Underestimation of Impaired Kidney Function with Serum Creatinine |
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| Authors: | M Kannapiran D Nisha A Madhusudhana Rao |
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| Institution: | (1) Department of Biochemistry, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, 641004, Tamilnadu, India; |
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| 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 m2). 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. |
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| Keywords: | Serum creatinine Renal failure eGFR MDRD Jaffe’s assay |
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