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October 31, 2026
Kidney disease and eyes are linked in diabetes. High blood sugar and high blood pressure damage the small blood vessels of both the kidneys and the retina [1,5]. Albuminuria, or albumin protein leaking into the urine, is an early sign of kidney damage and is linked with a higher chance of retinopathy [2,8]. But a urine test cannot show what is happening inside your eye, so you still need a dilated eye exam [5].
Below, we explain what a urine albumin-to-creatinine ratio (UACR) result means, how strong the eye–kidney link is, and how to coordinate care.
This article is general education. It does not replace advice from the clinicians who know your kidney and eye test results.
Key takeaways
In this article
Call 911 for chest pain, severe shortness of breath, fainting or sudden confusion.
Go to an emergency room or eye emergency service now for:
Call your eye doctor the same day for:
These can be signs of bleeding inside the eye or a retinal detachment. MedlinePlus advises care within 24 hours of new flashes and floaters, and the National Eye Institute (NEI) says retinal bleeding needs treatment right away [18,5]. If you are on dialysis, also follow your dialysis unit's emergency plan.
Both are microvascular complications of diabetes. High blood sugar and high blood pressure damage the tiny vessels that filter blood in the kidneys and feed the retina. People with retinopathy are more likely to have kidney disease, and the reverse is also true. But many people have one problem without the other.
Diabetes is the leading cause of kidney disease. About 1 in 3 adults with diabetes has kidney disease, also called diabetic kidney disease (DKD) or diabetic nephropathy [1]. Longer diabetes, high blood sugar, high blood pressure and smoking all raise the risk [1]. High blood pressure and high cholesterol also raise the risk of diabetic retinopathy [5].
Large studies show the link and its limits:
So in type 2 diabetes, kidney disease without advanced eye disease is common. For background on how diabetes damages the retina, see how diabetes affects your eyes.
Albuminuria means albumin, a protein that belongs in the blood, is leaking into the urine. Healthy kidneys hold albumin back, so finding it in urine is an early sign of kidney damage. It usually causes no symptoms, so it is found only by testing [1,4].
Older terms still appear on reports. "Microalbuminuria" describes 30 to 300 mg/g, an amount too small for a standard dipstick to detect. "Macroalbuminuria" describes more than 300 mg/g [2].
Higher or rising albumin levels usually mean more serious kidney disease that is likely to worsen faster. They also signal a higher risk of heart and blood vessel disease [3]. A falling level during treatment may mean the treatment is working [2,4].
The urine albumin-to-creatinine ratio (UACR) compares albumin with creatinine, a waste product, in one urine sample. The ratio corrects for how concentrated your urine is and estimates how much albumin you lose in a day. A result of 30 mg/g or less is normal. A result above 30 mg/g may be a sign of kidney disease [2,4].
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) advises a yearly urine albumin test for everyone with type 2 diabetes. In type 1 diabetes, yearly testing starts once you have had diabetes for 5 years [1,2].
| UACR result | Common label | What it suggests | What it means for your eyes |
|---|---|---|---|
| 30 mg/g or less | Normal | No sign of albumin leakage [4] | Keep yearly dilated eye exams. A normal UACR does not rule out retinopathy [5,7]. |
| Above 30 to 300 mg/g | Microalbuminuria (older term) | Possible early kidney damage, if repeat tests confirm it [2,3] | Linked with a higher retinopathy risk. Make sure your eye exam is current [8]. |
| Above 300 mg/g | Macroalbuminuria (older term) | Larger albumin losses and higher heart and vessel risk [2,3] | Same eye advice. Share your kidney results with your eye team. |
Labs may use different units, such as mg/mmol. Always compare your number with the units and range printed on your report.
Urine albumin can rise for a short time after hard exercise, fever, infection, inflammation or some medicines. That is why an abnormal result is usually repeated twice over the next 3 to 6 months. Two high results out of three suggest kidney disease [3].
Results also vary from day to day in stable people. In one study of stable patients, people with normal levels needed a day-to-day change of more than 460% to count as a true change [12]. A single big jump, or a single good result, may not mean much on its own.
Before your sample, MedlinePlus suggests you may need to avoid hard exercise and possibly meat for a day. Tell your provider if you have your period or bleeding hemorrhoids. Urinary tract infections, gum infections and hepatitis can also raise albumin [3].
