How high can creatinine levels go in the human body. What is the significance of extremely elevated creatinine levels. What are the potential consequences of severe azotemia.

Understanding Serum Creatinine and Its Importance

Serum creatinine is a crucial laboratory marker used to assess kidney function. It’s a byproduct of creatine metabolism in skeletal muscle and dietary meat intake. The kidneys filter creatinine from the blood, making it an excellent indicator of renal health.

Normal Creatinine Levels

What are considered normal creatinine levels? In the United States, average values are:

• Men: 1.14 mg/dL
• Women: 0.93 mg/dL

These values can vary based on factors such as muscle mass, diet, and race.

Record-Breaking Creatinine Levels: A Case Study

This case study presents a 23-year-old African American male with a history of pediatric deceased donor kidney transplant (DDKT). His case is remarkable for having the highest recorded serum creatinine level in medical literature.

Key Details of the Case

• Initial creatinine level: 64.6 mg/dL
• Peak creatinine level: 73.8 mg/dL
• Previous highest recorded level: 53 mg/dL

These levels far exceed what is typically seen in clinical practice, making this case particularly noteworthy.

Factors Contributing to Extreme Creatinine Elevation

Several factors contributed to the patient’s extraordinarily high creatinine levels:

1. History of kidney transplant
2. Multiple episodes of acute rejection
3. Two-month history of immunosuppressive medication nonadherence
4. Acute renal allograft failure

This case emphasizes the critical importance of medication adherence in transplant patients and the need for regular monitoring of renal function in high-risk individuals.

Clinical Presentation and Symptoms

How does severe azotemia manifest clinically? The patient presented with several symptoms indicative of acute renal failure:

• Decreased urine output
• Shortness of breath
• Generalized weakness
• Nausea

These symptoms, combined with the patient’s history, prompted immediate medical attention and laboratory testing.

Laboratory Findings and Metabolic Derangements

The patient’s laboratory results revealed severe metabolic derangements:

• Blood Urea Nitrogen (BUN): 244 mg/dL (normal range: 6-20 mg/dL)
• Potassium: 6.0 mmol/L (normal range: 3.5-5.1 mmol/L)
• Phosphorus: 14.7 mg/dL (normal range: 2.7-4.5 mg/dL)
• Total carbon dioxide: 7 mmol/L (normal range: 22-29 mmol/L)

These findings indicate severe azotemia, hyperkalemia, hyperphosphatemia, and metabolic acidosis, all consistent with acute renal failure.

Treatment Approach and Complications

Given the severity of the patient’s condition, emergency hemodialysis was initiated. However, this life-saving treatment was not without complications.

Dialysis-Related Complications

The patient experienced new-onset seizures following the initiation of dialysis. Initially, these were thought to be due to dialysis disequilibrium syndrome. However, further investigation revealed a more complex picture.

Neurological Findings

An electroencephalogram (EEG) showed:

• Right temporal spikes epileptiform discharges
• Intermittent slow waves lateralized to the right hemisphere

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

Implications for Clinical Practice and Research

This case raises several important questions and implications for clinical practice and future research:

1. Is there a maximum creatinine level compatible with life?
2. How can we improve medication adherence in transplant patients?
3. What are the long-term neurological effects of severe azotemia?
4. How can we optimize dialysis protocols for patients with extreme creatinine levels?

While this case represents an extreme scenario, it provides valuable insights into the management of severe renal failure and its associated complications.

The Importance of Medication Adherence in Transplant Patients

This case underscores the critical importance of medication adherence in transplant patients. Why is adherence so crucial?

• Prevents acute rejection episodes
• Maintains long-term graft function
• Reduces risk of life-threatening complications
• Improves overall quality of life

Healthcare providers must prioritize patient education and support to ensure consistent adherence to immunosuppressive regimens.

Strategies to Improve Medication Adherence

Several strategies can be employed to enhance medication adherence in transplant patients:

1. Comprehensive patient education programs
2. Regular follow-up appointments and monitoring
3. Use of medication reminders and apps
4. Addressing barriers to adherence (financial, psychological, social)
5. Involving family members or caregivers in the treatment plan

Implementing these strategies could potentially prevent cases of severe acute rejection and renal failure, as seen in this patient.

Dialysis Disequilibrium Syndrome: A Potential Complication

The patient’s post-dialysis seizures initially raised concerns about dialysis disequilibrium syndrome (DDS). What is DDS and why is it a concern in patients with severe azotemia?

Dialysis disequilibrium syndrome is a neurological disorder that can occur during or after hemodialysis, particularly in patients with severe uremia. It’s characterized by:

• Neurological symptoms (headache, nausea, vomiting, seizures)
• Rapid reduction in blood urea levels
• Cerebral edema due to osmotic shifts

In patients with extremely high creatinine and urea levels, the risk of DDS is particularly high, necessitating careful management of dialysis intensity and duration.

Preventing and Managing DDS

To minimize the risk of DDS in patients with severe azotemia, several strategies can be employed:

1. Gradual initiation of dialysis with shorter, less intense sessions
2. Use of high sodium dialysate
3. Administration of osmotically active substances (e.g., mannitol)
4. Close monitoring of neurological status during and after dialysis
5. Consideration of continuous renal replacement therapy in severe cases

These approaches aim to reduce the rapid shifts in osmolality that can lead to cerebral edema and neurological complications.

