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Journal ArticleDOI

Serum creatinine as an index of renal function: new insights into old concepts.

01 Oct 1992-Clinical Chemistry (American Association for Clinical Chemistry)-Vol. 38, Iss: 10, pp 1933-1953
TL;DR: The fundamental principles of physiology, metabolism, and analytical chemistry that are necessary to correctly interpret the serum creatinine concentration are reviewed and applied to important clinical circumstances, including aging, pregnancy, diabetes mellitus, drug administration, and acute and chronic renal failure.
Abstract: The serum creatinine concentration is widely interpreted as a measure of the glomerular filtration rate (GFR) and is used as an index of renal function in clinical practice. Glomerular filtration of creatinine, however, is only one of the variables that determines its concentration in serum. Alterations in renal handling and metabolism of creatinine and methodological interferences in its measurement may have a profound impact on the serum concentration of creatinine. We review the fundamental principles of physiology, metabolism, and analytical chemistry that are necessary to correctly interpret the serum creatinine concentration. These principles are then applied to important clinical circumstances, including aging, pregnancy, diabetes mellitus, drug administration, and acute and chronic renal failure. Despite numerous limitations, serum creatinine remains a useful clinical tool, but more accurate measures of renal function are frequently necessary.
Citations
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Journal ArticleDOI
TL;DR: The CKD-EPI creatinine equation is more accurate than the Modification of Diet in Renal Disease Study equation and could replace it for routine clinical use.
Abstract: The Modification of Diet in Renal Disease (MDRD) Study equation underestimates glomerular filtration rate (GFR) in patients with mild kidney disease. Levey and associates therefore developed and va...

18,691 citations


Cites background from "Serum creatinine as an index of ren..."

  • ...These variables are associated with muscle mass, the main determinant of creatinine generation (39)....

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Journal ArticleDOI
TL;DR: The purpose of this study was to develop an equation from MDRD Study data that could improve the prediction of GFR from serum creatinine concentration, and major clinical decisions in general medicine, geriatrics, and oncology are made by using the Cockcroft-Gault formula and other formulas to predict the level of renal function.
Abstract: The serum creatinine concentration is widely used as an index of renal function, but this measure is affected by factors other than the glomerular filtration rate (GFR). This study examined an equa...

14,711 citations

Journal Article
TL;DR: In the early 1990s, the National Kidney Foundation (K/DOQI) developed a set of clinical practice guidelines to define chronic kidney disease and to classify stages in the progression of kidney disease.

10,265 citations

Journal ArticleDOI
TL;DR: The Acute Kidney Injury Network (AKI Network) as discussed by the authors is a multidisciplinary collaborative network focused on AKI, which was established to improve care for patients with or at risk for AKI.
Abstract: Acute kidney injury (AKI) is a complex disorder for which currently there is no accepted definition. Having a uniform standard for diagnosing and classifying AKI would enhance our ability to manage these patients. Future clinical and translational research in AKI will require collaborative networks of investigators drawn from various disciplines, dissemination of information via multidisciplinary joint conferences and publications, and improved translation of knowledge from pre-clinical research. We describe an initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI. Members representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI participated in a two day conference in Amsterdam, The Netherlands, in September 2005 and were assigned to one of three workgroups. Each group's discussions formed the basis for draft recommendations that were later refined and improved during discussion with the larger group. Dissenting opinions were also noted. The final draft recommendations were circulated to all participants and subsequently agreed upon as the consensus recommendations for this report. Participating societies endorsed the recommendations and agreed to help disseminate the results. The term AKI is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria for AKI are proposed based on acute alterations in serum creatinine or urine output. A staging system for AKI which reflects quantitative changes in serum creatinine and urine output has been developed. We describe the formation of a multidisciplinary collaborative network focused on AKI. We have proposed uniform standards for diagnosing and classifying AKI which will need to be validated in future studies. The Acute Kidney Injury Network offers a mechanism for proceeding with efforts to improve patient outcomes.

5,669 citations

01 Mar 2007
TL;DR: An initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI is described.
Abstract: Acute kidney injury (AKI) is a complex disorder for which currently there is no accepted definition. Having a uniform standard for diagnosing and classifying AKI would enhance our ability to manage these patients. Future clinical and translational research in AKI will require collaborative networks of investigators drawn from various disciplines, dissemination of information via multidisciplinary joint conferences and publications, and improved translation of knowledge from pre-clinical research. We describe an initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI. Members representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI participated in a two day conference in Amsterdam, The Netherlands, in September 2005 and were assigned to one of three workgroups. Each group's discussions formed the basis for draft recommendations that were later refined and improved during discussion with the larger group. Dissenting opinions were also noted. The final draft recommendations were circulated to all participants and subsequently agreed upon as the consensus recommendations for this report. Participating societies endorsed the recommendations and agreed to help disseminate the results. The term AKI is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria for AKI are proposed based on acute alterations in serum creatinine or urine output. A staging system for AKI which reflects quantitative changes in serum creatinine and urine output has been developed. We describe the formation of a multidisciplinary collaborative network focused on AKI. We have proposed uniform standards for diagnosing and classifying AKI which will need to be validated in future studies. The Acute Kidney Injury Network offers a mechanism for proceeding with efforts to improve patient outcomes.

