How high can serum creatinine levels go. What are the implications of extremely elevated creatinine. Can a patient survive with creatinine levels over 70 mg/dL. What factors contribute to dangerously high creatinine. How is severe azotemia managed in transplant patients.

Understanding Serum Creatinine and Its Significance

Serum creatinine is a crucial laboratory marker used to assess kidney function. It is derived from the metabolism of creatine in skeletal muscles and dietary meat intake. Creatinine is freely filtered through the glomerulus and also secreted in the proximal tubule of the nephron. As such, serum creatinine levels reflect several factors:

• Glomerular filtration rate
• Creatinine secretion in renal tubules
• Creatine intake
• Baseline skeletal muscle mass

Normal creatinine levels vary by gender and race. In the United States, average values are 1.14 mg/dL for men and 0.93 mg/dL for women. However, in cases of severe kidney dysfunction, these levels can rise dramatically.

What is considered a dangerously high creatinine level?

While there is no established creatinine level that definitively predicts mortality, levels above 5 mg/dL are generally considered severe and indicative of significant kidney impairment. Prior to this case study, the highest reported serum creatinine was 53 mg/dL. However, as we’ll explore, levels can potentially climb much higher in extreme cases.

Record-Breaking Creatinine: A Case Study

This case study presents a 23-year-old African American male with a history of pediatric deceased donor kidney transplant (DDKT). The patient’s medical history included:

• Left-sided dysplastic kidney
• Right-sided obstructive uropathy
• Multiple episodes of acute T cell-mediated and antibody-mediated rejection

The patient was admitted to the emergency department with symptoms of decreasing urine output, shortness of breath, generalized weakness, and nausea. Crucially, he disclosed a two-month history of nonadherence to his immunosuppressive medications, including tacrolimus, mycophenolate, and prednisone.

Initial Presentation and Laboratory Findings

Upon admission, the patient’s vital signs and physical examination were relatively unremarkable. However, his laboratory results were striking:

• Initial serum creatinine: 64.6 mg/dL (normal range: 0.67–1.17 mg/dL)
• Blood urea nitrogen (BUN): 212 mg/dL (normal range: 6–20 mg/dL)
• Peak serum creatinine: 73.8 mg/dL
• Peak BUN: 244 mg/dL

These values represent the highest recorded serum creatinine in medical literature, surpassing the previous record of 53 mg/dL.

Factors Contributing to Extreme Creatinine Elevation

Several factors likely contributed to the patient’s unprecedented creatinine levels:

1. Acute renal allograft rejection due to medication nonadherence
2. History of multiple rejection episodes
3. Underlying kidney abnormalities
4. Possible increased muscle mass (as a young male)

Why is medication adherence crucial for transplant patients?

Immunosuppressive medications are essential for preventing rejection in organ transplant recipients. Nonadherence can quickly lead to acute rejection, causing rapid deterioration of graft function. This case underscores the critical importance of patient education and regular monitoring of medication adherence in high-risk transplant recipients.

Management of Severe Azotemia in Transplant Patients

The management of this patient’s severe azotemia involved several key steps:

1. Emergent hemodialysis via temporary dialysis catheter
2. Close monitoring of metabolic parameters
3. Management of complications (e.g., seizures)
4. Likely reinitiation of immunosuppressive therapy (not explicitly stated in the case report)

What are the risks of emergent dialysis in severely azotemic patients?

Emergent dialysis in patients with extreme azotemia carries several risks, including:

• Dialysis disequilibrium syndrome
• Electrolyte imbalances
• Hemodynamic instability
• Increased risk of arrhythmias

In this case, the patient experienced new-onset seizures following the initiation of dialysis, initially attributed to dialysis disequilibrium syndrome.

Neurological Complications in Severe Azotemia

The patient’s course was complicated by the onset of seizures following dialysis initiation. Further investigation revealed:

• Electroencephalogram (EEG) showing right temporal spikes and epileptiform discharges
• Intermittent slow waves lateralized to the right hemisphere

These findings suggested an underlying epilepsy, potentially exacerbated by the severe metabolic derangements associated with acute renal failure and extreme azotemia.

Can severe azotemia directly cause seizures?

While azotemia itself is not typically a direct cause of seizures, the associated metabolic disturbances can lower the seizure threshold. In this case, the patient’s severe electrolyte imbalances, acidosis, and rapid changes during dialysis likely contributed to the manifestation of an underlying seizure disorder.

