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Total Protein and Albumin/Globulin (A/G) Ratio
Reviewed by Medicinsk Expert•Last updated: 2026-10-22•Lab Tests

Total Protein and Albumin/Globulin (A/G) Ratio

This test measures the total amount of protein in your blood and the ratio of albumin to globulin to help evaluate liver and kidney function and nutritional status.

What is a total protein and albumin/globulin (A/G) ratio test?

This test measures the total amount of protein in your blood. Proteins are essential for providing energy, rebuilding muscles, and supporting the immune system. There are two major types of protein in the blood:

  • Albumin: Made in the liver, it keeps fluid from leaking out of blood vessels and transports hormones, medicines, vitamins, and other substances.
  • Globulins: Made by the liver and the immune system, these proteins help fight infection and move nutrients throughout the body.

The albumin/globulin (A/G) ratio compares the amount of albumin to the amount of globulin in your blood. Abnormal results can indicate serious health problems related to the liver, kidneys, or nutrition.

What is it used for?

The test is often part of a comprehensive metabolic panel (CMP). It is used to help diagnose kidney disease, liver disease, or nutritional problems.

Why do I need this test?

You may need this test as part of a routine checkup or if you have symptoms of abnormal protein levels, such as:

  • Swelling in the feet, ankles, legs, or abdomen
  • Fatigue
  • Unexplained weight loss
  • Loss of appetite
  • Nausea and vomiting
  • Jaundice (yellowing of the skin or eyes)
  • Blood in the urine

What happens during the test?

A health care professional will take a blood sample from a vein in your arm using a small needle. The procedure typically takes less than five minutes.

Will I need to do anything to prepare?

Tell your provider about all medicines you take, as some may need to be stopped. If the test is part of a larger panel, you may need to fast for several hours before the blood draw.

What do the results mean?

Results indicate whether your total protein levels and A/G ratio are normal, low, or high.

  • Low total protein: May indicate liver disease, kidney disease, malnutrition, or malabsorption syndromes (e.g., celiac or Crohn’s disease).
  • High total protein: May indicate an infection (such as HIV or viral hepatitis) or multiple myeloma.
  • Low A/G ratio: May be caused by autoimmune diseases (e.g., lupus), liver disease (including cirrhosis), or kidney disease.
  • High A/G ratio: May be caused by certain genetic disorders or leukemia.

Additional Information

Your provider may also order separate tests for albumin or globulins. Low albumin can be a sign of liver disease, kidney disease, malnutrition, thyroid disease, or severe burns (note: low albumin is normal during pregnancy). High albumin may indicate severe dehydration or diarrhea. Low globulin may indicate liver or kidney disease, while high globulin may indicate blood cancers, hemolytic anemia, autoimmune diseases, or tuberculosis.

Frequently Asked Questions

low A/G ratio (less than 1.0) means globulins are relatively higher than albumin. Common causes include chronic liver disease (reduced albumin production), kidney loss of albumin (nephrotic syndrome), inflammatory or autoimmune disorders (elevated globulins), and certain infections or multiple myeloma. Further testing (e.g., liver panel, urine protein, immunoglobulin electrophoresis) helps pinpoint the underlying problem.
Fasting is not required for this test. Protein levels are not acutely altered by food intake, so you can eat and drink normally before the draw. However, if the test is part of a comprehensive metabolic panel that includes glucose or lipid measurements, the ordering clinician may request a 8‑hour fast for those components.
In liver disease, albumin synthesis declines, leading to a lower total protein and a reduced albumin fraction. Globulin levels may stay the same or rise if there is chronic inflammation, causing the A/G ratio to drop. Advanced cirrhosis often shows total protein near normal or slightly low, albumin markedly low, and an A/G ratio well below 1.0.
normal total protein with low albumin suggests that globulin levels are elevated enough to offset the albumin drop. This pattern is seen in chronic infections, autoimmune diseases, or early-stage liver disease where albumin production falls but globulin production rises. It can also occur in dehydration, which concentrates globulins. Additional tests such as serum globulin quantification, urine protein assessment, and liver function studies are useful for clarification.
Source: MedlinePlus, National Library of Medicine

MedlinePlus brings together authoritative health information from the National Library of Medicine (NLM), the National Institutes of Health (NIH), and other government agencies and health-related organizations.

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