A urine protein-creatinine ratio (UPCR) test looks for high levels of protein in your urine, which can happen in kidney disease. Results that are higher than average may be a sign of a kidney-related issue.
The UPCR test uses measurements of protein and creatinine in a urine sample. The concentration of protein is divided by the concentration of creatinine to generate the result.
What is Creatinine?
Creatinine is a waste product that’s made in your muscles. Creatinine in your bloodstream is eventually filtered out by your kidneys and removed from your body in urine.
What about Proteins in Urine?
Proteins can be present in urine, but they’re normally only found at low levels. A UPCR tests looks for proteinuria. This is when protein levels in your urine are higher than normal.
Because proteins are important for your body’s health and function, your kidneys typically don’t filter them out of your bloodstream.
But when the filtering ability of your kidneys is impaired, they become less effective at ensuring that proteins remain in the body. This means that more protein makes its way into your urine.
As such, proteinuria can be a sign that you have problems with your kidneys. The level of proteinuria is associated with the progression of kidney disease, so high levels of proteinuria may indicate more severe kidney disease.
Assessing proteinuria, such as through a UPCR test, is a part of diagnosing kidney disease. This test can also be used to check kidney disease severity and to see how effectively your treatment plan is managing your kidney disease.
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A high degree of correlation was observed between P/C ratio values and the protein concentration in 24-h urine collections. The spot urine P/C ratio is a quick and reliable test that can eliminate the need for a daily 24-h urine collection. However, in doubtful situations, it is still recommended to assess proteinuria in a 24-h urine collection.
When both a urine creatinine and a random urine protein test are performed, the resulting protein/creatinine ratio approaches the accuracy of the 24-hour urine protein test.
Since saving all of the urine for 24 hours can be cumbersome for adults and difficult for infants and children, a random urine protein to creatinine ratio is sometimes substituted for a 24-hour urine protein sample.
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The urine protein-creatinine ratio test measures the amount of two different substances in your urine - protein and creatinine.
Protein is normally found in the blood and serves many roles in the body. These roles include building muscle, repairing tissue, and fighting infection. It is not usually found in the urine.
Creatinine is a waste product that comes from the digestion of protein in your food and the normal breakdown of muscle tissue. It is removed from the body through the kidneys and is expected to be found in the urine.
Healthy kidneys stop most of your protein from getting through their filters and entering the urine. There should be very little or no protein in your urine. If your kidneys are damaged, protein can “leak” through their filters and into your urine. Having protein in your urine (also known as proteinuria) can be a sign of kidney disease, even if your estimated glomerular filtration rate (eGFR) is above 60 or “normal”.
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There are three categories of proteinuria:
1. Normal to mildly increased
2. Moderately increased
3. Severely increased
The below shows the values for each category of proteinuria when measured using a UPCR test.
Normal to mildly increased: less than 0.15 mg/mg creat / 150 mg/g creat
Moderately increased: 0.15–0.50 mg/mg creat / 150–500 mg/g creat
Severely increased: greater than 0.50 mg/mg creat / greater than 500 mg/g creat
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What does it mean if your levels are outside of the normal range?
A result on the Protein/Creatinine Ratio test that’s higher than normal may mean that you have kidney disease. Kidney disease is often caused by the effects that other health conditions have on your kidneys.
This may include conditions such as:
→ diabetes
→ high blood pressure
→ heart disease
→ kidney stones
→ autoimmune diseases such as lupus
→ cancers such as kidney cancer and multiple myeloma
→ rare inherited conditions such as polycystic kidney disease
It’s also important to note that other, more benign factors can also lead to proteinuria and therefore a higher result on a Protein/Creatinine Ratio test.
This includes:
→ dehydration
→ stress
→ vigorous physical activity
→ having an acute illness or infection
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→ An elevated Protein/Creatinine ratio may signify kidney disease, kidney damage, urinary tract infections, diabetes, high blood pressure, or other medical conditions that affect the kidneys or urinary system.
→ Changes in the Protein/Creatinine ratio over time can be used to monitor the progression or regression of kidney disease. In some cases, it may be more sensitive than other markers like urine total protein or albumin/Creatinine ratio.
→ The urine total protein to creatinine ratio or UPCR (mg/mg) is normally less than 0.2 for adults. Elevated urine protein levels may be seen temporarily with conditions such as infections, stress, pregnancy, diet, cold exposure, or heavy exercise.
→ Persistent protein in the urine suggests possible kidney damage or some other condition that requires additional testing to determine the cause.
→ If slight to moderate amounts of protein are detected, then a repeat urinalysis and dipstick protein may be performed later to see if there is still protein in the urine or if it has become undetectable.
If the values of your Protein/Creatinine Ratio test are outside of the normal range, a doctor may want to order additional tests to evaluate your kidney function. This may include additional urine tests, blood tests, imaging tests, or a biopsy.
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If you have a high Protein/Creatinine Ratio, but a low Protein, Total, Random Ur:
A high Protein/Creatinine Ratio in urine alongside low Protein, Total, Random Ur can indicate a specific type of proteinuria called tubular proteinuria. Here's what this combination of results may signify:
→ Tubular Proteinuria: Tubular proteinuria occurs when there is an increased excretion of specific proteins in the urine. Unlike total proteinuria, which involves the loss of a variety of proteins, tubular proteinuria involves the loss of certain proteins produced by the renal tubules in the kidneys. In tubular proteinuria, the renal tubules, responsible for reabsorbing proteins back into the bloodstream, may be damaged or dysfunctional. As a result, specific proteins, such as beta-2 microglobulin and alpha-1 microglobulin, are not effectively reabsorbed and are excreted in the urine.
→ Low Total Protein: Despite a high Protein/Creatinine ratio, the total protein in urine may be low because only specific proteins are being lost, and the loss is not extensive enough to significantly impact total protein levels.
→ Possible Kidney Tubule Damage: This pattern of results could be indicative of kidney tubule damage or dysfunction. It may be associated with conditions like tubulointerstitial nephritis or certain medications that can affect the renal tubules.
If you have a high Protein/Creatinine ratio but low total protein in urine, it's essential to consult a healthcare professional for further evaluation. Additional tests and clinical assessment will help determine the underlying cause and guide appropriate treatment.
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