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L-Arginine, ADMA, SDMA, creatinine, MDRD formula: detour to renal function testing
Jan T Kielstein1, Jens Martens-Lobenhoffer, Stefan Vollmer
1Department of Nephrology, Medical School Hannover, Hannover - Germany. kielstein@yahoo.com
Journal of Nephrology
|November 27, 2008
Summary
Elevated symmetrical dimethylarginine (SDMA) indicated chronic kidney disease missed by normal serum creatinine. Routine glomerular filtration rate testing is crucial for accurate diagnosis.
Area of Science:
- Nephrology
- Clinical Chemistry
Background:
- Serum creatinine is a common biomarker for kidney function.
- L-arginine supplementation is sometimes pursued for non-evidence-based reasons.
- Symmetrical dimethylarginine (SDMA) is an emerging biomarker for kidney function.
Observation:
- A 50-year-old woman presented with suspected L-arginine deficiency.
- Laboratory work-up revealed elevated SDMA levels.
- Chronic kidney disease (CKD) was diagnosed based on elevated SDMA, despite a normal serum creatinine.
Findings:
- Normal serum creatinine can mask early-stage chronic kidney disease.
- Elevated SDMA is a sensitive indicator of reduced kidney function.
- Non-evidence-based treatments may delay or obscure proper diagnosis.
Implications:
- Routine glomerular filtration rate (GFR) estimation should accompany serum creatinine tests.
- Physicians and patients should prioritize evidence-based diagnostic approaches.
- SDMA warrants consideration as a routine biomarker for renal function assessment.
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