A short-lived rise after exercise is no reason to stop being active. A 2010 joint statement from the American College of Sports Medicine and the American Diabetes Association said microalbuminuria alone needs no exercise limits [16].
Estimated glomerular filtration rate (eGFR) is a blood test that estimates how well your kidneys filter waste. UACR shows leakage; eGFR shows filtering. An eGFR of 60 or more is in the normal range, while below 60 may mean kidney disease [4]. You can have an abnormal result on one test and a normal result on the other.
NIDDK advises checking eGFR at least once a year in everyone with diabetes [2]. The estimate comes from blood creatinine, which is affected by muscle mass. It is less reliable when creatinine is changing quickly, with very high or low muscle mass or body size, or with unusual diets [2].
Kidney disease in diabetes is not always caused by diabetes. In a US national survey from 1988 to 1994, 13% of adults with type 2 diabetes had reduced kidney function. Of those, 30% had neither albuminuria nor retinopathy, which points to other kidney conditions [11].
It raises the odds but does not decide your outcome. In one study, people with microalbuminuria and normal eGFR had about 3 times the risk of new or worsening retinopathy. The comparison group had moderately reduced eGFR but no albuminuria. Your retina exam, not your urine test, shows what is happening in your eyes [8].
That Taiwanese study followed 487 people with type 2 diabetes for up to 8 years. Its confidence range was wide, so the true effect could be smaller or larger [8].
In the US Chronic Renal Insufficiency Cohort (CRIC), people with kidney disease and retinopathy were 4.4 times more likely to reach kidney failure. After accounting for eGFR and urine protein, retinopathy no longer added to the prediction [9]. Kidney tests remain the best way to track kidney health.
A meta-analysis of kidney biopsy studies in type 2 diabetes asked whether retinopathy points to diabetes as the cause of kidney disease. Retinopathy was found in about 65% of people whose biopsy showed diabetic kidney disease. Proliferative retinopathy was rarer but, when present, strongly pointed to diabetic kidney disease [10]. Retinopathy makes a diabetic cause more likely, but its absence does not rule one out.
Retinopathy staging depends on what the eye doctor sees, such as bleeding spots and abnormal new vessels. Swelling at the center of the retina is called diabetic macular edema (DME). A urine test cannot show any of these. Learn how eyes are checked in our guide to dilation, OCT and angiography.
It should prompt you to check that your dilated eye exam is current, not to change eye treatment by itself. NEI advises a comprehensive dilated eye exam at least once a year for everyone with diabetes. Some people with retinopathy need one every 2 to 4 months [5]. Share the result with your eye team.
Practical steps after a new result:
A new kidney result does not mean you need an injection, laser or extra scan. Those decisions depend on what your eye exam shows.
The shared foundations are blood sugar control, blood pressure control and not smoking. These lower the risk of both kidney disease and retinopathy [1,5]. Some kidney-protecting medicines have strong evidence for the kidneys and heart. That kidney evidence does not prove they treat the retina.
ACE inhibitors (names ending in -pril) and ARBs (names ending in -sartan) are blood pressure medicines. They slow kidney damage in people with diabetes, high blood pressure and DKD. They are not safe in pregnancy [1]. A joint American Diabetes Association and Kidney Disease: Improving Global Outcomes (KDIGO) report describes adding other proven medicines on top of healthy habits. These include SGLT2 inhibitors, GLP-1 receptor agonists and a nonsteroidal mineralocorticoid receptor antagonist [13].
If your blood sugar drops quickly on a new medicine, ask whether you need an earlier eye check. Our diabetic retinopathy guide explains why fast drops can briefly worsen retinopathy.
Bring a full medicine list to every visit, including over-the-counter products and supplements. The US Food and Drug Administration (FDA) warns that "natural" does not always mean safe and that supplements can interact with medicines [17].
Current trial evidence does not show a clear rise in kidney problems from anti-VEGF eye injections in people with diabetes. A 2025 review of 16 trials found similar rates of acute kidney injury and chronic kidney disease with and without injections. The certainty was very low, so both teams should know about your injections and any kidney changes [14].
