Navigating an unexpected creatinine result during a pre-intravenous contrast renal function workup.

Area of Science:

• Clinical Chemistry
• Diagnostic Imaging
• Nephrology

Background:

• Rising chronic disease rates increase demand for contrast-enhanced imaging.
• Pre-procedure renal assessment is crucial for patients with predisposing factors to mitigate contrast-induced neuropathy risk.
• Point-of-care creatinine testing often produces ambiguous results, causing delays and patient anxiety.

Observation:

• A 61-year-old male with diabetes, hypertension, and chronic kidney disease had a point-of-care creatinine result slightly above the normal range.
• A subsequent laboratory-based test showed a significantly lower creatinine level, within the normal range.
• This discrepancy prompted further investigation into the patient's renal function and assay variability.

Findings:

• Patient-centered metrics, including index of individuality and reference change value, were used for comprehensive analysis.
• These metrics confirmed the patient's renal health and resolved concerns regarding the assay result disparity.
• The allowable error limit for creatinine assay results was not exceeded.

Implications:

• Accurate renal function assessment is vital for safe intravenous contrast administration.
• Advanced analytical methods can resolve ambiguous point-of-care test results.
• Timely diagnostic imaging can be facilitated by reliable renal function evaluation, improving patient outcomes and healthcare efficiency.