Spurious Serum Creatinine Elevations in Ketoacidosis

In May 2004, a new classification, the RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) classification, was proposed in order to define and stratify the severity of acute kidney injury (AKI). This system relies on changes in the serum creatinine (SCr) or glomerular filtration rates and/or urine output, and it has been largely demonstrated that the RIFLE criteria allows the identification of a significant proportion of AKI patients hospitalized in numerous settings, enables monitoring of AKI severity, and is a good predictor of patient outcome. Three years later (March 2007), the Acute Kidney Injury Network (AKIN) classification, a modified version of the RIFLE, was released in order to increase the sensitivity and specificity of AKI diagnosis. Until now, the benefit of these modifications for clinical practice has not been clearly demonstrated.Here we provide a critical and comprehensive discussion of the two classifications for AKI, focusing on the main differences, advantages and limitations.

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“…acetoacetate accumulated in diabetic ketoacidosis can interfere with the alkaline picrate method), causing a false elevation in SCr [32];…”

Section: The Rifle Classificationmentioning

confidence: 99%

The RIFLE and AKIN classifications for acute kidney injury: a critical and comprehensive review

2013

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“…In ketoacidosis, elevated levels of acetoacetate may increase the serum creatinine measurement by as much as 2.2 mgjdl (57,58). Numerous cephalosporins (cephalothin, cefazolin, cefoxitin, and cefa mandole) also may contribute to the colorimetric reaction (59)(60)(61).…”

Section: Creatinine Measurementmentioning

confidence: 99%

Serum Creatinine and Renal Function

Levey

Perrone²,

Madias³

1988

Annu. Rev. Med.

490

193

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Serum creatinine is widely interpreted as a measure only of renal function; however, the serum level reflects not only renal excretion, but also the generation, intake, and metabolism of creatinine. In this review, we demonstrate that serum creatinine does not provide an adequate estimate of glomerular filtration rate (GFR), and contrary to recent teachings, that the slope of the reciprocal of serum creatinine vs time does not permit an accurate assessment of the rate of progression of renal disease. In clinical investigation, it is essential to utilize more accurate and sensitive measures of renal function to estimate GFR and progression. As effective treatments for progressive renal diseases are discovered, it will also be necessary to employ these measurements in clinical practice.

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“…Drugs that can interfere with the assay include antibiotics such as cephalosporins, specifically cefoxitin and cefazolin; barbiturates; N-acetylcyteine; and chemotherapeutic agents such as flucytosine (although by a different assay: the Kodak Ektachem method). 4,5 Another material known to interfere with the Jaffe reaction is nitromethane, a common component of radiocontrolled-vehicle fuels.…”

Section: Interference With the Assaymentioning

confidence: 99%

False Estimates of Elevated Creatinine

Samra¹,

Abcar²

2012

TPJ

106

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One of the most common reasons for a nephrology consult is an elevated creatinine. An elevation in the serum creatinine concentration usually reflects a reduction in the glomerular filtration rate (GFR). Given the association of elevated creatinine and risk of cardiovascular mortality, it is important to keep in mind that at times the elevation of the creatinine is not representative of a true reduction in GFR. There are various causes of factitious elevation of creatinine. They can be broadly grouped into increased production of creatinine, interference with the assay and decreased tubular secretion of creatinine.

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Spurious Serum Creatinine Elevations in Ketoacidosis

Cited by 69 publications

References 6 publications

The RIFLE and AKIN classifications for acute kidney injury: a critical and comprehensive review

The RIFLE and AKIN classifications for acute kidney injury: a critical and comprehensive review

Serum Creatinine and Renal Function

False Estimates of Elevated Creatinine

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