Long-Term Outcomes and Prognosis

While this case report focuses on the acute presentation and management of extreme azotemia, it raises questions about long-term outcomes. What are the potential long-term consequences of such severe renal failure?

• Increased risk of cardiovascular disease
• Potential for chronic neurological deficits
• Challenges in achieving stable renal function
• Psychological impact of near-death experience
• Increased risk of future rejection episodes

Long-term follow-up of patients who survive such extreme cases of azotemia could provide valuable insights into the resilience of the human body and the potential for recovery.

Research Opportunities

This case opens up several avenues for future research:

1. Identifying biomarkers predictive of extreme creatinine elevation
2. Developing targeted therapies to protect organs during severe azotemia
3. Investigating the neurological sequelae of extreme uremia
4. Optimizing dialysis protocols for patients with record-high creatinine levels
5. Exploring novel approaches to improve medication adherence in high-risk transplant patients

Such research could lead to improved management strategies and outcomes for patients with severe renal failure.

The Role of Race and Genetics in Creatinine Levels

This case involves an African American patient, which raises questions about the role of race and genetics in creatinine levels and kidney function. How do these factors influence creatinine production and clearance?

Several studies have shown that African Americans tend to have higher baseline creatinine levels compared to other racial groups. This is attributed to several factors:

• Higher average muscle mass
• Differences in dietary habits
• Genetic variations in creatinine metabolism and excretion
• Higher prevalence of certain kidney diseases

These differences have led to the development of race-specific equations for estimating glomerular filtration rate (GFR) based on serum creatinine levels.

Controversies and Evolving Perspectives

Recent discussions in the medical community have questioned the use of race in GFR estimation equations. Why is this approach being reconsidered?

1. Race is a social construct, not a biological one
2. Genetic diversity within racial groups is greater than between them
3. Use of race in medical algorithms may perpetuate health disparities
4. Growing recognition of the need for more personalized medicine approaches

As a result, there’s a growing movement towards race-neutral approaches to estimating kidney function, which may have implications for how we interpret creatinine levels in diverse patient populations.

Lessons for Transplant Centers and Healthcare Systems

This case highlights several important lessons for transplant centers and healthcare systems. What can be done to prevent similar cases of severe acute rejection and renal failure?

• Implement robust medication adherence monitoring programs
• Develop early warning systems for detecting non-adherence
• Provide comprehensive, ongoing patient education
• Ensure access to mental health support for transplant recipients
• Create systems for rapid intervention in cases of suspected rejection

By implementing these measures, healthcare systems can work to prevent cases of severe acute rejection and potentially life-threatening complications.

The Importance of a Multidisciplinary Approach

Managing complex transplant patients requires a coordinated effort from multiple specialties. Who should be involved in the care of these high-risk patients?

1. Transplant nephrologists
2. Transplant surgeons
3. Pharmacists specializing in transplant medications
4. Mental health professionals
5. Social workers
6. Nurse coordinators
7. Dietitians

This multidisciplinary approach ensures that all aspects of the patient’s care are addressed, from medical management to psychosocial support.

Ethical Considerations in Extreme Medical Cases

Cases like this one often raise ethical questions about resource allocation and the limits of medical intervention. What are some of the ethical considerations in managing patients with extreme azotemia?

• Balancing the potential for recovery against the risk of futile interventions
• Addressing issues of medication non-adherence and repeat transplantation
• Ensuring equitable access to life-saving treatments like emergency dialysis
• Managing family expectations and hopes in the face of severe illness
• Considering the broader impact on healthcare resources and other patients

These ethical dilemmas require careful consideration and often benefit from the input of clinical ethicists and ethics committees.

The Role of Advance Care Planning

Cases of extreme illness underscore the importance of advance care planning. How can healthcare providers facilitate these discussions with transplant patients?

1. Initiate conversations about goals of care early in the transplant process
2. Regularly update advance directives and healthcare proxies
3. Discuss potential complications and limitations of treatment
4. Explore patient values and preferences regarding quality of life
5. Involve family members or caregivers in these discussions when appropriate

By addressing these issues proactively, healthcare providers can ensure that patient wishes are respected, even in extreme medical situations.

The Future of Kidney Transplantation and Monitoring

As medical technology advances, new possibilities are emerging for monitoring transplant patients and preventing severe complications. What innovations might shape the future of kidney transplantation?

• Wearable devices for continuous creatinine monitoring
• Artificial intelligence algorithms to predict rejection events
• Gene therapy approaches to reduce the need for immunosuppression
• 3D-printed organs to increase the availability of transplants
• Telemedicine platforms for remote monitoring and intervention

These technological advancements hold the potential to revolutionize transplant care and prevent cases of extreme azotemia like the one described in this report.

Challenges and Opportunities

While these innovations offer exciting possibilities, they also present challenges. What are some of the hurdles in implementing these new technologies?

1. Ensuring accuracy and reliability of new monitoring devices
2. Addressing privacy concerns with continuous health data collection
3. Integrating new technologies into existing healthcare systems
4. Managing the cost of cutting-edge treatments and devices
5. Training healthcare providers in the use of new technologies

Overcoming these challenges will require collaboration between medical professionals, researchers, technologists, and policymakers.

Highest Recorded Serum Creatinine – PMC

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• Case Rep Nephrol
• v.2021; 2021
• PMC8531789

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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.

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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.

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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.