Microalbuminuria is the earliest manifestation of kidney dysfunction in people with diabetes and a key risk factor for progression to diabetic kidney disease (DKD). Although chronically elevated hemoglobin A1c (HbA1c) is known to increase long-term risk of microalbuminuria,1 acute changes in glomerular function resulting from exposure to short-term severe hyperglycemia have not been documented. We recently identified an association between acute kidney injury during episodes of diabetic ketoacidosis (DKA) and development of microalbuminuria in children with type 1 diabetes (T1D).2 Within this cohort, we observed a high frequency of transiently elevated urine albumin-to-creatinine ratios (uACR) after episodes of DKA. In this analysis, we aimed to characterize the association between states of short-term severe hyperglycemia and transiently elevated uACR.