The feedback from high creatinine or hypercreatininemia and often symptom kidney failure, which can be acute or chronic. There main causes of high creatinine are the presence of hypertension, diabetes, dehydration or the use of substances harmful to the kidneys. THE symptoms of elevated blood creatinine they are multiple and depend on the underlying disease.
What is creatinine?
What is creatinine? There creatinine it is a waste molecule that is generated during muscle metabolism. Creatinine is produced from creatine, a molecule essential for the production of energy in the muscles.
Approximately 2% of creatine is converted into creatinine in our body every day. Creatinine is then transported through the bloodstream to the organs responsible for its elimination, i kidneys. Kidneys filter most of the creatinine present in the blood and excrete it in the urine.
Since the muscle mass of our body is relatively constant from day to day, even creatinine production normally remains substantially unchanged over time.
Please note: the creatinemia expresses the concentration of creatine in the blood, while the amount of creatinine circulating is expressed by creatininemia. Don't get confused. Similarly, creatinine should not be confused with serum creatinine kinase, better known as creatine kinase or PCK. The latter is an enzyme found mainly in striated muscle cells and cardiac smooth muscle fibers.
Why measure creatinine?
The kidneys, by eliminating circulating creatinine, help maintain the concentration of creatinine in the blood (creatininemia) in a normal range. For this reason, creatinine is a rather reliable indicator of kidney function. High creatinine usually means kidney malfunction, resulting in impaired kidney function.
When the kidneys lose some of their functionality, blood creatinine levels go up, due to poor creatinine clearance. The kidneys may function poorly due to kidney disease (parenchymal renal failure), or due to reduced renal blood flow (prerenal renal failure), or due to an obstruction in the flow of urine produced by the kidneys (post-renal renal failure). In addition, it is common in people with severe liver problems to develop yet different renal insufficiency, caused by vasoconstriction of the renal arteries, called hepatorenal syndrome. For this reason, creatinine is the main test used to evaluate the actual functioning of the kidneys.
High creatinine values
What are the normal blood creatinine values? When you can talk about values of high creatinine in the blood?
High creatinine in children and men
- High creatinine newborns: 0.2 g / dl or 19 µmol / l
- High creatinine children 1-2 years: 0.4 g / dl or 35 µmol / l
- High creatinine children 3-4 years: 0.5 mg / dl or 44 µmol / l
- High creatinine for children 5-9 years: 0.6 mg / dl or 53 µmol / l
- High creatinine for boys 10-11 years: 0.7 mg / dl or 62 µmol / l
- High creatinine for boys 12-13 years: 0.8 mg / dl or 71 µmol / l
- High creatinine adolescents 14-15 years: 0.9 mg / dl or 80 µmol / l
- Adult high creatinine: 1.2 mg / dl or 106 µmol / l
High creatinine in women
- High creatinine in newborns: 0.2 g / dl or 19 µmol / l
- High creatinine for girls 1-3 years: 0.4 mg / dl or 35 µmol / l
- High creatinine for girls 4-5 years: 0.5 mg / dl or 44 µmol / l
- High creatinine for girls 6-8 years: 0.6 mg / dl or 53 µmol / l
- High creatinine girls and adolescents 9-15 years: 0.7 mg / dl or 62 µmol / l
- Adult high creatinine: 1.1 mg / dl or 97 µmol / l
Creatinine normal values
THE normal blood creatinine levels they are approximately between 0.6 and 1.2 milligrams (mg) per deciliter (dl) in adult males and 0.5 to 1.1 milligrams per deciliter in adult women. Infants have normal values of about 0.2 mg / dl, and then gradually grow over the years, as they depend on the degree of muscle development. In people with malnutrition, severe weight loss, or chronic disease, muscle mass tends to decrease over time and, as a result, their creatinine level may be lower than expected for their age. The creatinine reference values should therefore be adapted according to age, gender and muscle mass.
In the young, muscular adults and in adults, slightly higher creatinine levels than normal for the general population may be found, even in the absence of specific kidney disease. In the Older people as already mentioned instead, there may be the finding of low creatinine in the blood compared to the norm.
