A Healthy Active Duty Soldier with an Elevated Serum Creatinine

Tobin, Trevor W; Thurlow, John S.; Yuan, Christina M.

doi:10.1093/milmed/usab163

Cited by 1 publication

(1 citation statement)

References 5 publications

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“…These findings may not be uncommon given that 65% of active-duty military use protein supplements and 38% use other performanceenhancing supplements, such as creatine, according to a study. 25 Unfortunately, the BMP/CMP traditionally used at VA centers use the eGFR Cr equation, and it is unknown how many primary care practitioners recognize the limitations of these metabolic panels on accurate estimation of kidney function. However, in 2022 an expert panel including VA physicians recommended the immediate use of eGFR Cr-Cys or eGFR Cys for confirmatory testing and potentially screening of CKD.…”

Section: Discussionmentioning

confidence: 99%

My Kidney Is Fine, Can't You Cystatin C?

Beckstead

2024

Federal Practitioner

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Background: Independent of age, sex, and body composition, individuals of African American race and individuals with high muscle mass have elevated serum creatinine (sCr) levels on average that may result in overestimation of chronic kidney disease (CKD). We present a misdiagnosed case of CKD based on sCr levels, illustrating the utility of cystatin C (CysC) confirmation testing to answer the question: Can confirmation screening of kidney function with CysC in African American patients and patients with high muscle mass reduce the misdiagnosis of CKD? Case Presentation: A 35-year-old African American man with a history of well-controlled HIV was found to have consistently elevated creatinine (Cr). We diagnosed CKD stage 3A based on the estimated glomerular filtration rate (eGFR). Further evaluation showed isolated elevation of sCr with unremarkable urinalysis and other laboratory tests. sCr elevation predated diagnosis and HIV treatment. A CysC-based eGFR (eGFR cys ) test confirmed the absence of CKD. Conclusions: The 2009 CKD Epidemiology Collaboration calculation of eGFR based on sCr concentration uses age, sex, and race, with an updated recommendation in 2021 to exclude race. Both equations are less accurate in African American patients, individuals taking medications that interfere with sCr secretion and assay, and patients taking creatine supplements or high protein intake. These clinical scenarios decrease sCr-based eGFR (eGFR Cr ) but do not change measured eGFR or eGFR Cys . Using sCr and serum cystatin C (eGFR Cr-Cys ) yields better concordance to measured eGFR across all races than does eGFR estimation based on Cr alone. Confirmation with CysC can avoid misdiagnosis, incorrect dosing of drugs, and inaccurate representation of the fitness for duty.

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Section: Discussionmentioning

confidence: 99%

My Kidney Is Fine, Can't You Cystatin C?

Beckstead

2024

Federal Practitioner

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A Healthy Active Duty Soldier with an Elevated Serum Creatinine

Cited by 1 publication

References 5 publications

My Kidney Is Fine, Can't You Cystatin C?

My Kidney Is Fine, Can't You Cystatin C?

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