Implications for Clinical Practice and Research

This case study has several important implications for clinical practice and future research:

1. It demonstrates that humans can potentially survive creatinine levels far higher than previously documented.
2. It highlights the critical importance of medication adherence in transplant patients.
3. It underscores the need for close monitoring of high-risk transplant recipients.
4. It raises questions about the relationship between extreme creatinine levels and mortality.

Does this case change our understanding of creatinine and mortality risk?

While this case demonstrates survival with an unprecedented creatinine level, it does not necessarily change our overall understanding of the relationship between creatinine and mortality risk. Extremely elevated creatinine remains a marker of severe kidney dysfunction and is associated with increased morbidity and mortality. However, this case suggests that there may not be a specific creatinine level that is universally incompatible with life.

Future Directions in Transplant Medicine and Nephrology

This case study opens up several avenues for future research and clinical practice improvements:

• Development of more effective strategies to improve medication adherence in transplant patients
• Investigation of biomarkers that may better predict outcomes in severe azotemia
• Exploration of optimal dialysis strategies for patients with extreme creatinine elevations
• Further study of the neurological complications associated with severe renal failure and rapid correction of azotemia

How can we improve long-term outcomes for high-risk transplant recipients?

Improving long-term outcomes for high-risk transplant recipients may involve a multi-faceted approach:

1. Enhanced patient education programs
2. Use of technology (e.g., smartphone apps) to improve medication adherence
3. More frequent monitoring of renal function and drug levels
4. Development of longer-acting immunosuppressive medications
5. Psychological support to address barriers to adherence

By implementing these strategies, we may be able to reduce the incidence of severe acute rejection episodes and improve graft survival rates.

Limitations and Considerations in Interpreting This Case

While this case report presents a fascinating extreme, it’s important to consider several limitations:

• It represents a single case and may not be generalizable to all patients with severe azotemia
• The long-term outcome for this patient is not reported
• Factors such as race, age, and muscle mass may have influenced the extreme creatinine levels
• The accuracy of creatinine measurement at such high levels may be questioned

Are current laboratory methods accurate for measuring extremely high creatinine levels?

Most standard laboratory methods for measuring creatinine are designed and validated for the typical range of values seen in clinical practice. At extremely high levels, such as those seen in this case, the accuracy of these methods may be compromised. Dilution techniques or alternative assay methods may be necessary to ensure accurate measurement of such extreme values. This case highlights the need for laboratory methods capable of accurately quantifying creatinine across a wider range of values.

In conclusion, this extraordinary case of a serum creatinine level of 73.8 mg/dL pushes the boundaries of our understanding of renal physiology and the human body’s resilience. It serves as a stark reminder of the importance of medication adherence in transplant patients and the potential for survival even in extreme cases of azotemia. As we continue to advance our knowledge in nephrology and transplant medicine, cases like this provide valuable insights and raise important questions for future research and clinical practice.

Highest Recorded Serum Creatinine – PMC

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Case Rep Nephrol. 2021; 2021: 6048919.

Published online 2021 Oct 14. doi: 10.1155/2021/6048919

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Serum creatinine is a commonly used laboratory marker to assess kidney function; however, there has not been an established level of serum creatinine to predict mortality. After extensive literature review, we present a case of the highest recorded serum creatinine of 73.8 mg/dL in a 23-year-old male with the history of pediatric deceased donor kidney transplant (DDKT). He initially presented with uremia and signs of acute renal allograft failure after two months of immunosuppressive medication nonadherence, ultimately requiring emergent hemodialysis, which was complicated by new onset seizures. This was the patient’s fourth episode of late acute rejection and emphasizes the need for education of immunosuppressant adherence and periodic monitoring of renal function in high-risk patients. Though there is no known creatinine level incompatible with life, this patient appears to have the highest known serum creatinine in a uremic patient on record.

Serum creatinine is a commonly used laboratory measurement to gauge renal function in clinical practice. Creatinine is a byproduct of the metabolism of creatine in skeletal muscle and dietary meat intake [1]. It is freely filtered across the glomerulus, and there is additional creatinine secretion in the proximal tubule of the nephron via organic cation secretory pathways [2]. Therefore, serum creatinine is a reflection of glomerular filtration rate, creatinine secretion in the renal tubule, creatine intake, and baseline skeletal muscle mass. Creatinine is also known to vary by gender and race, with average values of 1.14 mg/dL in men and 0.93 mg/dL in women in the United States [3]. The previously highest serum creatinine reported was 53 mg/dL [4]. In current clinical practice, there remains uncertainty regarding the role of serum creatinine and mortality, specifically in the context of the degree of creatinine elevation. We present a case of acute renal allograft rejection with the highest serum creatinine reported in previous literature.