A person monorene (with a kidney only) may have a creatinine level considered normal even in the presence of high creatinine (above 1.5 mg / dl). The presence of very high creatinine levels, with creatinine levels greater than 2 mg / dl in infants and greater than 6-7 mg / dl in children and adults, may indicate severe kidney damage and the need for haemofiltration (dialysis) to remove waste substances that are accumulating in the blood.
What does creatinine clearance and glomerular filtrate mean? A more precise measure of kidney function can be estimated by calculating the amount of creatinine excreted from the body through the kidneys. This data is called creatinine clearance and is used to estimate the filtration rate of the kidneys (glomerular filtration rate or GFG, in English glomerular filtration rate or GFR).
The calculation of creatinine clearance is carried out with specific formulas, using serum creatinine level (serum creatinine), patient weight and age, using formulas such as Cockcroft-Gault, the Modification of Diet in Renal Disease (MDRD), and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI).
There Cockcroft-Gault formula was the first to be used to estimate glomerular filtrate, and is calculated as follows: "140 minus the patient's age in years multiplied by the weight in kilograms (0.85 times in women), divided by 72 multiplied by blood creatinine expressed in mg / dL.
GFR or VFG0 [(140 - age in years) * weight in kg] + 0.85 if woman / (72 * creatinine in mg / dl)
This method is currently discontinued, and creatinine clearance is calculated by the method MDRD.
There creatinine clearance according to MDRD is calculated using the following formula:
GFR or VFG = 186 * (creatinine) –1.154 * (age) –0.203 * 0.742 if female and * 1.210 if African.
There creatinine clearance can also be measured in direct way through the collection of a 24-hour urine sample and a blood sample, and then through the measurement of urinary creatinine (ie the concentration of creatinine in the urine) and blood.
A normal creatinine clearance for healthy women it is between 88 and 128 ml / min, while in men it is between 97 and 137 ml / min. It should be noted that these data may vary slightly from laboratory to laboratory.
Other indicators of kidney function are urea (uremia) and urea nitrogen (azotemia, that is, the amount of nitrogen contained in plasma urea, called in English BUN). Urea is a by-product of the body's metabolism, it is synthesized in the liver and to a lesser extent in the kidneys during the urea cycle from ammonia or by oxidation of amino acids.
Urea can also accumulate if kidney function is impaired. The urea / creatinine ratio generally provides more accurate information on state of kidney health and its possible underlying cause with respect to the blood level of creatinine alone. In fact, urea increases a lot with dehydration, to a greater extent than creatinine does.
High creatinine symptoms
What are the symptoms of high creatinine? Symptoms of elevated creatinine are mainly symptoms of kidney dysfunction (kidney failure).
Although often the high creatinine is an occasional finding, in the absence of any specific symptom, in most cases, the blood creatinine levels are accompanied by symptoms of renal failure.
Symptoms of high creatinine are:
- hypotension (low blood pressure)
- tiredness (asthenia, difficulty performing moderate exertion or even normal everyday activities)
- edema-induced swelling of the legs, especially in the distal part of the lower limbs, then swelling of the feet or ankles and pretibial succulence
- shortness of breath (dyspnoea)
- difficulty concentrating confusional state
- itchy and dry, thin skin
- nausea vomiting
- Frequent or painful urination
High creatinine causes
What are the causes of high creatinine? Any condition that can alter the function of our kidneys is a possible cause of high creatinine. However, there are also physiological conditions, such as intense physical exertion or temporary dehydration, which are causes of high creatinine while not leading to real kidney failure. It is important to recognize if the process that led to the malfunctioning of our kidneys, resulting in an increase in creatinine and blood urea (uremia) is a recent process (acute renal failure) or a long-running process (chronic renal failure).
This is because an acute rise in creatinine, in the context of an acute kidney failure picture, is both more serious and worrying in the immediate future, but also more likely to be treated and resolved. Conversely, a process of chronic kidney damage can slowly but surely lead to the development of chronic kidney failure, which is often difficult to resolve.
