Extensive tubular secretion and reabsorption of creatinine in humans

The validity of creatinine as a marker for the glomerular filtration rate was studied in 8 healthy volunteers in different stages of hydration and during large variations in urinary flow rates. The urine flow was 8.4 ml/min in a dehydrated state (due to furosemide infusion; 8 mg/h) and raised to 23.2 ml/min after rapid rehydration. The creatinine to inulin clearance ratio changed considerably from 1.47 in rehydrated state, indicating a substantial tubular secretion of creatinine, to 1.05 in dehydrated state, indicating a reabsorption of creatinine almost equal to secretion. Thus, substantial tubular secretion and reabsorption of creatinine, changing in relative importance in relation to the degree of hydration, make creatinine clearance an unreliable marker for the glomerular filtration rate.