A kidney function test is no longer reserved for people with diabetes or obvious kidney symptoms. On 5 September 2026, new joint guidelines from the European Society of Cardiology and the European Renal Association drew wide coverage for one blunt message: everyone diagnosed with cardiovascular disease should be screened for chronic kidney disease straight away, using one blood sample and one urine sample. The recommendations were published in the European Heart Journal and presented at ESC Congress 2026 in Munich. In this article you’ll learn what those two measurements actually show, why the urine half is the one most often skipped, and how to make sense of the numbers on your own lab report.
What the new cardiology guidelines changed
Heart disease and chronic kidney disease feed each other. Damaged kidneys speed up arterial disease; a struggling heart sends less blood to the kidneys. The European Society of Cardiology estimates that around 100 million people in Europe live with chronic kidney disease, and each of them carries a higher risk of heart attack, stroke and heart failure as a result.
Until now, routine kidney checks were mostly aimed at people with diabetes or high blood pressure. The 2026 guidelines widen that door. Their organising idea is summed up by the acronym STAMP on CKD: Screen, Triage, Address kidney risk, Modify cardiovascular management, Plan health services. Screening comes first, and it is deliberately simple — the task force asked cardiologists to order kidney function and urine albumin testing at the moment cardiovascular disease is diagnosed, rather than years later.
The two halves of a kidney function test
What clinicians call a kidney function test is really a pair of measurements, and they answer different questions. One estimates how much blood your kidneys filter each minute. The other looks for a leak.
| 检测项目 | 示例 | 该指标说明什么 | Usual concern threshold |
|---|---|---|---|
| Estimated glomerular filtration rate (eGFR), calculated from blood creatinine | 血液 | How much waste your kidneys clear per minute — the filtering capacity that is left | Below 60 mL/min/1.73 m2, sustained for at least three months |
| 尿白蛋白与肌酐比值（UACR） | Urine | Whether albumin, a blood protein healthy kidneys keep in, is leaking into the urine | Above 30 mg of albumin per gram of creatinine |
Neither number means much on its own. Someone can have a perfectly normal filtration rate alongside clear albumin leakage — and that is exactly the pattern the new guidelines are built to catch. The reverse also happens, particularly in older adults and in people who have lost muscle mass, a situation we cover in our article on muscle loss, eGFR and the cystatin C test. That is why the recommendation asks for both measurements, on the same day.
Why the urine test is the one that gets skipped
Blood creatinine is nearly automatic. It sits inside most routine chemistry panels, so an estimated filtration rate is usually printed whether or not anyone asked for it. The urine albumin-to-creatinine ratio has to be ordered deliberately, and frequently it is not. Closing that gap is precisely what the task force chairs described when they said the guidelines aim to increase the use of kidney function and urine albumin testing in patients with cardiovascular disease.
For a patient, the practical burden is small: a single urine sample, usually the first of the morning, with no fasting and no special preparation. Albumin excretion does move with exercise, fever, urinary infection, menstruation and dehydration, so a first raised result is normally repeated a few weeks later before anyone draws conclusions. Anyone unsure how a one-off abnormal value should be handled can read our step-by-step guide to abnormal blood test results.
Reading your own numbers without panicking
Lab reports rarely explain the two scales side by side. A few practical anchors help:
- An eGFR above 90 with a urine albumin-to-creatinine ratio under 30 mg/g is the reassuring combination.
- An eGFR between 60 and 89 is common with age and is not, by itself, a diagnosis.
- A ratio between 30 and 300 mg/g is what used to be called microalbuminuria. It is the early signal the guidelines want found.
- A ratio above 300 mg/g points to heavier leakage and warrants prompt medical review.
- Chronic kidney disease is only diagnosed when an abnormality persists for at least three months, which is why repeat testing matters more than a single figure.
Reference intervals also vary between laboratories and between reporting units, so compare your value with the range printed on your own report rather than a figure found online. We keep a plain-language reference chart of normal blood test ranges for the markers that appear most often.
最新科学进展
The guideline did not appear out of nowhere. Three strands of recent research explain why albumin in the urine moved from a nephrology detail to a cardiology priority.
A 2025 state-of-the-art review in Circulation described the urine albumin-to-creatinine ratio as a unifying marker across heart, kidney and metabolic conditions — one number that flags trouble in several systems at once, probably because albumin leakage reflects widespread damage to the lining of small blood vessels. What this means for you: a urine test ordered for your kidneys can also say something about your blood vessels. The authors are careful to add that it is still unclear how broadly and how often people should be screened, so this is a direction of travel rather than a settled protocol.
A 2023 review in the Journal of the American College of Cardiology looked specifically at heart failure and found that the amount of albumin in the urine predicts both who develops heart failure and how it progresses — independently of the filtration rate. In other words, the urine test adds information the blood test does not contain. What this means for you: a normal creatinine result does not make the urine sample redundant.
A 2026 analysis published in the Journal of the American Heart Association went further, using the long-running MESA cohort — a group of thousands of adults followed over many years. Even when a coronary calcium score was already known, adding albuminuria improved the prediction of heart failure and of overall mortality, and improved prediction across the board in people with diabetes. What this means for you: the test earns its place even alongside sophisticated imaging.
Finally, screening only pays off if something can be done afterwards. A 2026 meta-analysis in JAMA pooled ten randomised trials and more than 70,000 participants and found that a drug class called SGLT2 inhibitors slowed kidney disease progression across every level of filtration rate and every level of albumin leakage — including in people with barely any albumin in their urine. What this means for you: finding the problem early now opens a treatment door that did not exist a decade ago. These are pooled trial results in people already known to be at risk, not a promise about any individual.
