Serum creatinine alone is not adequate - Serum creatinine levels reflect muscle mass, age, gender, and race.
- A typical “normal” reference range of 0.6–1.2 mg/dL listed on many lab reports does not account for muscle mass, age, gender, and race.
- A 28-year-old African American man with serum creatinine of 1.2 has an eGFR > 60.
- A 78-year-old white woman with serum creatinine of 1.2 has an eGFR of 43.
Creatinine-based estimates of kidney function have limitations - Results may be inaccurate with:
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- Rapidly changing creatinine levels
- Example: acute kidney injury
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- Extremes in muscle mass, body size, or altered diet patterns
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- Medications that interfere with the measurement of serum creatinine
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- Use of creatine supplements
Decreased kidney function versus kidney disease - Estimating equations are less reliable at higher GFR.
- Kidney function declines with age.
- While there is an association between decreased eGFR and morbidity, even in elderly, this association does not mean causality.
- Use diagnostic terms denoting disease with caution, especially in older people without evidence of kidney damage (e.g. elderly with eGFR 55).
Kidney function and eGFR decline with age - Reference Table for Population Mean eGFR from NHANES III
| - Mean eGFR (mL/min/1.73 m2)
| | | | | | | | | | | | | - In healthy kidney donors the number of glomeruli per kidney decrease 25% by age 60-69 and GFR declines proportionately.
- Reference: Coresh et al. Am J of Kidney Dis. 2003;41(1):1–12.
- Denic et al. J Am Soc Nephrol. 2017;28(1):313–320.
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