Serum creatinine: It's source, interpretation and effect on the management of renal and hepatic diseases

Christopher M. Moore, Omar Lateef, David H. Van Thiel*

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Chronic kidney disease (CKD) comprises a spectrum of pathology with significant medical and financial burden, affecting at least 26 million individuals in the United States. The staging of CKD has implications upon the utilization of medical therapeutics and procedural interventions, including renal replacement therapies such as hemodialysis and transplantation. The ability to measure CKD is based upon many parameters, an important one being the glomerular filtration rate (GFR). The assessment of GFR, despite numerous iterations, still for practical reasons, relies heavily upon the serum creatinine level, a suboptimal marker. Creatinine exists within a complex biology wherein its serum level is affected by intrinsic factors such as age and nutritional status, and extrinsic factors such as medications and other forms of iatrogenic intervention. Furthermore, the nature of the creatinine assays themselves are non-standardized, and their ability to sense true creatinine concentrations are affected at times quite severely by non-creatinine chromogens. Unfortunately many clinical decisions are made with the simple assumption that the reported serum creatinine level truly represents an in vivo level and that by extension the severity of CKD. Beyond the immediate consequences of this assumption, the long-term consequences can be quite significant. Medical surveillance, specific pharmacologic and procedural replacement therapies, including transplantation of a kidney and simultaneous liver-kidney transplantation rest in large measure upon the serum creatinine level and its expression of kidney function. Implementation of therapy can be life-extending, however, unfortunately in other cases, medically-deserving patients are denied treatment given the limitations and/or mis-allocation of these resources based upon the same creatinine measurement. In this review, the complexities of creatinine analysis, it's evolving role in assessing kidney function, and it's ultimate effect upon renal and liver replacement therapies will be discussed.

Original languageEnglish (US)
Title of host publicationCreatinine
Subtitle of host publicationProduction, Diagnostic Uses and Role in Renal Disease
PublisherNova Science Publishers, Inc.
Pages53-70
Number of pages18
ISBN (Print)9781622574759
StatePublished - Jan 1 2013

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ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Moore, C. M., Lateef, O., & Van Thiel, D. H. (2013). Serum creatinine: It's source, interpretation and effect on the management of renal and hepatic diseases. In Creatinine: Production, Diagnostic Uses and Role in Renal Disease (pp. 53-70). Nova Science Publishers, Inc..