The most common causes of high creatinine in the context of achronic renal failure I'm:
- Hypertension (high blood pressure): hypertension that is poorly controlled for a long period can lead to damage to the renal arteries, with the formation of atherosclerotic plaques, reduced blood flow and hardening of the vascular walls, in the context of angiosclerotic nephropathy or nephronagiosclerosis.
- Diabetes mellitus: Diabetes, regardless of whether it is type 1 or type 2 diabetes, is a leading cause of elevated creatinine. Diabetic disease, especially if poorly controlled by diet and / or oral and insulin hypoglycemic therapy, can lead to damage to the small blood vessels (arterioles) that supply the kidney, as part of the so-called diabetic nephropathy, characterized by microalbuminuria (small loss of protein with urine), which then evolves into overt proteinuria. In addition, diabetes increases the rate of formation of atherosclerotic damage which occurs in the presence of high blood pressure, smoking and dyslipidemia (cholesterol High LDL, low HDL and high blood triglycerides).
- Chronic kidney infections: in case of recurrent nephritis or pyelonephritis, the affected kidneys may slowly lose parts of the functioning parenchyma, gradually reducing the efficiency in blood filtration and elimination of waste substances.
- Polycystic kidney syndrome: the pathology of the polycystic kidney is a hereditary, chronic disease with progressive course, characterized by the formation of cysts (rounded accumulations of liquid or solid tissue, benign) within the renal parenchyma. The cysts increasingly alter the structure of the organ and reduce its functionality leading to progressive damage, which slowly but surely evolves towards kidney failure.
- Chronic glomerulonephritis: glomerulonephritis are inflammatory diseases that affect the glomerulus and over time lead to impaired renal function, with elevated urea and creatinine and accumulation of fluids and toxic substances. The most frequent glomerulonephritis are IgA nephropathy, minimal change glomerulopathy, mesangial proliferating glomerulonephritis, focal and segmental glomerulosclerosis, membranous glomerulonephritis and membrano-proliferative glomerulonephritis and rapidly progressive glomerulonephritis. Although the mechanism of kidney damage is not yet clear at 100%, the strong autoimmune component of these chronic kidney diseases is certain.
- High-protein diet: an unbalanced diet, with the intake of a diet rich in proteins, can lead to a slight increase in creatinine. The finding of high creatinine in people who take exaggerated levels of protein (for example in people who practice body building in the gym) does not in itself represent a pathological finding, but in the long run this type of diet is absolutely not recommended, as it is not balanced and low in carbohydrates and fiber. The association high creatinine–diet should be considered in people who frequent a gym.
- Chronic obstruction of the excretory tract: the obstruction of the excretory passages (which are the ureters, i.e. the pathways that carry urine from the kidneys to the bladder, and the urethra, i.e. the pathway that carries urine from the bladder to the outside) can be caused by anatomical changes congenital or acquired (which most often give chronic renal failure). The chronic obstacle to the outflow of urine can lead to an alteration of creatininemia.
Between the causes of congenital obstruction of the excretory tract we remember
- The ureteral pyeal joint syndrome (presence of stenosis, i.e. a narrowing, of the passageway between the renal pelvis and ureter)
- Stenosis or obstruction of the ureter (often due to the presence of congenital uterine valves)
Between acquired causes of urinary tract obstruction we quote:
- Obstruction due to enlarged prostate often caused by benign prostatic hypertrophy.
- Obstruction due to mechanical compression by prolapse of the pelvic organs, usually resulting from prolapse of the uterus.
- Retroperitoneal fibrosis
- Chronic partial obstruction of the urethra (from congenital urethral valves, acquired strictures, or more rarely other causes).
- Chronic kidney inflammation: in the presence of autoimmune diseases such as rheumatoid arthritis, SLE (Systemic Lupus Erythematosus), scleroderma or vasculitis of small, medium and large vessels, circulating autoantibodies can also affect the kidneys, causing chronic inflammatory damage that in the long run it can lead to the development of renal dysfunction with hypercreatininemia.