We report a 23-year-old African American male with a medical history of pediatric DDRT secondary to left-sided dysplastic kidney and right-sided obstructive uropathy. He presented to the emergency department with a one-week history of decreasing urine output, increased shortness of breath, generalized weakness, and nausea. He initially received his DDKT in 2010, which has been complicated by multiple episodes of both acute T cell-mediated and acute antibody-mediated rejection. The patient admitted to a two-month history of immunosuppressive medication nonadherence with tacrolimus, mycophenolate, and prednisone.

Physical examination revealed a young male, in no distress, weighing 142 pounds. He had a blood pressure of 153/102 mmHg and a heart rate of 77 beats/min. Exam findings are as follows: pale conjunctiva, lungs clear to auscultation, regular heart rate and rhythm, active bowel sounds, no abdominal tenderness, and no focal neurological deficit. Admission labs included a serum creatinine of 64.6 mg/dL (0.67–1.17 mg/dL) with a blood urea nitrogen (BUN) of 212 mg/dL (6–20 mg/dL), which increased to a serum creatinine of 73.8 mg/dL and BUN of 244 mg/dL prior to initiation of emergent dialysis. Serum chemistry included sodium 137 mmol/L (136–145 mmol/L), potassium 6.0 mmol/L (3.5–5.1 mmol/L), chloride 98 mmol/L (98–107 mmol/L), total carbon dioxide 7 mmol/L (22–29 mmol/L), glucose 68 mg/dL (74–106 mg/dL), and phosphorus 14.7 mg/dL (2.7–4.5 mg/dL).

The patient was initiated on emergent dialysis via a temporary dialysis catheter. Dialysis was complicated by new onset of seizures, initially thought to be secondary to dialysis disequilibrium syndrome. An electroencephalogram (EEG) was performed showing right temporal spikes epileptiform discharges with intermittent slow waves lateralized to the right hemisphere. Patient was thought to have epilepsy with initial seizure exacerbation secondary to severe metabolic derangements in setting of acute renal failure and severe azotemia. He was initiated on daily levetiracetam with resolution of seizures.

Patient received continuous renal replacement therapy (CRRT) while in the intensive care unit. After stabilization of his acute medical issues, a tunneled dialysis catheter was placed in his right internal jugular vein prior to discharge. Ultimately, the patient was diagnosed with renal allograft failure secondary to medication nonadherence and was discharged home on intermittent hemodialysis with improvement in serum creatinine to 23.8 mg/dL and BUN of 76 mg/dL at time of discharge, after completion of four hemodialysis sessions.

This case demonstrated a record high serum creatinine of 73.8 mg/dL based on our review of previous literature [4–7]. Currently, there is not a known effect of creatinine levels on human physiology or survivability [5]. Even with its inherent limitations, previous studies have explored the relationship between increased serum creatinine and mortality. In a prospective population-based study of people >65 years old, 11.2% of the population had an elevated serum creatinine (>1.5 mg/dL in men and >1.3 mg/dL in women) which was associated with a higher overall mortality (76.7 vs. 29.5/1000 years) [8]. In a retrospective study of hospitalized patients, very low serum creatinine admission value of <0. 4 mg/dL was significantly associated with increased mortality, exceeding the risk related to a creatinine value of >1.5 mg/dL [9].

This patient had elevated creatinine secondary to acute renal allograft rejection. Acute allograft rejection is a functional deterioration of the allograft caused by specific pathologic changes due to recipient’s immune system recognizing nonself-antigens from the allograft [10]. Typically, such rejection leads to subsequent rise in serum creatinine indicating substantial histological damages without significant symptom manifestation [11]. The long-term function of a renal allograft is associated significantly with acute rejection episodes, especially late acute rejections [12]. Late acute rejections occur greater than 3 months after transplant, and this case represented the patient’s fourth episode of such. In a previous historical cohort study, the late acute rejection group was shown to have the highest amount of graft loss when compared to the no rejection and early acute rejection groups [12]. This patient was ultimately diagnosed with renal allograft failure and remained dialysis dependent after discharge.

Our patient showed minimal symptoms initially, likely related more to azotemia and metabolic derangements rather than the elevated serum creatinine level. Chronic kidney disease (CKD) symptoms typically do not manifest until KDIGO CKD stages IV and V [13]. Chronic kidney disease is commonly detected by routine urine testing and labs, as it initially can present asymptomatically [13]. This case demonstrates the importance of periodic lab evaluation to assess kidney function in high-risk renal patients and the need for counseling on the importance of medication adherence. There is no known creatinine incompatible with life, and this patient appears to have the highest survivable serum creatinine recorded in the medical literature.