何时应该去看医生
- You have just been diagnosed with a heart or vascular condition and no urine albumin test has been ordered.
- Your report shows a urine albumin-to-creatinine ratio above 30 mg/g, whatever your filtration rate.
- Your eGFR has dropped noticeably compared with a previous result, rather than sitting slightly low.
- You have diabetes or long-standing high blood pressure and have not had a kidney check in the past year. Our review of the blood tests behind your blood pressure risk explains why the two are linked.
- You notice persistent foamy urine, swollen ankles or unexplained fatigue alongside an abnormal result.
None of these situations is an emergency in itself. They are reasons to book an appointment rather than to worry, and one abnormal result is not a diagnosis.
词汇表
| 学期 | 定义 |
|---|---|
| 白蛋白 | The most abundant protein in blood. Healthy kidneys keep almost all of it out of the urine. |
| 蛋白尿（白蛋白尿） | Albumin present in the urine in more than trace amounts, usually an early sign of kidney damage. |
| 肌酐 | A waste product from normal muscle activity. Kidneys remove it, so its level in blood reflects filtering capacity. |
| 肾小球滤过率 (eGFR) | Estimated glomerular filtration rate. A calculation, based mainly on blood creatinine, of how much fluid your kidneys filter per minute. |
| UACR | Urine albumin-to-creatinine ratio. Comparing albumin with creatinine in the same sample corrects for how diluted the urine is. |
| 慢性肾脏病 | Abnormal kidney structure or function lasting at least three months and affecting health. |
| Cardiorenal | Describing the two-way relationship in which heart problems worsen kidney problems and the reverse. |
| 队列研究 | Research design in which a defined group of people is followed over time to see who develops a given outcome. |
常见问题解答
Do I need to fast before a kidney function test?
Not for the kidney measurements themselves. Blood creatinine and urine albumin can both be measured without fasting. You may still be asked to fast if the same appointment includes a cholesterol or glucose panel, so check the instructions on your request form. We set out the practical rules in our guide to fasting before a blood test.
What is the most accurate test of kidney function?
For everyday screening, the pairing of estimated filtration rate and urine albumin-to-creatinine ratio is the standard, and no single test replaces it. When blood creatinine is likely to mislead — after significant muscle loss, for example — a laboratory may add a marker called cystatin C to refine the estimate.
Can I check my kidney function at home?
Home urine strips can suggest that protein is present, but they are far less precise than a laboratory albumin-to-creatinine ratio and they say nothing about filtration rate. A blood sample is still needed for that. Home results are best treated as a prompt to arrange a proper laboratory test, not as a substitute.
Does one abnormal result mean I have kidney disease?
No. Chronic kidney disease requires an abnormality that persists for at least three months. Albumin excretion in particular fluctuates with fever, heavy exercise, dehydration and urinary infection, which is why a raised value is normally confirmed on a second sample.
Why does the test compare albumin with creatinine?
Because urine concentration varies through the day. Measuring albumin alone would make a dilute sample look reassuring and a concentrated one look alarming. Dividing by creatinine, which is excreted at a fairly steady rate, cancels that effect out.
该检测需要多久复查一次？
That depends on your starting values and your other risk factors, and it is a decision for your own clinician. Annual testing is a common baseline for people with diabetes, high blood pressure or established cardiovascular disease, with closer follow-up when results are already abnormal.
来源
- Centers for Disease Control and Prevention — Testing for Chronic Kidney Disease — cdc.gov
- National Institute of Diabetes and Digestive and Kidney Diseases (NIH) — Chronic Kidney Disease Tests and Diagnosis — niddk.nih.gov
- MedlinePlus (National Library of Medicine) — Microalbumin Creatinine Ratio — medlineplus.gov
- European Society of Cardiology — New ESC Guidelines recommend all patients with heart disease are tested for kidney disease, 28 August 2026 — escardio.org
- Damman K, Herrington WG et al. — 2026 ESC Guidelines for the management of cardiovascular disease and chronic kidney disease, in collaboration with the European Renal Association — European Heart Journal, 2026 — doi.org/10.1093/eurheartj/ehag098
- Claudel SE, Verma A — Albuminuria in Cardiovascular, Kidney, and Metabolic Disorders: A State-of-the-Art Review — Circulation, 2025 — doi.org/10.1161/CIRCULATIONAHA.124.071079
- Neuen BL, Fletcher RA et al. — SGLT2 Inhibitors and Kidney Outcomes by Glomerular Filtration Rate and Albuminuria: A Meta-Analysis — JAMA, 2026 — doi.org/10.1001/jama.2025.20834
- Khan MS et al. — Albuminuria and Heart Failure: JACC State-of-the-Art Review — Journal of the American College of Cardiology, 2023
- Barzilay JI et al. — Impact of Renal Disease Markers on Cardiovascular Disease Risk Prediction When Coronary Calcium Score Is Known — Journal of the American Heart Association, 2026
延伸阅读
- Full blood panel: what is included and why
- 验血前禁食：规则和时间安排
- Lipoprotein(a) screening and the 2026 guideline
- Prediabetes A1c and heart risk below 6.5%
- Rising bicarbonate on a CO2 blood test
利用 AI DiagMe 了解您的实验室结果
A kidney report can be hard to interpret when two numbers point in different directions and neither comes with an explanation. AI DiagMe reads your laboratory results — blood, urine and stool — and turns markers such as creatinine, estimated filtration rate and urine albumin into plain language, alongside the reference ranges your own laboratory used. It helps you understand a result and prepare your questions. It does not make a diagnosis and does not replace your doctor.