In that review of 5,930 people, acute kidney injury occurred in 2.0% of those receiving injections and 1.5% of controls. Chronic kidney disease occurred in 2.4% and 2.1%. People at highest kidney risk were not studied well [14].
Tell your retina specialist about kidney disease, recent acute kidney injury or hard-to-control blood pressure. Tell your kidney doctor the injection name and schedule. Do not cancel sight-saving injections without a plan from both teams. For treatment of swelling at the center of the retina, see diabetic macular edema.
Advanced kidney disease can make the A1C test less accurate. Kidney failure, hemodialysis, erythropoietin treatment, recent blood loss and transfusions can all shift A1C results [15]. Ask whether glucose meter or sensor readings should carry more weight. Dialysis does not remove the need for retinal exams or treatment.
If an eye appointment clashes with dialysis, call both services instead of skipping one. Ask which eye visits are time sensitive.
Do not change fluid intake, water pills or dialysis sessions to treat an eye symptom on your own. Swollen ankles or weight gain cannot show whether the macula is swollen; an eye exam and OCT scan can.
Keep a one-page shared care summary and bring it to every visit. Include:
Ask each office to send reports to the others, and do not assume a referral carried every result. For the wider prevention plan, see how to prevent diabetic vision loss.
Netra Restoration Therapy (NRT) is an acupuncture and Oriental medicine program that Netra Eye Institute offers alongside care from your eye doctor. It does not treat kidney disease, lower albuminuria, or treat or reverse diabetic retinopathy. NRT has not been tested in controlled trials for diabetic retinopathy or diabetic kidney disease.
It never replaces kidney care, eye injections, laser or retina follow-up, and it should never delay them. If you consider it, tell your kidney and diabetes clinicians, and list any herbs or supplements on your medicine list. Learn what NRT involves and what is known about its effectiveness.
Yes. In diabetes, kidney disease and retinopathy share causes such as high blood sugar and high blood pressure. People with one are more likely to have the other. Anyone with diabetes and kidney disease should keep up at least yearly dilated eye exams, or more often if advised.
Albuminuria means albumin, a protein that belongs in the blood, is leaking into the urine. Healthy kidneys keep albumin in the blood, so albumin in the urine is an early sign of kidney damage. It usually causes no symptoms and is found with a urine albumin-to-creatinine ratio (UACR) test.
A urine albumin-to-creatinine ratio of 30 mg/g or less is normal. A result above 30 mg/g may be a sign of kidney disease, and above 300 mg/g shows larger albumin losses. Because results vary, an abnormal UACR is usually repeated twice over 3 to 6 months, and two high results out of three suggest kidney damage.
No. Albuminuria raises the chance of diabetic retinopathy, but many people with albuminuria have healthy retinas, and some people with serious retinopathy have normal urine tests. Only a dilated eye exam, sometimes with imaging such as OCT, can show whether you have retinopathy.
Retinopathy is linked with higher kidney risk. In the US ARIC study, adults with diabetes and retinopathy had a 22% higher risk of chronic kidney disease over about 14 years. Their risk of kidney failure was 69% higher. In people who already had kidney disease, the link disappeared after accounting for kidney test results. Urine and blood tests remain the main kidney checks.
Urine albumin should be checked yearly in type 2 diabetes, and yearly after 5 years of type 1 diabetes. eGFR, a blood test of kidney filtering, should be checked at least yearly. Everyone with diabetes needs a comprehensive dilated eye exam at least once a year. Some people with retinopathy need one every 2 to 4 months.
A 2025 review of 16 trials found no clear increase in kidney injury or chronic kidney disease from anti-VEGF eye injections in diabetes. The certainty of that evidence was very low, and people at highest kidney risk were not studied well. Tell both your retina and kidney teams about your injections rather than stopping treatment on your own.
There is no evidence that lowering urine albumin by itself reverses diabetic retinopathy. Steps that protect the kidneys, such as blood pressure and blood sugar control, also lower retinopathy risk, but the eyes and kidneys can respond differently. A better UACR does not mean your eyes can skip their checkups.
Sources checked October 31, 2026.
This article provides general education and does not replace an individual eye examination, diagnosis or treatment plan. If you have diabetes and notice sudden vision loss, a curtain or shadow, or a new shower of floaters, get same-day eye care even if your kidney tests have been stable.