The views expressed in this material are those of the authors and do not reflect the official policy or position of the U.S. Government, the Department of Defense or the Department of the Air Force.

The authors declare that they have no conflicts of interest.

1. Levey A. S., Perrone R. D., Madias N. E. Serum creatinine and renal function.
Annual Review of Medicine
. 1988;39(1):465–490. doi: 10.1146/annurev.me.39.020188.002341. [PubMed] [CrossRef] [Google Scholar]

2. Shemesh O., Golbetz H., Kriss J. P., Myers B. D. Limitations of creatinine as a filtration marker in glomerulopathic patients.
Kidney International
. 1985;28(5):830–838. doi: 10.1038/ki.1985.205. [PubMed] [CrossRef] [Google Scholar]

3. Jones C., McQuillan G., Kusek J., et al. Serum creatinine levels in the US population: third national health and nutrition examination survey.
American Journal of Kidney Diseases
. 1998;32(6):992–999. doi: 10.1016/s0272-6386(98)70074-5. [PubMed] [CrossRef] [Google Scholar]

4. Asif A. A., Hussain H., Chatterjee T. Extraordinary creatinine level: a case report.
Cureus
. 2020;12 doi: 10.7759/cureus.9076. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

5. Storm A. C., Htike N. L., Cohen D. A., Benz R. L. A surviving patient with record high creatinine.
Open Journal of Nephrology
. 2013;3(4):217–219. doi: 10.4236/ojneph.2013.34037. [CrossRef] [Google Scholar]

6. Master Sankar Raj V., Garcia J., Gordillo R. 17 year-old boy with renal failure and the highest reported creatinine in pediatric literature.
Case Reports in Pediatrics
. 2015;2015:4. doi: 10.1155/2015/703960.703960 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

7. Abuhasna S. D. Highest serum creatinine ever reported.
Hemodialysis International
. 2012;17(1):137–138. doi: 10.1111/j.1542-4758.2012.00725.x. [PubMed] [CrossRef] [Google Scholar]

8. Fried L. F., Shlipak M. G., Crump C., et al. Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals.
Journal of the American College of Cardiology
. 2003;41(8):1364–1372. doi: 10.1016/s0735-1097(03)00163-3. [PubMed] [CrossRef] [Google Scholar]

9. Thongprayoon C., Cheungpasitporn W., Kittanamongkolchai W., Harrison A. M., Kashani K. Prognostic importance of low admission serum creatinine concentration for mortality in hospitalized patients.
The American Journal of Medicine
. 2017;130(5):545–554. doi: 10.1016/j.amjmed.2016.11.020. [PubMed] [CrossRef] [Google Scholar]

10. Naik R.
Renal Transplantation Rejection
. Treasure Island, FL, USA: StatPearls Publishing; 2020.
https://www.statpearls.com/articlelibrary/viewarticle/17170/
[Google Scholar]

11. Reisner H., Jennette J. C., Hussein Gasim A. M.
Pathology: A Modern Case Study
. 2nd . Chapel Hill, NC, USA: McGraw-Hill; 2015. Chapter 13: pathology of medical renal disease. [Google Scholar]

12. Jalalzadeh M., Mousavinasab N., Peyrovi S., Ghadiani M. H. The impact of acute rejection in kidney transplantation on long-term allograft and patient outcome.
Nephro-Urology Monthly
. 2015;7(1) doi: 10.5812/numonthly.24439.e24439 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

13. Vaidya S.
Chronic Renal Failure
. Treasure Island, FL, USA: StatPearls Publishing; 2020.
https://www.statpearls.com/articlelibrary/viewarticle/28357/
[Google Scholar]

Articles from Case Reports in Nephrology are provided here courtesy of Hindawi Limited

Creatinine blood test Information | Mount Sinai

Serum creatinine; Kidney function – creatinine; Renal function – creatinine

The creatinine blood test measures the level of creatinine in the blood. This test is done to see how well your kidneys are working.

Creatinine can also be measured with a urine test.

A measurement of the serum creatinine level is often used to evaluate kidney function. Urine creatinine levels can be used as a screening test to evaluate kidney function, or can be part of the creatinine clearance test.

How the Test is Performed

A blood sample is needed.

How to Prepare for the Test

The health care provider may tell you to temporarily stop taking certain medicines that can affect the test. These medicines include:

• Cimetidine, famotidine, and ranitidine
• Certain antibiotics, such as cefoxitin and trimethoprim

Tell your provider about all the medicines you take.

