Underestimation of Impaired Kidney Function with Serum Creatinine

Abstract

Serum creatinine (SCr) levels are frequently used as a screening test to assess impaired renal function; however, patients can have significantly decreased glomerular filtration rate (GFR) with normal SCr values and making the recognition of kidney dysfunction more difficult. Hence, this study was designed to determine the extent of misclassification of the patients who have significantly reduced GFR as calculated by reexpressed four variable modification of diet in renal disease (MDRD) equation but, normal range of SCr. The study included 1040 in and out patients referred by physicians for serum creatinine measurement. When an exclusion criterion was applied 928 patients were qualified for the study. SCr was measured in 928 patients by a Roche kinetic compensated Jaffe's assay. GFR was calculated using reexpressed four variable MDRD study equation. Of the 928 patients 270 (29.1%) had renal dysfunction on the basis of eGFR (\60 ml/min/1.73 m 2 ). However, with SCr only 162 (17.5%) patients had abnormal renal function ([1.5 mg/dl) and SCr values misrepresented (108) 11.6% patients with impaired kidney function. In addition, more females, about 15% were failed to detect by SCr method in contrast to males of 9%. This study documented that, a large proportion of patients with impaired renal function are not diagnosed if clinicians rely solely on normal SCr as evidence of normal renal function. Inclusion of eGFR calculated by re-expressed 4 variable MDRD equation may facilitates the early identification and intervention of patients with renal impairment.

A Profile of Renal Function in Northern Cameroonians with Essential Hypertension

“…Related data portray systemic hypertension as being second only to diabetes mellitus as a cause of end stage renal disease (ESRD). Our records of a higher prevalence of decreased eGFR compared to that of increased serum creatinine correlates with the findings of Kannapiran et al [14] who observed 29.1% prevalence of glomerular filtration ≤60 mL/min/1.73 m 2 (MDRD) and 17.5% of increased serum creatinine [14], suggesting a possible under-representation of a diminishing renal capacity with the use of serum creatinine only as the tool for evaluating renal function [15,16]. This is probably a direct effect of the processes of creatinine generation, secretion and extrarenal excretion [14,17,18].…”

Cisplatin-Based Chemotherapy Eligibility: Discrepancy Between Serum Creatinine Level and Glomerular Filtration Rate

“…However, with SCr only 162 (17.5%) patients had abnormal renal function and SCr values misrepresented 108 (11.6%) patients with impaired kidney function. This discrepancy was even more pronounced either among female or older patients (1). A probable explanation for lower discrepancy between SCr and eGFR in their study (11.6% versus 27.3% in the present study) is using MDRD equation for calculating the patients' GFRs by them.…”

“…Renal function assessment is critical in determining the eligibility or need to dose modification of nephrotoxic drugs in clinical practice (1). Measuring glomerular filtration rate (GFR) is a widely accepted index of renal function.…”

“…However, there are some situations in which patients may suffer significant renal impairment though serum creatinine levels remain within normal ranges (1,6). Despite discrepancies between serum creatinine and GFR to show normal kidney status, many oncologists continue to interpret a normal SCr level as an indicator of a normal renal function.…”

The Uncertainty of the eGFR

“…A further increase to 265 lmol/L reflects a decline of only 14 mL/min/ 1.73 m 2 [2,3]. It has been shown that 11 % of patients will have a serum creatinine in the reference range when their eGFR is \60 mL/min/1.73 m 2 [4].…”