5,467 citations

References
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Journal ArticleDOI
01 Jan 1976-Nephron
TL;DR: A formula has been developed to predict Creatinine clearance from serum creatinine (Scr) in adult males: Ccr = (140 – age) (wt kg)/72 × Scr (mg/100ml) (15% less i).
Abstract: A formula has been developed to predict creatinine clearance (Ccr) from serum creatinine (Scr) in adult males: Ccr = (140 – age) (wt kg)/72 × Scr(mg/100ml) (15% less i

14,211 citations


"Serum creatinine as an index of ren..." refers background or methods in this paper

  • ...Perhaps the simplest, and therefore the most widely used, is the formula of Cockcroft and Gault (32) for creatinine clearance (Ccr) in males: Cci, = [140 -age (years)] x weight ( kg)1/ [7.2 x serum creatinine (mgJL)] This...

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  • ...Perhaps the simplest, and therefore the most widely used, is the formula of Cockcroft and Gault (32) for creatinine...

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  • ...Numerous formulas and nomograms have been developed for estimating creatinine clearance from the serum creatinine concentration, thereby bypassing the need for urine collection (32-40)....

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  • ...The larger muscle mass of men accounts for the greater creatinine production and renal excretion in them than in women (32)....

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Journal ArticleDOI
TL;DR: With the development and increasingly widespread availability of dialysis and transplantation in the past three decades, relatively little attention has been paid to the influence of diet on the progression of renal disease, despite general awareness that renal disease typically follows an inexorably progressive course.
Abstract: IT is now more than 30 years since Addis suggested that protein intake be restricted in patients with chronic renal insufficiency.1 His aim was not to reduce uremic symptoms but rather to prevent a...

2,020 citations


"Serum creatinine as an index of ren..." refers background in this paper

  • ...(132, 187) have suggested that the progressive nature of renal disease is the...

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  • ...The cause of these lesions is not known, but it is hypothesized that they are related to generalized arteriosclerosis, the higher blood pressure observed in older populations, and a lifetime of excessive intake of dietary protein (131-133)....

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Journal ArticleDOI

2,005 citations


"Serum creatinine as an index of ren..." refers background in this paper

  • ...This reaction is well-characterized with regard to its attributes and limitations (95)....

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Journal ArticleDOI
TL;DR: Serial creatinine clearances were obtained for 446 normal volunteers in the Baltimore Longitudinal Study of Aging followed between 1958 and 1981 and there was a small group of patients who showed a statistically significant increase (P < 0.05) in Creatinine clearance with age.
Abstract: Serial creatinine clearances (5 to 14 studies) were obtained for 446 normal volunteers in the Baltimore Longitudinal Study of Aging followed between 1958 and 1981. When those subjects with possible renal or urinary tract disease and subjects on diuretics and antihypertensives were removed from the study, leaving a group of 254 "normal" subjects, the mean decrease in creatinine clearance was 0.75 ml/min/year. The slopes of the creatinine clearance vs. time fell into a normal (Gaussian) distribution around this mean. One third of all subjects followed had no absolute decrease in renal function (positive slope of creatinine clearance vs. time) and there was a small group of patients who showed a statistically significant increase (P less than 0.05) in creatinine clearance with age.

1,433 citations


"Serum creatinine as an index of ren..." refers background in this paper

  • ...73 m2 per decade after age 40 years (135-137)....

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Journal ArticleDOI
TL;DR: It is concluded that true filtration markers with rs less than 20 A, including inulin, are unrestricted in glomerular disease, and that creatinine is hypersecreted progressively by remnant renal tubules as the disease worsens.

1,182 citations


"Serum creatinine as an index of ren..." refers background or result in this paper

  • ...Tubular secretion of creatinine is known to be enhanced, resulting in maintenance of creatiine clearance at a higher value than the GFR (18)....

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  • ...Despite the description of tubular creatinine secretion more than half a century ago (13) and its recent reemphasis (18), this contribution to creatiine excretion and the resulting overestimation of GFR have largely been ignored....

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  • ...ance due to tubular secretion), however, appears greatest at GFRs from 40 to 80 mL/min and decreases at lower GFRs (18,199,201) (Table 3)....

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  • ...Hence, we suggest, as have others (18, 28-31), that measurement of creati....

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  • ...study (18), patients with progression of glomerular disease, as evidenced by worsening proteinuria and...

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Trending Questions (1)
What determines plasma creatinine concentration?

The paper does not directly answer the question of what determines plasma creatinine concentration. The paper discusses the limitations and factors that can affect the serum creatinine concentration, but it does not provide a comprehensive explanation of what determines it.