How the Test will Feel

When the needle is inserted to draw blood, some people feel moderate pain. Others feel only a prick or stinging sensation. Afterward, there may be some throbbing or slight bruising. This soon goes away.

Why the Test is Performed

Creatinine is a chemical waste product of creatine. Creatine is a chemical made by the body and is used to supply energy mainly to muscles.

This test is done to see how well your kidneys work. Creatinine is removed from the body entirely by the kidneys. If kidney function is not normal, the creatinine level in your blood will increase. This is because less creatinine is excreted through your urine.

Normal Results

A normal result is 0. 7 to 1.3 mg/dL (61.9 to 114.9 µmol/L) for men and 0.6 to 1.1 mg/dL (53 to 97.2 µmol/L) for women.

Women often have a lower creatinine level than men. This is because women often have less muscle mass than men. Creatinine level varies based on a person’s size and muscle mass.

The examples above are common measurements for results of these tests. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

A higher than normal level may be due to:

• Blocked urinary tract
• Kidney problems, such as kidney damage or failure, infection, or reduced blood flow
• Loss of body fluid (dehydration)
• Muscle problems, such as breakdown of muscle fibers (rhabdomyolysis)
• Problems during pregnancy, such as seizures caused by eclampsia or high blood pressure caused by preeclampsia

A lower than normal level may be due to:

• Conditions involving the muscles and nerves that lead to decreased muscle mass
• Malnutrition

There are many other conditions for which the test may be ordered, such as high blood pressure, diabetes, or medicine overdose. Your provider will tell you more, if needed.

Risks

There is little risk involved with having your blood taken. Veins and arteries vary in size from one person to another and from one side of the body to the other. Taking blood from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

• Excessive bleeding
• Fainting or feeling lightheaded
• Multiple punctures to locate veins
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Landry DW, Bazari H. Approach to the patient with renal disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 106.

Oh MS, Briefel G, Pincus MR. Evaluation of renal function, water, electrolytes, and acid-base balance. In: McPherson RA, Pincus MR, eds. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 15.

Last reviewed on: 7/21/2021

Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Serum creatinine (with GFR)

Creatinine is a non-enzymatic breakdown product of creatine and creatine phosphate, formed in muscle. It is excreted from the body by the kidneys.

Synonyms Russian

1-methylglycocyamidine, a product of the conversion of creatine phosphate, creatinine in the blood.

Synonyms English

Research method

Kinetic method (Jaffe method).

Units

µmol/l (micromoles per litre).

What biomaterial can be used for research?

Venous blood.

How to properly prepare for an examination?

• Do not eat for 12 hours before the test.
• 30 minutes before the study, exclude physical and emotional overstrain.
• Do not smoke for 30 minutes before the test.

Study Overview

Creatinine is a waste product produced in muscles when a substance called creatine is broken down. Creatine is part of the cycle that provides the body with energy for muscle contraction. After 7 seconds of intense physical activity, creatine phosphate is converted to creatine, then turns into creatinine, which is filtered in the kidneys and excreted in the urine. Creatine and creatinine are stably produced by our body in a constant amount. Almost all creatinine is excreted by the kidneys, so its concentration in the blood is a good indicator of their function. The amount of creatinine produced depends on the total body weight and, in particular, muscle mass. Therefore, for example, creatinine levels in men will be significantly higher than in women and children.

A small part (15%) is secreted by the tubules, but it is mainly produced by filtration in the glomerulus. The level of creatinine in the blood does not go beyond the norm until the glomerular filtration rate drops to critical values, especially in patients with low muscle mass. Then the creatinine level rises.

Precisely because of the large number of factors (muscle mass, sex, age) that affect the concentration of creatinine in the blood, this study is not the best screening test for detecting kidney failure. At the same time, creatinine is a more sensitive indicator of kidney disease than urea.

What is research used for?

• To assess kidney function.
• To assess the function of the main organs and systems (in combination with other studies).
• To evaluate and treat renal impairment if creatinine or urea is abnormal and the patient has an underlying chronic disease such as diabetes that affects the kidneys.
• If blood and urine creatinine levels are known, creatinine clearance (Rehberg’s test) can be calculated – this test shows how efficiently the kidneys filter small molecules, such as creatinine, from the blood.
• To calculate glomerular filtration rate to confirm kidney damage.

When is the examination scheduled?

