Renal Function test (RFT)

creatinine &GFR

T.A Khadija Balubaid kbalubaid@kau.edu.sa

KAU-Faculty of Science- Biochemistry department
Clinical biochemistry lab (BIOC 416) 2013
 Creatinine
 Creatinine is a break-down product of creatine phosphate and
creatine, that it is a waste product of energy metabolism in
muscle.
 its filtered from the blood by kidneys and then excreted into
the urine.(100% execreted)
 Production of creatinine depends on an individual's muscle
mass, which is usually constant.
 Its level considered a sensitive renal function marker.
 In renal failure, the level of creatinine is elevated in blood and
decreased in urine because kidney unable to excrete creatinine
in urine.
Serum creatinine:
 Elevated blood creatinine is a more sensitive indication of
impaired kidney function than the BUN:
 Its level only effected by muscle mass which is usually constant
 creatinine level is very little affected by liver function
 BUN/Creatinine ratio:
 BUN-creatinine ratios increase with renal disease.
 Effected by other factors as: liver function, muscle
mass, dietary protein
 - High BUN-to-creatinine ratio: Low BUN-to-creatinine ratio:
 Sudden acute kidney failure.  Low protein diet
 Urinary tract blockage (kidney stone).
 Very high ratio may be caused by  Severe muscle
bleeding in the digestive tract or injury.
respiratory tract.
 Glomerular Filtration Rate (GFR):

Glomerular Filtration Rate (GFR):

 It is the rate (volume per minute) at which the filtration of
blood is performed by the glomerulus and transferred to
Bowman's space.
 It is determined practically by measuring creatinine clearance.
Creatinine clearance:
 It is the volume of blood plasma that is cleared of creatinine
per unit time (expressed in ml/min).
 It measures GFR .
 Normal range: ( man: 120ml/min & women:100ml/min )
 If GFR less than 60 ml/min: for 3 months the patient has chronic
kidney disease CKD.
 If GFR is less than 10 ml/min: this stage is called end-stage
kidney disease or end-stage renal disease (ESRD).
 End stage means kidneys can’t filter chemicals and minerals out
of blood. In this stage patient needs dialysis or kidney transplant.
 However, because a small amount of creatinine is released by the
filtering tubes in the kidneys, creatinine clearance is not exactly
the same as the GFR. In fact, creatinine clearance usually
overestimates the GFR. This is particularly true in patients with
advanced kidney disease.
According to the value of GFR, kidney disease
is classified to five stages:

Stage of kidney disease

1 2 3 4 5

Moderately severely Kidney

Normal Mild reduced
reduced reduced failure

120 90 60 30 10

Glomerular Filtration Rate

(approximate percent of kidney failuar)
Creatinine clearance calculation:

First way :Creatinine clearance can be calculated without a 24 hour

urine collection using Cockcroft equation which require (serum
creatinine concentration , sex, age, and weight)
Cockcroft equation:
 Creatinine clearance = (140 – age) x weight x constant
serum creatinine

 Weight in Kg, in,

 If serum creatinine is measured in mg/dl:
 Serum creatinine must be multiplied by factor 72
 Constant = 1 for men, constant = 0.85 for women
 If serum creatinine is measured in μmol/l:
 Constant = 1.23 for men, constant = 1.04 for women
 The second way: This way is using 24-hour urine collection.
 Creatinine clearance (mL/min) = urine creatinine (mg/dl) x urine volume (ml)
serum creatinine (mg/dl) x 1440 min
 Urine Volume is the total urine volume in 24 hour by ml and 1440 is a number
of minutes in 24 hours.

Cystatin C:
 It is a protein secreted by most cells in the body and small amounts excreted
in the urine.
 It may be used as an alternative to creatinine and creatinine clearance for
monitoring kidney dysfunction.
 It is a better marker of the GFR. A reduction in GFR causes a rise in the
concentration of cystatin C.
Principle:
Alkaline

The rate of formation of colored complex is directly related to

creatinine conc.

Sample: Serm or urine

Kit components
Procedure:
 Calculations

 Can you calculate creatinine clearance for

your sample?
 Normal range of creatinine clearance :
 Male: 97 to 137 ml/min.
 Female: 88 to 128 ml/min
 What Abnormal Results Mean

 Abnormal results (lower than normal creatinine clearance) may indicate:

 Acute tubular necrosis
 Bladder outlet obstruction
 Congestive heart failure
 Dehydration
 End-stage kidney disease
 Glomerulonephritis
 Kidney failure
 Renal ischemia (too little blood flow to the kidneys)
 Renal outflow obstruction (usually must affect both kidneys to reduce
the creatinine clearance)
 Shock
 Considerations

 Factors that may interfere with the accuracy of the test are as
follows:
 The creatinine clearance appears to decrease with age (each
decade corresponds to a decrease of about 6.5 ml/min./1.73 m2).
 Incomplete urine collection
 Pregnancy
 Vigorous exercise
 Drugs that can interfere with creatinine clearance measurements
include: cimetidine, trimethoprim, and drugs that can damage the
kidneys, such as cephalosporins.
 Case study

 An 87-year-old retired tailor appears in his physician’s office complaining of

the slow onset of ankle and shin swelling, mild shortness of breath, and fatigue.
Urinalysis performed in the office reveals marked proteinuria, and the patient is
seen for further evaluation and work-up. The serum urea-N was 35 mg/dL,
creatinine 3.8 mg/dL, sodium 136 mmol/L, potassium 5.6 mmol/L, chloride
104 mmol/L, and bicarbonate 20 mmol/L. Total serum protein was 4.3 g/dL
with albumin 1.4 g/dL.
 Given a serum creatinine of 3.8 mg/dL, a urine creatinine concentration of 210
mg/dL and a 24 hour urine volume of 288 mL, calculate the creatinine
clearance in this patient.
 Interpret the creatinine clearance you have obtained for this patient.
 What other blood/serum tests may be abnormal?
 What is the differential diagnosis for this patient?
 Are the increased SUN and creatinine values typical for this disease?