Association of serum uric acid-creatinine ratio with microalbuminuria and glycemic status (HbA1c) as an early indicator of diabetic nephropathy

Swathi Kulkarni, Anurag Yadav


Background: The serum uric acid is a good predictor of renal injury in both diabetes patients and non-diabetes. Creatinine is the marker to detect the renal function. Aim of our study was to assess the correlation of the serum uric acid to creatinine ratio with the Microalbuminuria and glycemic status (HbA1c) in diabetes mellitus patients.

Methods: It is analytical observational study conducted in urban tertiary care hospital attached to medical college between July to august 2019 after obtaining the ethics clearance. Participants aged between 18 to 60 years with type 2 diabetes mellitus and healthy controls were included in present study. The patients with diabetic nephropathy with grade 3 and above and non-diabetes patients with history of ischemic heart disease, advanced hypertension, Chronic or acute kidney disease, liver disease, known case of hyperuricemia/gout, alcoholics, acute febrile illness, urinary tract infection, cancer were excluded from present study.

Results: Total of 131 individuals were included in present study that fulfilled inclusion criteria. The mean age of the participants was 56.70±11.9 with 64 females and male 67 (male: female ratio of 1). Among 131 participants, 60 were with T2DM and 71 were normal control. Our study showed a significant strength of association between the UACr with the urine MAU (r=0.760, p<0.001), where-as the SAU was associated with MAU excretion in urine (0.52, p<0.001). The UACr was also significantly associated with the HbA1c (r=0.25, p=0.01).

Conclusions: Urine microalbuminuria and HbA1c were significantly correlated with the ratio of uric acid to creatinine in the serum. The serum uric acid creatinine ratio (UACr) is a good predictor for predicting renal damage in patients with diabetes mellitus at an early stage of illness.


Microalbuminuria, Uric acid-creatinine ratio, T2DM, Serum uric acid, HbA1c

Full Text:



Al-Khawaldeh OA, Al-Hassan MA, Froelicher ES. Self-efficacy, self-management, and glycemic control in adults with type 2 diabetes mellitus. J Diabet Complicat. 2012;26(1):10-6.

KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. Am J Kidney Dis. 2007;49(2 Suppl 2):S12-154.

Webster AC, Nagler E V, Morton RL, Masson P. Chronic Kidney Disease. Lancet. 2017;389:1238-52.

Lin F, Zhang H, Huang F, Chen H, Lin C, Zhu P. Influence of changes in serum uric acid levels on renal function in elderly patients with hypertension: a retrospective cohort study with 3.5-year follow-up. Bio Med Cent Geriatr. 2016;16:35-9.

Maiuolo J, Oppedisano F, Gratteri S, Muscoli C, Mollace V. Regulation of uric acid metabolism and excretion. Int J Cardiol. 2016;213:8-14.

County H, Division R, Nephrologie S De, Division R, Division N, Do H, et al. The risk of developing end-stage renal disease in patients with type 2 diabetes and nephropathy. Renal Study. 2010;63(2003):1499-507.

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604-12.

Article R. Biomarkers of endothelial function in cardiovascular diseases: hypertension. 2016;15(3):224-33.

Kang D-H, Nakagawa T, Feng L, Watanabe S, Han L, Mazzali M, et al. A role for uric acid in the progression of renal disease. J Am Soc Nephrol. 2002;13(12):2888-97.

Bo S, Cavallo-Perin P, Gentile L, Repetti E, Pagano G. Hypouricemia and hyperuricemia in type 2 diabetes: two different phenotypes. Eur J Clin Invest. 2001;31(4):318-21.

Mazzali M, Hughes J, Kim YG, Jefferson JA, Kang DH, Gordon KL, et al. Elevated uric acid increases blood pressure in the rat by a novel crystal-independent mechanism. Hypertension. 2001;38(5):1101-6.

Rosolowsky ET, Ficociello LH, Maselli NJ, Niewczas MA, Binns AL, Roshan B, et al. High-normal serum uric acid is associated with impaired glomerular filtration rate in nonproteinuric patients with type 1 diabetes. Clin J Am Soc Nephrol. 2008;3(3):706-13.

Kawamoto R, Ninomiya D, Kikuchi A, Akase T, Kasai Y, Ohtsuka N, et al. Serum uric acid to creatinine ratio is a useful predictor of renal dysfunction among diabetic persons. Diabetes Metab Syndr. 2019;13(3):1851-6.

Chunlei Y, Liubao G, Tao W, Changying X. The association between serum uric acid to creatinine ratio and renal disease progression in type 2 diabetic patients in Chinese communities. J Diabet Complicat. 2019;33(7):473-6.

Gu L, Huang L, Wu H, Lou Q, Bian R. Serum uric acid to creatinine ratio: A predictor of incident chronic kidney disease in type 2 diabetes mellitus patients with preserved kidney function. Diabet Vasc Dis Res. 2017;14(3):221-5.