• At regular intervals for known kidney disease or a disease that can cause deterioration of kidney function (together with the test for urea and microalbuminuria).
• In the diagnosis of skeletal muscle diseases.
• Before and after hemodialysis.
• For symptoms of kidney dysfunction:
  • weakness, fatigue, decreased attention, poor appetite, sleep problems,
  • swelling of the face, wrists, ankles, ascites,
  • Foamy, red or coffee-colored urine,
  • decreased diuresis,
  • problems with the act of urination: burning, discontinuity, change in frequency (dominance of nocturnal diuresis),
  • pain in the lumbar region (especially on the sides of the spine), under the ribs,
  • high pressure.
• For any pathological conditions accompanied by dehydration.
• In preparation for a CT scan.
• Before prescribing drugs that can cause damage to the kidney tissue.

What do the results mean?

Reference values ​​(creatinine norm):

Creatinine

GFR (glomerular filtration rate): 60 or more.

Causes of increased creatinine levels

• Acute and chronic renal failure (amyloidosis, kidney damage in diabetes mellitus, etc.).
• Failure of the cardiovascular system (myocardial infarction, cardiogenic shock, myocardial dystrophy, etc.).
• Massive destruction of muscle tissue (crash syndrome) and release of creatinine from cells.
• Burns (massive necrosis of cells with the release of their contents into the intercellular substance).
• Acromegaly.
• Gigantism.
• Hyperthyroidism.
• Dehydration (blood clotting and relative hypercreatininemia).
• Excessive exercise.
• Excess consumption of meat products.
• Radiation sickness.
• Obstruction of the urinary tract.
• Taking nephrotoxic drugs (mercury compounds, sulfonamides, thiazides, antibiotics from the group of aminoglycosides, cephalosporins and tetracyclines, barbiturates, salicylates, androgens, cimetidine, trimethoprim-sulfamethoxazole).
• Damage to the vessels of the glomerular apparatus of the kidneys (glomerulonephritis), which may be the result of an infectious or autoimmune disease.
• Bacterial infection of the kidneys (pyelonephritis).
• Necrosis of tubular epithelium (acute tubular necrosis) caused, for example, by drugs or toxins.
• Diseases of the prostate, nephrolithiasis or other factors causing obstruction of the urinary system.
• Decreased blood flow to the kidneys due to shock, dehydration, acute heart failure, atherosclerosis, or complications of diabetes.

Causes of low creatinine levels

• Fasting.
• Hyperhydration (blood dilution – relative hypocreatininemia).
• Muscle atrophy.

What can influence the result?

• Confounding factors
  • Pregnancy (especially I and II trimesters).
• Performance enhancing factors
  • Excessive muscle mass, such as in some athletes (may increase creatinine levels despite normal kidney function).
  • Increased blood concentration of some endogenous metabolites: glucose, fructose, ketone bodies, urea.
  • Use of drugs: ascorbic acid, levodopa, cefazolin, cefaclor, reserpine, nitrofurazone, ibuprofen, barbiturates, clonidine, kanamycin.
  • Major muscle injury.

Important remarks

• Pregnant women are almost halved in creatinine due to increased blood volume (hypervolemia), increased blood flow to the kidneys, and consequently increased filtration rate; all this leads to an increase in creatinine clearance (urinary excretion).
• In the elderly, creatinine formation is normally reduced, this must be taken into account when determining the severity of their kidney disease.
• Some people who have had chronic renal failure for several years have normal creatinine levels.

Also recommended

• Urinalysis with microscopy
• Rehberg test (endogenous creatinine clearance)
• Serum uric acid
• Uric acid in daily urine
• Albumin in urine (microalbuminuria)
• Serum urea
• Urea in urine
• Creatinine in daily urine
• Potassium, sodium, chlorine in daily urine
• Serum potassium
• Serum sodium
• Chlorine in serum
• Phosphorus in daily urine
• Phosphorus in serum
• Serum calcium
• Daily urine calcium
• Calcium, ionized

Who orders the examination?

Therapist, urologist, nephrologist, infectious disease specialist, endocrinologist, gynecologist, cardiologist.

what does this mean, norms and causes of increased indicators

What is creatinine?

Creatinine is a chemical compound in the human body, which is formed during the breakdown of protein molecules. The substance is part of the residual nitrogen. The beginning of the chain is creatine, a component that moves throughout the body, starting from the renal parenchyma.

The methylation process takes place in the liver. After that, creatine enters the muscles, where it is converted to creatine phosphate. The latter enters the myofibrils and decomposes into phosphate and creatinine. Muscles receive energy for contraction. The rest goes into the blood. In the liver, creatinine is not converted and is easily excreted in the urine. Energy turnover is constantly happening. In a healthy body, the amount of a substance is always stable.

