From the Guidelines
Hypercreatininemia is primarily caused by a decrease in glomerular filtration rate (GFR), which can be due to various factors such as acute kidney injury (AKI), chronic kidney disease (CKD), or other conditions that affect kidney function.
Factors Affecting Serum Creatinine
- Muscle mass: Lower muscle mass, often seen in older adults, females, or individuals with muscle-wasting conditions, can lead to lower serum creatinine levels 1
- Diet: Low dietary protein intake can also decrease serum creatinine levels 1
- Assay interferences: Certain substances, such as hyperbilirubinemia, can interfere with creatinine assays, leading to inaccurate measurements 1
- Tubular secretion: Creatinine is not only filtered by the glomerulus but also secreted by the renal tubules, which can affect serum creatinine levels 1
Causes of Hypercreatininemia
- Prerenal factors: Impaired blood flow to the kidneys, such as hypotension, hypovolemia, or decreased cardiac output, can cause hypercreatininemia 1
- Renal causes: Diseases that damage renal parenchyma, such as vasculitis, acute tubular necrosis, or glomerulonephritis, can lead to hypercreatininemia 1
- Postrenal factors: Obstruction of the urinary tract, such as ureteral or bladder obstruction, can also cause hypercreatininemia 1
- Medications: Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or contrast dye, can affect kidney function and lead to hypercreatininemia 1 It is essential to consider these factors and causes when interpreting serum creatinine levels and diagnosing hypercreatininemia, as the underlying condition may require specific treatment and management 1.
From the Research
Causes of Hypercreatininemia
- Hypercreatininemia can be caused by various factors, including:
- Creatine supplements, which may transitorily rise serum creatinine levels and mimic a kidney disease 2
- High protein diet, which can increase blood urea nitrogen and lead to confusion with kidney disease 2
- Certain medications, such as cimetidine, trimethoprim, corticosteroids, pyrimethamine, phenacemide, salicylates, and active vitamin D metabolites, which can increase plasma creatinine without decreasing glomerular filtration rate (GFR) 3
- Hypertension, which can increase the risk of cardiovascular disease and hypercreatininemia 4, 5
- Chronic kidney disease, which is associated with increased risks of several co-morbidities, including cardiovascular disease and chronic renal failure 6
Relationship between Serum Creatinine and Estimated Glomerular Filtration Rate
- Hypercreatininemia is associated with low levels of estimated glomerular filtration rate (eGFR) in chronic kidney diseased patients 6
- Studies have shown that eGFR is significantly decreased and serum creatinine is significantly increased in patients with chronic kidney disease compared to healthy subjects 6
- The relationship between serum creatinine and eGFR is important for preventing complications related to chronic kidney disease 6
Other Factors that Can Contribute to Hypercreatininemia
- Left ventricular hypertrophy (LVH) and microalbuminuria (MA) are independent risk factors for cardiovascular disease and can contribute to hypercreatininemia 5
- Impaired renal sodium handling and sodium retention are physiological hallmarks of the very early stages of heart failure, which can lead to hypercreatininemia 5