- Type 2 hepatorenal syndrome: it is a type of renal failure that develops in people with advanced liver cirrhosis, given by a slight slow but progressive increase in creatinine with values greater than 1.5 mg / dl but less than 2.5 mg / dl. It is often accompanied by refractory ascites, that is, with the accumulation of fluid in the abdomen, which cannot be managed with diuretic therapy, which makes it necessary to perform periodic paracentesis. Type 2 hepatorenal syndrome is a leading cause of high creatinine in people with liver disease.
- Congenital or hereditary diseases: Rare syndromes, such as Lesch-Nyhan Syndrome, Alport Syndrome, Fanconi Syndrome, can lead to elevated creatinine levels in blood tests.
Acute causes of high creatinine
What are the causes of acute kidney damage with elevated creatinine? Here are the most frequent acute causes of high creatinine:
- Use of nephrotoxic drugs: many drugs can cause kidney damage. The most frequent type of renal impairment in this case is the acute tubular necrosis, which falls within the context ofacute intra-renal renal failure. The list of toxic substances would be very long (see here for the full list), among the most common we mention:
- Immunosuppressants such as tacrolimus and cyclosporine.
- Anti-inflammatories (NSAIDs) such as ibuprofen, ketoprofen, diclofenac, naproxen, acetylsalicylic acid (aspirin)
- Antihypertensives such as ace inhibitors, sartans, beta blockers
- Antibiotics widely used as aminoglycosides (especially gentamicin), colistin, vancomycin, quinolones, beta lactams.
- Antifungals such as amphotericin-B
- D.iuretics such as furosemide, amiloride, hydrochlorothiazide and metolazone.
- Chemotherapies anticancer drugs such as cisplatin
- Iodized contrast medium: the contrast agent used for CT scans.
- Acute glomerulonephritis: they can belong to the large group of immune-mediated glomerulonephritis, or be secondary to infections (post-streptococcal glomerulonephritis) or be secondary to substances. Here is a short but detailed list:
- Acute infectious glomerulonephritis: secondary ad bacterial infection (Group A b-haemolytic streptococcus, gonococcus, meningococcus, brucella, typhus), secondary to viral infectious agents (hepatitis, mononucleosis, mumps, chicken pox, measles etc), secondary to fungal or protozoal infection (histoplasma, toxoplasma) or parasitic (malaria, trichinosis)
- Acute systemic glomerulonephritis: it can be present during SLE (systemic lupus erythematosus) and other autoimmune diseases, during systemic vasculitis (Wegener's vasculitis, Schoenlein-Henoch purpura, mixed cryoglobulinemia) or in the presence of neoplasms (lymphomas, carcinomas, solid tumors)
- Acute glomerulonephritis due to heterologous antigens, such as post-vaccination (tetanus, diphtheria, mumps, measles)
- Acute drug-induced glomerulonephritis: Penicillamine, Allopurinol, Penicillins, etc.
- Acute Idiopathic Glomerulonephritis: unknown antigens, probably autologous.
- Acute IgA glomerulonephritis: Berger's disease, Herpetiform dermatitis, Cirrhosis of the liver, Sjögren's syndrome.
- Hypotension: in case of reduced renal perfusion (renal hypoperfusion, i.e. a reduced blood supply to the kidney), the body tries to remedy by decreasing the amount of fluid excreted in the urine. Consequently, kidney function is heavily affected by the drop in blood flow, eliminating fewer waste substances and leading to an increase in urea and creatinine.
- Acute heart failure: determines a condition of acute renal hypo inflow, with consequent hypofunction of the kidney.
- Dehydration: in case of dehydration, all substances present in the blood will be more concentrated, as the body fluid content will be reduced. Creatinine will also be increased, even in the absence of real kidney damage. In case of dehydration, urea usually rises more than creatinine. Dehydration is common in elderly people, who drink little and are often on diuretic drugs, which can eliminate fluids more than those introduced with food. This is typical acute pre-renal renal failure. Note: if the problem is simple dehydration, by supplementing the missing fluids, creatinine should return to normal values.
