture.
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