Serum Creatinine May Not Be an Accurate Marker of Glomerular Filtration Rate in Rhabdomyolysis Patient
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AbstractKuhlbäck, B., Pasternack, A., Launiala, K. & Stenberg, M. Serum Creatine and Creatinine in Children and Adolescents. Scand. J. clin. Lab. Invest. 22, 37-40, 1968. The creatine and creatinine concentration in the serum was studied in 229 children and adolescents aged 0-19 years. Almost normal adult values were recorded immediately after birth. At the age of half a year to 15 years the serum creatine level was high and the serum creatinine level was low. A steady decrease in serum creatine and increase in creatinine was observed. The ratio creatine/creatinine did not drop to under 1 until the age of 14-15 years. Completely normal adult values were only noted in those aged 16-20 years. The possible causes of these changes are discussed. The low serum creatinine concentration in children should be borne in mind on evaluating renal function and its possible changes in childhood.Key Words: Adolescentschildhoodcreatinecreatininerenal function
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A survey of the creatine and creatinine excretion of large numbers of mentally defective patients in circumstances which precluded both keeping them on creatine-free diet and the obtaining of 24-hour specimens, led Penrose and Pugh (1939) to the use of the creatine creatinine ratio in early morning specimens of urine as an index of the metabolism of these substances in each patient, as compared with controls. The use of the ratio was found to yield results of qualitative significance. Patients suffering from conditions known to affect creatine-creatinine metabolism, such as muscular dystrophies, diplegias, and hyperthyroidism, were readily picked out, and the creatinuria of children was marked; conclusions could be drawn as to the creatine-creatinine metabolism in certain other conditions. In the above survey the numbers allowed of statistical treatment to a considerable extent, and this confirmed the validity of the conclusions drawn from the ratio.
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ARECENT TEXT on biochemistry states that creatinine is a useless waste product and when ingested most of it is excreted into the urine. It further states that about one third of the body creatine is changed into creatinine and that the sex hormones are involved in this process (I). These views have long been accepted in the field of creatine creatinine metabolism and are derived chiefly from the fact that women and children are known to excrete some creatine while men usually do not. The sex hormones, however, do not effect the change of creatine into creatinine, even if creatine were transformed into creatinine. This is shown by the fact that almost as much creatinine is excreted in women as compared to men in 24-hour periods. We have shown that the so called constancy in creatinine elimination in both sexes is not due to body weight or muscle weight but to a uniform protein.
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OBJECTIVE: To examine the effect of creatine supplementation on renal function and estimates of creatinine clearance. DATA SOURCES: A MEDLINE search was conducted (1966—September 2004) using the key terms creatine, creatinine, kidney function tests, drug toxicity, and exercise. Relevant articles were cross-referenced to screen for additional information. DATA SYNTHESIS: Supplementation with creatine, an unregulated dietary substance, is increasingly common in young athletes. To date, few studies have evaluated the impact of creatine on renal function and estimates of creatinine clearance. Because creatine is converted to creatinine in the body, supplementation with large doses of creatine may falsely elevate creatinine concentrations. Five studies have reported measures of renal function after acute creatine ingestion and 4 after chronic ingestion. All of these studies were completed in young healthy populations. Following acute ingestion (4–5 days) of large amounts of creatine, creatinine concentrations increased slightly, but not to a clinically significant concentration. Creatinine is also only minimally affected by longer creatine supplementation (up to 5.6 y). CONCLUSIONS: Creatine supplementation minimally impacts creatinine concentrations and renal function in young healthy adults. Although creatinine concentrations may increase after long periods of creatine supplementation, the increase is extremely limited and unlikely to affect estimates of creatinine clearance and subsequent dosage adjustments. Further studies are required in the elderly and patients with renal insufficiency.
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Abstract. Serum and urinary creatine and creatinine have been studied in eight patients with paralytic poliomyelitis. The serum and urinary creatine concentrations were strikingly high, while the corresponding creatinine concentrations were extremely low. The creatine/creatinine ratio showed an obvious change in both the serum and urine as compared to normal control values. The cause of the changes observed and their clinical implications are discussed.
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When muscle tissue is allowed to autolyze, creatine is transformed to creatinine at a constant rate. The velocity of this reaction increases with a rise in temperature, although practically negligible at 0° C. The rate of formation at body temperature is nearly sufficient to account for the daily elimination of creatinine. The velocity of the reaction is increased by acids but not reduced by Henderson's neutral phosphate mixture. Added creatine experiences the same fate as the creatine originally present, while added creatinine inhibits the reaction, or if added in sufficient quantity causes it to proceed in the opposite direction. Pure solutions of creatine and creatinine experience the same transformations, although much more slowly. On the long standing of pure solutions there seems to be a slight loss in total creatinine (from both creatine and creatinine). This appears to be due in part to a transformation to urea. Whether or not these phenomena are vital factors in the formation of creatinine in the body, we are unprepared to say. To obtain further light on this point, experiments have been conducted on nephrectomized animals. The creatine and creatinine content of the various body tissues have been determined several days after a double nephrectomy. In certain of these experiments creatine and creatinine have been injected. Some what similar deductions may be drawn from our experiments in vivo to those in vitro; although there are certain differences between the two types of experiments, the significances of which are not as yet entirely clear to us.
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