- Urinary stones: acute renal failure resulting from acute obstruction of urinary flow by urinary tract stones is a type of acute post-renal renal failure, and it's not that rare. The stones can totally or partially obstruct the ureteral pyel joint or ureter. The condition may be asymptomatic or, more frequently, cause renal colic, with very severe pain in the abdomen or back, often accompanied by nausea and vomiting.
- Abdominal neoplasms: Obstructions similar to those given by urinary stones can be caused by tumors of the urinary tract or, much more frequently, by neighboring organs that compress or engulf the ureters, creating an obstacle to the outflow of urine, with consequent worsening of renal function and reduction of creatinine clearance.
- Type 1 hepatyrenal syndrome: is the most common form of acute kidney failure in people with cirrhosis of the liver advanced. It occurs due to a sudden vasoconstriction (reduction of flow) in the kidney and a simultaneous vasodilation (increase in the capacity of blood vessels) at the splanchnic level (arteries and veins of the abdomen). This is often triggered by a precipitating event such as a bacterial or fungal infection, alcohol abuse, or gastrointestinal bleeding. If unresolved it has a mortality of 100%, responds very well to therapy with terlipressin or noradrenaline.
High creatinine consequences
What are the i risks and the consequences of a high creatinine? Exist remedies or care on this condition?
Creatinine testing is often done as part of a general check-up, even in the absence of symptoms. Often, however, signs and symptoms of kidney disease are already present, and in this case you should not waste time, referring immediately to the treating doctor or a specialist. The finding of high creatinine in the context of renal failure is mainly accompanied by elevated urea, hyperkalemia (high potassium) and loss of protein in the urine, initially mild (microlabuminuria, up to 300 mg of protein in 24 hours) and then more severe (proteinuria, over 300 mg of protein in 24 hours) up to the actual nephrotic syndrome, with loss of over 4 g of protein per day.
If not treated adequately (drug therapy and / or dialysis), theend-stage renal failure (called vulgarly kidney failure) leads to fluid overload, accumulation of toxic substances for the body, severe loss of proteins and other essential substances for our body. This unfortunately leads inexorably to death. Fortunately, most acute kidney failure is reversible and treatable, and most chronic kidney failure never reaches such high life-threatening creatinine levels.
And what to do instead in case of low blood creatinine? What are the symptoms and causes associated with finding a low creatinine? Find out in related articles.
High creatinine in the urine
The dosage of creatinine in the urine - creatininuria - allows to evaluate the renal filtration function. The presence of high creatinuria - high creatinine in the urine - is an indication of defective kidney function, and can be caused by multiple situations including intense muscular effort, fever, dehydration, diabetes mellitus, nephritis and glomerulonephritis, kidney infections.
Creatinine measurement is also often required to measure clearance creatinine and is performed on the collection of urine 24 hours.
Creatinine alsita in pregnancy
The feedback from high creatinine in pregnancy it can be the simple result of a slight dehydration (for example in the first months of gestation, when nausea and vomiting are very frequent). In other cases, the presence of high hemoglobin values may be indicative of actual renal failure, especially if associated with other signs or symptoms such as arterial hypertension and proteinuria (high protein in the urine), in what can be outlined in a picture of preeclampsia (gestosis) or eclampsia gravidarum. These pathologies are potentially serious and require hospitalization and for observation and proper therapy.
High creatinine and nutrition
What to eat is what not to eat in presence of high creatinine? The diet to be taken in case of elevated creatinine and urea values in a framework of renal insufficiency depends on each case, depending on the pre-existence of other concomitant diseases (diabetes mellitus, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, mixed dyslipidemia). In any case, some general indications are the consumption of fruit and vegetables in at least 3-4 daily portions, whole grains and legumes. It is useful to reduce the consumption of animal proteins such as red meat and dairy products, trying to obtain proteins from vegetable sources, such as legumes, nuts and other cereals. It is also better to stay properly hydrated (6-8 glasses of water a day, unless you are on dialysis) avoiding salty foods.Tags: Laboratory medicine Kidneys Blood