Blood creatinine level in postmortem cases

Nishida, Atsushi; Funaki, Hironao; Kobayashi, Masaki; Tanaka, Yuka; Akasaka, Yoshihisa; Kubo, Toshikazu; Ikegaya, Hiroshi

doi:10.1016/j.scijus.2014.12.005

Cited by 17 publications

(24 citation statements)

References 18 publications

(29 reference statements)

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“…Some authors described a slight increase in creatinine 14 , which is also shown in a mouse experiment 31 , and in urea 14 , 26 , 32 after death, in line with our results. Nevertheless, both markers have been presented in literature as reliable post-mortem markers 1 , 3 , 14 , 31 and post-mortem cut-offs are used for diagnosing lethal acute kidney failure 26 . These cut-offs seem to be sufficient, since no single value of urea was above its threshold, and only one single creatinine level increased above it during the post-mortem interval.…”

Section: Discussionsupporting

confidence: 93%

Intra-individual alterations of serum markers routinely used in forensic pathology depending on increasing post-mortem interval

Woydt

Bernhard

Kirsten³

et al. 2018

Sci Rep

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Post-mortem biochemistry of serum markers has been the subject of numerous studies, but in-situ marker stability after death has not been sufficiently evaluated yet. Such laboratory analyses are especially necessary in the cases of functional deaths without morphological evidence of the death causes and also in cardiac death cases with only very short survival times. The aim of the study was to determine the post-mortem stability of commonly-used serum markers at predefined time points. In 20 cases, peripheral venous samples were taken starting immediately after circulatory arrest and ending 48 hours after death. Serum creatinine, urea, 3-β-hydroxybutyrate, tryptase, myoglobin, troponin T, creatin kinase and creatin kinase-MB have been included. For all markers, we observed increasing marker levels for longer post-mortem intervals. Significant marker level changes began two hours after death. Excessive increases were observed for cardiac and muscle markers. Marker levels showed high intra-assay precision. Furthermore, the markers were robust enough to withstand freeze-thaw cycles. Potential contamination of arteriovenous blood did not influence the post-mortem marker levels. Post-mortem blood should be sampled as soon as possible, as increased post-mortem intervals may heavily change marker levels in-situ in individual cases, whereas the markers are mostly unaffected by laboratory conditions.

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Section: Discussionsupporting

confidence: 93%

Intra-individual alterations of serum markers routinely used in forensic pathology depending on increasing post-mortem interval

Woydt

Bernhard

Kirsten³

et al. 2018

Sci Rep

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“…This can, in part, be explained by significant renal impairment in some subjects, as all subjects with creatinine clearance >30 mL/min had concentrations similar to those reported in the package insert . Creatinine, which is stable in postmortem blood for at least 3 days, was significantly correlated with tenofovir and lamivudine exposures in our study, but not with efavirenz, consistent with their respective clearance mechanisms. In addition, tenofovir and lamivudine partition into red blood cells and, therefore, drug release upon cell death is likely .…”

Section: Discussionsupporting

confidence: 80%

Cerebrospinal Fluid and Brain Tissue Penetration of Tenofovir, Lamivudine, and Efavirenz in Postmortem Tissues with Cryptococcal Meningitis

Nicol

Pastick

Taylor

et al. 2019

Clinical Translational Sci

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The central nervous system (CNS) is a known HIV reservoir, yet little is known about drug exposure in the brain. Our primary objective was to quantify exposure of three common antiretrovirals in brain tissue and compare exposures to plasma and cerebrospinal fluid (CSF). We also sought to identify pockets of brain most vulnerable to inadequate drug exposures and examine the role of meningitis in drug penetration into the CNS. Tenofovir, lamivudine, and efavirenz concentrations were measured using liquid chromatography and tandem mass spectrometry in plasma and CSF from 14 individuals with HIV, 7 with cryptococcal meningitis. In four individuals (three with meningitis) drug concentrations were also measured in 13 distinct brain tissue regions. In subjects with meningitis, geometric mean ratio (95% confidence interval) of tenofovir CSF to plasma was 66% (7–598%) and 14% (6–31%) in subjects without meningitis. Lamivudine CSF penetration was 100% (25–409%) in subjects with meningitis and 30% (24–37%) in subjects without meningitis. Tenofovir brain tissue concentrations were 36% (14–124%) of plasma and 49% (1–572%) of CSF. Lamivudine brain concentrations were 37% (23–64%) of plasma and 27% (1–104%) of CSF. Efavirenz brain tissue concentrations were 128% (108–179%) of plasma. Tissues collected postmortem provide a unique opportunity to assess drug distribution in tissues difficult to sample in living subjects. CSF is a poor surrogate for drug exposure throughout the CNS. Antiretrovirals differentially penetrate into the CNS and penetration may be enhanced by meningitis.

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“…These results may show that the death process has a larger influence on the creatinine levels than previously expected and any interpretation of post mortem creatinine should be performed with extreme caution, especially the younger age groupings (<65 years) and also in females (see fig 3). shown to increase after death from ~18 mol/L at the time of death to ~800 mol/L 2 hours after death [31]. This increase is most likely due to the release of creatinine from muscles into the blood in the early post mortem period [31,32].…”

Section: Accepted Manuscriptmentioning

confidence: 95%

“…shown to increase after death from ~18 mol/L at the time of death to ~800 mol/L 2 hours after death [31]. This increase is most likely due to the release of creatinine from muscles into the blood in the early post mortem period [31,32]. Studies have also shown the shown that serum, blood and pericardial fluid creatinine concentrations are on average higher than the creatinine clinical reference ranges [7,8,21].…”

Section: Accepted Manuscriptmentioning

confidence: 99%