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Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance01:25

Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance

In healthy individuals, serum creatinine levels remain stable due to a balance between its constant production—primarily from muscle metabolism—and renal excretion. Creatinine is freely filtered by the glomeruli, making it a valuable marker for estimating renal function. When the glomerular filtration rate (GFR) decreases, the kidneys can only eliminate less creatinine, causing serum levels to rise.Serum creatinine concentration is widely used to estimate creatinine clearance (Clcr), a...
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Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area. This equation is...
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Serum Studies: Renal Function Tests

Renal function tests are crucial for assessing kidney health, monitoring disease progression, and evaluating the kidneys' efficiency in waste elimination, fluid balance, and electrolyte regulation. These tests offer critical insights into kidney function, even though routine measurements may appear normal until there is a significant decline in the glomerular filtration rate or GFR. Typically, signs of kidney impairment only become evident when the GFR falls to about 50% of its normal level.
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Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
Diabetic Ketoacidosis l: Introduction01:25

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Diabetic ketoacidosis (DKA) is a metabolic emergency characterized by hyperglycemia, ketonemia, and metabolic acidosis. It results from severe insulin deficiency and an excess of counterregulatory hormones, leading to uncontrolled lipolysis, ketogenesis, and widespread electrolyte and fluid disturbances.Pathophysiology The central event in DKA is a profound loss of insulin action. Without insulin, glucose uptake in insulin-dependent tissues is impaired, while hepatic glucose production...

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Murine Renal Transplantation Procedure
18:48

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Spurious serum creatinine elevations in ketoacidosis.

M E Molitch, E Rodman, C A Hirsch

    Annals of Internal Medicine
    |August 1, 1980
    PubMed
    Summary

    Diabetic ketoacidosis can falsely elevate creatinine levels due to acetoacetate interference in automated tests. A manual method is recommended for accurate assessment of kidney function in these patients.

    Area of Science:

    • Biochemistry
    • Nephrology
    • Endocrinology

    Background:

    • Diabetic ketoacidosis (DKA) commonly presents with volume depletion and prerenal azotemia.
    • Elevated creatinine and blood urea nitrogen (BUN) levels are typical indicators of kidney dysfunction.

    Observation:

    • A case study and chart review revealed disproportionately elevated creatinine compared to BUN in DKA patients.
    • This suggested potential true renal insufficiency upon admission.

    Findings:

    • Further investigation indicated that elevated creatinine levels were largely artifactual.
    • Acetoacetate interference in automated creatinine assays was identified as the primary cause.
    • A manual assay, excluding interfering chromagens, demonstrated accurate creatinine measurement without interference.

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    Implications:

    • Automated creatinine assays may overestimate renal impairment in DKA patients.
    • Accurate creatinine measurement is crucial for diagnosing coexistent renal insufficiency.
    • Manual creatinine testing is recommended for patients admitted with ketoacidosis to ensure reliable assessment of kidney function.