A normal creatinine result can be reassuring. But for someone with diabetes, high blood pressure, or another risk factor for kidney disease, it may answer only part of the question. Creatinine helps us estimate how well the kidneys filter blood. It does not tell us whether albumin, a protein normally kept in the bloodstream, is leaking into the urine. Before we describe a kidney assessment as complete, we should know which of those questions has been answered.
Laboratories use creatinine to calculate an estimated glomerular filtration rate, or eGFR. It is an important measure of kidney function, especially when clinicians compare results over time. A preserved eGFR, however, can coexist with signs of kidney damage. Increased albumin in the urine is one such sign.
For people at risk, the urine albumin-to-creatinine ratio, or uACR, offers complementary information. It measures albumin relative to creatinine in a urine sample. Most people do not need a 24-hour urine collection. An ordinary urine dipstick can miss smaller increases in albumin, which is why an albumin-specific measurement matters.
Many people with early chronic kidney disease have no symptoms. A person with diabetes, hypertension, cardiovascular disease, or a family history of kidney failure may feel well and have a reassuring blood result. Neither is enough on its own to rule out kidney damage.
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The guidance is clear about assessing people at increased risk. The 2024 Kidney Disease: Improving Global Outcomes guideline advises testing both kidney filtration and urine albumin. The American Diabetes Association’s 2026 standards recommend at least annual assessment of eGFR and uACR for all people with type 2 diabetes and for those who have had type 1 diabetes for at least five years.
Knowing the recommendations is one thing. Making sure the right results are available, reviewed together, and explained is another.
An observational study published in 2022 examined 291,155 commercially insured or Medicare Advantage adults in the United States who had laboratory-defined chronic kidney disease and were followed in primary care. Using data from 2015 to 2019, researchers found that 59 percent had no albuminuria measurement available in the study data. This does not prove that all those patients were never tested, nor does it measure missed screening among people with normal kidney filtration. It does show that information central to kidney risk assessment was often unavailable in a large group already known to have kidney disease.
That is where careful communication matters. If we tell someone that their “kidney tests are normal,” they may reasonably assume that the relevant questions have been answered. But a normal blood result and a complete kidney assessment are not necessarily the same thing. The distinction should be made explicit, particularly when the patient has established risk factors.
There are limits to this argument. It does not mean every healthy adult needs repeated urine testing. Nor should one abnormal urine albumin result trigger an immediate diagnosis of chronic kidney disease. Albumin levels may rise temporarily with fever, infection, strenuous exercise, or other conditions. Abnormal results need to be interpreted in context and usually repeated. Chronic kidney disease generally requires evidence of kidney abnormalities persisting for at least three months.
The other danger is dismissing persistent albuminuria because the eGFR remains reassuring. When confirmed, albuminuria helps clinicians assess kidney and cardiovascular risk. Depending on the person’s overall condition, it may influence blood pressure management, medication decisions, monitoring, or referral. The value of testing lies in what the result changes, not simply in collecting another laboratory number.
Patients should not leave this discussion believing that a normal creatinine result is meaningless. It is useful information, and many results really are reassuring. The point is to explain what the test can establish and what it cannot. A clinician may decide that urine testing is not needed for a particular person; that decision, too, can be explained.
Patients with diabetes, high blood pressure, or other kidney risk factors can ask a simple question: “Have I had both an eGFR blood test and a urine albumin test, and what do they mean together?” The answer may confirm that the assessment is complete. It may identify a reason to repeat a result or adjust care. Or it may reveal that one relevant measurement has yet to be made.
Reassurance should reflect the questions we have actually answered. Before we tell an at-risk patient that their kidneys are fine, we should be confident that we have looked for the kinds of kidney problems their risks make relevant.
Girishkumar Modi is a senior specialist anesthesiologist at Sheikh Tahnoon Bin Mohammed Medical City and Tawam Hospital (SEHA) in the United Arab Emirates. His clinical practice includes regional anesthesia, trauma and orthopedic anesthesia, neuroanesthesia and spine anesthesia, obstetric anesthesia, pediatric anesthesia, perioperative medicine, and the management of complex surgical patients. He serves as faculty in an anesthesiology residency program accredited by the Accreditation Council for Graduate Medical Education International, where he contributes to resident teaching, clinical supervision, assessment, and mentorship. He also contributes to trauma-service development and multidisciplinary perioperative care.
His academic interests include perioperative physiology and pharmacology, regional anesthesia, total intravenous anesthesia, acute pain management, point-of-care coagulation and hemostasis, medical education, health care economics, and perioperative patient safety. He is active in clinical research, medical writing, and peer review, with publications spanning anesthesiology, pharmacology, perioperative medicine, regional anesthesia, point-of-care coagulation and rotational thromboelastometry, and medical education. His work has appeared in the Mathews Journal of Anesthesia, the Journal of Anesthesia & Pain Medicine, and Anaesthesia, with abstracts presented at the Association of Anaesthetists Winter Scientific Meeting in London and the Integrated Anesthesia and Comprehensive Care Conference in Abu Dhabi.
He also writes commentary on clinical judgment, artificial intelligence, and patient readiness for surgery, including rapid responses in The BMJ such as “Medicine is not a 64-square board: Human oversight requires independent judgment” and “AI systems need a tested exit plan.”