Creatinine in Moscow

from 1 cal. days

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Daily urine creatinine in Moscow

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from 249 ₽

Coronavirus, RNA (SARS-CoV-2, PCR) smear, quality in Moscow

from 1 cal. days

from 999 ₽

Depending on the health of the kidneys and the state of the muscles, the level of creatinine changes. A decrease in this substance in the blood is required with increased breakdown of muscle tissue. This happens in the case of kidney failure, when it becomes difficult for the body to remove toxic substances.

A person can detect a deviation of creatinine from the norm independently according to the specific signs of the body. For example, kidney pathology leads to a change in the color of urine. It acquires a cloudy color, a brown tint or a shade of coffee grounds. The patient begins to go to the toilet less often, the volume of urine decreases. A typical symptom is the accumulation of fluid in the abdominal cavity and swelling of the face and extremities.

When urinating, it hurts a person, he feels pain. Pain when the situation worsens may appear in the hypochondrium or in the lumbar region. People get tired quickly, when they wake up they immediately feel weak, appetite decreases, attention is disturbed, it is difficult to concentrate on one thing. Insomnia appears, blood pressure either goes down or goes up. Infectious lesions of the kidneys are accompanied by fever.

Creatinine norm

The norm of creatinine depends entirely on the level of accumulation of muscle mass in the body. The indicator is usually denoted in microcol / l. Normative values ​​are not the same throughout life. In men with good health, the rate is always higher than that of women. In general, for children and adults, the following standard indicators can be compiled, measured in µmol / l:

• in women under 60 years old – 53-97, over 60 years old – 53-106;
• in men under 60 years old – 80-115, over 60 years old – 71-115;
• in children in the newborn state – 27-88, up to 1 year – 18-35, from one year to 10 years – 27-62 and from 10 to 18 years – 44-88.

The required amount of a substance is calculated based on the total mass of a person, the level of his physical endurance, activity in everyday life. What causes the fact that the norm of creatinine in a blood test for men, women and children is significantly different.

Gender, weight, age of the patient are mandatory criteria for evaluation. This makes it possible to classify a biochemical blood test for creatinine as an exclusively primary diagnostic method. It is noted that the criterion is characterized by a greater degree of sensitivity to kidney pathologies than urea.

It should be understood that creatinine can decrease not only against the background of pathological problems. Strong physical overstrain or overwork will certainly affect the analysis. This includes the delivery of creatinine after several days of feasting, where predominantly meat food prevailed and there was a lot of alcohol.

If there has been a state of dehydration, leading to thickening of the blood, then the creatinine level temporarily increases. Many drugs, if taken uncontrollably, can have a toxic effect on the urinary organs.

Indications for creatinine testing

Creatinine analysis helps to evaluate the filtration function of the kidneys. It is also prescribed for severe injuries and diagnosed diseases of varying degrees of course. It also allows you to evaluate the efficiency of renal filtration of small molecules and to diagnose the glomerular filtration rate. The main indications are:

• known renal insufficiency or suspected disease;
• different degrees of kidney disease, including pyelonephritis, polycystic disease, urolithiasis, glomerulonephritis;
• burns and injuries;
• muscle atrophy;
• endocrine diseases;
• problems with the cardiovascular system;
• acute inflammation;
• sepsis;
• recovery period after surgical interventions.

Preparing for a creatinine test

Biochemical analysis is carried out with a certain preparation. Firstly, it is done on an empty stomach and always in the morning. The day before the analysis, the last time they eat is no later than 20 pm. And in one day it is important to comply with the following conditions:

• do not stress and get enough sleep;
• do not overwork physically and do not do complex exercises, such as push-ups with dumbbells;
• avoid overheating, including sauna visits;
• do not drink alcoholic beverages;
• do not eat fatty foods and try to eat less meat;
• avoid spicy and salty foods;
• do not smoke 2 hours before the analysis.

Incorrect sampling of biomaterial can lead to unreliable results. This leads to the destruction of red blood cells. Their contents are released. The result is a distorted biochemical composition of the blood. In this case, a retest is simply necessary.

False positive results can occur in the presence of a large amount of muscle mass. If a weightlifter passes the diagnosis, then this fact should be taken into account. The result is affected by diabetes mellitus in the patient’s history, against which the concentration of simple sugars, acetone and urea increases. With muscle damage, as well as against the background of taking medications such as barbiturates or aminoglycoside antibiotics, creatinine readings are distorted.

