Making impact (improving methodology for proteinuria and albuminuria measurement in clinics and trials): a report of the 2025 Proteinuria – Albuminuria Workshop sponsored by the National Kidney Foundation

Journal article

Glomerular damage is traditionally assessed by measuring urinary protein loss. While both the urinary albumin:creatinine ratio (UACR) and protein:creatinine ratio (UPCR) are used in clinical practice via 24-hour or spot urine samples, a more uniform approach to the assessment of urinary proteins and guidance when and how to assess urinary proteins would facilitate the diagnosis and monitoring of CKD. The United States National Kidney Foundation sponsored a scientific workshop to define optimal methods for the measurement of urinary proteins in April 2025. Based on existing literature, prospective studies and meta-analyses, workshop participants concluded that in general the measurement of urinary albumin is preferred over measurement of total urinary protein for several reasons. Firstly, urinary albumin assays are expected to be internationally standardized beginning in 2027, allowing optimal comparability within laboratories over time and across laboratories. Secondly, optimal pre-analytical handling of urine samples are well documented for urinary albumin unlike protein. Thirdly, urinary albumin concentration shows a moderately stronger association with clinical outcomes compared to urinary total protein, particularly in high-risk individuals. Thus, measurement of urinary albumin concentration should in general be preferred when determining the urinary excretion of proteins in future clinical practice and trials.

Authors: Heerspink, H; Inker, L; Jongs, N; Barbour, S; Barratt, J

• Publication status: Accepted
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: American Journal of Kidney Diseases More from this journal
• Acceptance date: 2026-10-29
• EISSN: 1523-6838
• ISSN: 0272-6386
• Language: English
• Keywords: chronic kidney disease; albuminuria; proteinuria