creatinine, blood (Serum creatinine) Type of test: Blood Adult Female: 0.5-1.

1 mg/dL or 44-97 mol/L (SI units) Adult Male: 0.6-1.2 mg/dL or 53-106 mol/L (SI units) Elderly: decrease in muscle mass may cause decreased values Possible critical values: >4 mg/dL (indicates serious impairment in renal function) Drugs that may increase creatinine values include ACE inhibitors, aminoglycosides (e.g., gentamicin), cimetidine, heavy-metal chemotherapeutic agents (e.g., cisplatin), and other nephrotoxic drugs, such as cephalosporins (e.g., cefoxitin). Increased levels: Glomerulonephritis, Pyelonephritis, Acute tubular necrosis, Urinary tract obstruction, Reduced renal blood flow (e.g., shock, dehydration, congestive heart failure, atherosclerosis), Diabetic nephropathy, Nephritis, Rhabdomyolysis, Acromegaly, Gigantism Decreased levels: Debilitation, Decreased muscle mass (e.g., muscular dystro- phy, myasthenia gravis) Procedure and patient care Before: Explain the procedure to the patient. Tell the patient that no fasting is required. During: Collect a venous blood sample in a red-top tube. For pediatric patients, blood is usually drawn from a heel stick. After: Apply pressure to the venipuncture site.

creatinine, blood (Serum creatinine) Type of test: Blood This test measures the amount of creatinine in the blood. Creatinine is a catabolic product of creatine phosphate, which
is used in skeletal muscle contraction. The daily production of creatine, and subsequently creatinine, depends on muscle mass, which fluctuates very little. Creatinine, as with blood urea nitrogen (BUN, see p. 944), is excreted entirely by the kidneys and therefore is directly proportional to renal excretory function. Thus, with normal renal excretory function, the serum creatinine level should remain constant and normal. Besides dehydration, only such renal disorders as glomerulonephritis, pyelonephritis, acute tubular necrosis, and urinary obstruction will cause abnormal elevations in creatinine. There are slight increases in creatinine levels after meals, especially after ingestion of large quantities of meat. Furthermore, there may be some diurnal variation in creatininenadir at 7 am and peak at 7 pm. The serum creatinine test, as with BUN, is used to diagnose impaired renal function. Unlike BUN, however, the creatinine level is affected very little by hepatic function. The creatinine test is used as an approximation of glomerular filtration rate (GFR). The serum creatinine level has much the same significance as the BUN level but tends to rise later. Therefore, elevations in creatinine suggest chronicity of the disease process. In general, a doubling of creatinine suggests a 50% reduction in GFR. The creatinine level is interpreted in conjunction with the BUN test. These tests are referred to as renal function studies. The BUN/creatinine ratio is a good measurement of kidney and liver function. The normal adult range is 6 to 25, with 15.5 being the optimal adult value for this ratio Although serum creatinine is the most commonly used biochemical parameter to estimate GFR in routine practice, there are some shortcomings. Such factors as muscle mass and protein intake can influence serum creatinine, leading to an inaccurate estimation of GFR. Moreover, in unstable, critically ill patients, acute changes in renal function can make real-time evaluation of GFR using serum creatinine difficult. On the other hand, cystatin C, a protein that is produced at a constant rate by all nucleated cells, is probably a better indicator of GFR. Because of its constant rate of production, its serum concentration is determined only by glomerular filtration. Its level is not influenced by those factors that affect creatinine and BUN. Cystatin C might predict the risk for developing chronic kidney disease, thereby signaling a state of preclinical kidney dysfunction. Several studies have found that increased levels of cystatin C are associated with the risk of death and several types of cardiovascular disease (including MI, stroke, heart failure, peripheral arterial disease, and metabolic syndrome). For women, the average reference interval is 0.52 to 0.90mg/L with a mean of 0.71mg/L. For men, the average reference interval is 0.56 to 0.98mg/L with a mean of 0.77mg/L.