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Urinary free corticosteroid excretion and renal function.

J Gilliland, P J Phillips

    Journal of Clinical Pathology
    |July 1, 1978
    PubMed
    Summary
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    Urinary free corticosteroid excretion correlates with renal function, potentially impacting hypercortisolaemia diagnosis. A short dexamethasone test is recommended for patients with suspected hypercortisolaemia and abnormal kidney function.

    Area of Science:

    • Endocrinology
    • Nephrology
    • Clinical Chemistry

    Background:

    • Urinary free corticosteroid excretion is a marker for hypercortisolaemia.
    • Renal function can influence urinary analyte excretion.
    • The impact of renal function on urinary free corticosteroid measurements is not fully elucidated.

    Purpose of the Study:

    • To investigate the relationship between renal function and urinary free corticosteroid excretion.
    • To assess the utility of urinary free corticosteroid measurements as an index of hypercortisolaemia in patients with varying renal function.

    Main Methods:

    • Analysis of 28 consecutive urine samples.
    • Measurement of urinary free corticosteroid excretion.
    • Determination of creatinine clearance to assess renal function.

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    Main Results:

    • A significant positive correlation (r = 0.83; P < 0.001) was observed between urinary free corticosteroid excretion and creatinine clearance across a wide range (0.3-200 ml/min).
    • While renal function adjustment is possible, it may not improve diagnostic discrimination between normal and abnormal states.
    • The study highlights the potential for renal impairment to affect the interpretation of urinary free corticosteroid levels.

    Conclusions:

    • Urinary free corticosteroid excretion is significantly influenced by renal function.
    • Adjusting for renal function may not enhance the diagnostic accuracy for hypercortisolaemia.
    • In patients with suspected hypercortisolaemia and abnormal plasma creatinine, a short dexamethasone test is advised as the initial diagnostic step.