Background: Outside of pregnancies, the protein-to and albumin-to creatinine ratios have been extensively investigated and applied. In most cases, these tests (rather than a 24-hour urine collection) are currently what the National Kidney Foundation advises for diagnosing proteinuria. The aim of the present study is to compare the diagnostic accuracy of the random urine albumin-creatinine ratio (ACR) to that of the gold standard, the 24-hour urinary protein, in patients with preeclampsia. Patients and methods: At Said Galal Hospital, we enrolled 100 women who had been diagnosed with hypertension problems during pregnancy and were admitted for further diagnostic testing. Albumin 24 hour collection and albumin creatinine ratio (ACR) were measured for all participants. Results: Albumin in a 24-hour urine collection was positively correlated with albumin-to-creatinine ratio in a random urine sample (r = 0.935, P <0.001). ACR of 303 mg/g creatinine was found to be the "ideal" cutoff value for the identification of substantial proteinuria with a sensitivity of 96% and a specificity of 92%. Albumin creatinine ratio cutoff value for predicting severe proteinuria in cases of preeclampsia was 2 gm/24hr. We found that cutoff value of >1238 mg/g creatinine had a sensitivity of 100% and a specificity of 86%. Conclusion: Since ACR in random urine corresponds well with 24-hour urine protein, using it as a substitute was deemed appropriate. Thus, it can be used as a clinical screening test, benefiting from the fact that the ACR rarely changes significantly throughout the day, more easy and rapid method, not affected by urine concentration.