Elevated creatinine

A person is in energy exchange throughout his life. A slight deviation of creatinine from the norm is not considered a problem. But if this excess is significant and is observed regularly, then there are definitely problems.

An increase in creatinine is indicated by weakness, drowsiness and loss of strength. You may feel dizzy and have a nausea reflex. Breathing quickens, a person does not get fresh air. These are indirect signs of kidney failure with a high level of creatinine in the blood. May indicate inflammation and destruction in the muscular system, infectious diseases leading to kidney damage.

What does elevated creatinine indicate?

Elevated creatinine in human blood can be associated with two reasons: physiological or pathological. The first option is associated with a large amount of muscle mass as a result of intense physical exercise. Such cases occur among people who do a lot and often do wrestling, powerlifting and bodybuilding.

Those who cannot imagine life without meat are also prone to increased creatinine levels. In many cases, the uncontrolled use of drugs leads to the need to reduce the creatinine level. It is especially dangerous to use tetracycline antibiotics, cephalosporins, non-steroidal anti-inflammatory drugs without the advice of a doctor.

Elevated creatinine can also speak of pathological disorders in the body. For example, an increase in the rate is often observed in case of kidney diseases in the acute and chronic stages, as well as in violation of the patency of the urinary tract. The kidneys can suffer due to impaired blood supply, which sooner or later leads to serious pathologies of the cardiovascular system.

Radiation sickness or oncological diseases can lead to constant jumps in creatinine. Septic shock, burns of varying severity, as well as diagnosed endocrine pathologies can cause changes in the indicator.

Causes of elevated creatinine

The main reason for the increase in the indicator is its increased production or poor excretion process from the body. This phenomenon is typical when diagnosing the following pathologies:

• liver problems, including inflammation, toxic poisoning and cirrhosis;
• necrosis of internal organs due to damage to cells and tissues;
• renal insufficiency;
• increased level of the thyroid gland;
• muscle and bone lesions;
• second and third degree burns;
• vascular lesions in the kidneys;
• complication after diabetes mellitus;
• weakness of the muscular system;
• diseases of the pulmonary system;
• fever;
• drug poisoning, manifested by toxic effects on the kidneys.

Fasting, pregnancy and long-term treatment with corticosteroids can cause temporary phenomena of an increase in the indicator.

How to lower blood creatinine?

It is almost impossible to lower the blood count on your own. This is due to the fact that one cannot do without passing certain tests and consulting with a specialist. It is important to adhere to competent treatment and limit nutrition in accordance with the recommendations of the doctor. During the diagnosis, a serious pathology may be revealed, without the treatment of which it is impossible to adjust the level of creatinine in the blood.

If a patient’s creatinine is elevated as a result of improper and unbalanced nutrition, then in order to restore the indicator, it is necessary to abandon the use of a number of products. These include primarily fatty meats and fish, smoked and spicy foods, dairy products, cheeses, salt, sugar, and strong drinks such as coffee and black tea.

The food should contain a minimum of protein and salt. Try to eat foods that contain antioxidants. These include cabbage, beans, walnuts, pistachios, strawberries, oranges, tangerines, eggplants. Drink at least a liter of pure water per day. Specialists can prescribe a course of taking special drugs that will help to cope with the problem quickly and efficiently.

It should be temporarily canceled toxic drugs and anabolic hormones. In case of kidney failure or in case of serious injury, special treatment is prescribed. It is important to restore the patency of the renal tubules and normalize blood flow. The damaged surface will close faster and the shock will pass. Thyrotoxicosis requires drugs that suppress excessive thyroid function.

If, after the measures taken, the indicators do not give a positive trend and a return to normal is not expected, then it is necessary to adjust the approach to treatment. Perhaps the connection of fasting days is required to reduce the load on the organs and urinary systems.

Creatinine decreased

When an amino acid is used by the body for energy, part of it is consumed according to needs. The remaining creatinine remains as waste. Decreased creatinine is often seen in vegetarians and pregnant women. In the first case, the problem is the lack of animal products, leading to protein deficiency in the body, and consequently, to muscle weakness with subsequent atrophy. During the bearing of a child, a physiological mechanism takes place, during which the total volume of blood increases. In many older people, this figure goes down, but should not cause concern.

Causes of low creatinine

It can be concluded that a reduced level of creatinine is observed in the following cases:

• For low muscle mass. The share of muscles may decrease against the background of a sharp weight loss. For example, during illness or due to age.
• In diseases of the liver. If the liver is not healthy, then it cannot fully produce creatinine.