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Increased creatinine levels
contents
creatinine
Creatinine in the blood
Physiology of the kidney
Increased creatinine in the blood
Creatinine clearance
Influence of creatinine level in serum
When the creatinine value is measured
Symptoms of elevated creatinine levels
therapy
creatinine
Creatinine is the excretory form of creatine. Creatine is important for muscle contraction and also occurs in the muscles. What kind of muscle a person has, what kind of life he is leading, how old he is and how he feeds, all of this affects the amount of creatine. This substance is produced in the liver and kidneys from glycine, increases the absorption capacity of the muscle for sugar and can also be absorbed by meat consumption.
Creatine is available for the rapid supply of energy in the muscles, the breakdown product is creatinine. (Image: lassedesignen / fotolia.com) Creatine is a high-energy compound that can deliver energy to the muscle when needed. The excretion is in the form of creatinine, which is considered excretion product of creatine. Approximately 1.0 to 1.5 grams of creatinine are excreted in the urine daily. This amount is directly proportional to muscle mass. Thus, a muscular person shows a higher average value, rather than rather slender persons. Likewise, the value is higher in men than in women and unlike in children and elderly patients. Creatinine is completely filtered in the kidney and none of it is reabsorbed. Therefore, the creatinine values are a good parameter for the filtration performance of the kidney and are always used for kidney diagnostics.
Creatinine in the blood
If a kidney dysfunction occurs, it is often associated with an excretory disorder. Accordingly, less creatinine is excreted, although at the same time creatine is still degraded. Creatinine thus accumulates in the blood and can then be used for diagnostic purposes. Thus, the so-called glomerular filtration rate can be determined.
An increase in creatinine levels is usually due to impaired kidney function. (Image: 7activestudio / fotolia.com) Physiology of the kidney
The main tasks of the kidneys include, above all, the excretion of the metabolic end products urea, uric acid and creatinine.The urine formation takes place in the nephron, which consists of a kidney body and the associated finest hair canals. Together they form the smallest functional unit in the kidney. The renal body again consists of so-called glomeruli, a capsule and their capsule space. In the kidney body, the primary urine is filtered off, which takes place in the glomeruli (vascular loops). In the hair canals, also called tubule apparatus, the urine is then massively concentrated by resorption processes, from which the secondary urine is produced. This is the end product that subsequently excretes.
About 1,500 liters of blood flow through the kidney in one day, producing about 150 liters of primary urine. Of these, approximately 1.5 liters of urine remain, which is then eliminated via the bladder. In order to filter the blood in such a way that finally urine develops, a certain blood pressure must prevail inside the kidney corpuscles. In kidney disease, a change in blood pressure can contribute to the filtration no longer functioning properly and therefore an altered creatinine value.
Increased creatinine in the blood
About 125 milliliters of blood are filtered off per minute. If this filter performance drops to 60 to 40 milliliters per minute, the blood count changes or the creatinine level increases. If the filtration volume lies between these areas, the diminishing kidney function is not yet recognizable on the blood picture. As a result, creatinine is not a parameter to diagnose kidney disease at an early stage. Also, the severity of kidney damage can not be read from the creatinine level in the blood. The body can defend itself with reduced filtration ability and release some creatinine through the intestine. If the kidney recovers, for example after a kidney failure, the creatinine level in the blood does not normalize in the same fast way. Again, the value is not necessarily an indicator of whether the kidney can get back to work properly.
Creatinine clearance
To determine the filtering performance of the kidney, creatinine clearance is a meaningful method. It measures how much creatinine the kidney can release from the blood into the urine in a given period of time. For the clearance calculation, the amount of creatinine in the blood and the amount of creatinine in the 24 hour urine are used. A specific formula, which also considers the body surface (calculated from the weight and size) of the patient, allows an individual result. Dependent is the value of gender, age and body surface. Falsified results occur with high protein intake, loss of muscle mass and unbalanced water balance. In these cases, the much more costly process of inulin clearance is consulted.
Influence of creatinine level in serum
The mentioned kidney damage is mentioned here first. However, there are other factors that can affect the value. These include prolonged diarrhea, severe vomiting, long periods without hydration, high levels of meat consumption, muscle breakdown, hemolysis (red blood cell disintegration), heavy physical work and medications such as opiates, diuretics or cytotoxic drugs.
The creatinine level drops during pregnancy and diabetes. It increases due to massive meat consumption, kidney disease, urinary stones, muscle diseases, heart failure, acromegaly (enlargement of the acres by too much growth hormone), severe blood loss, shock and protein deficiency syndrome.
When the creatinine value is measured
The doctor will estimate creatinine in suspected kidney disease, diabetes, collagenosis (autoimmune disease, rheumatic inflammatory), hypertension (high blood pressure), hemolysis, and in patients on medications that could potentially damage the kidney.
Increase of creatinine levels in the blood
Acute renal failure increases the keratin value. The causes of this are a reduced blood flow to the kidney, triggered by shock, after burns, sudden drop in blood pressure, sepsis (blood poisoning) and after surgery. Acute renal failure is also referred to when damage to the kidney was caused by toxins or drugs.
Likewise, a massive muscle breakdown in which large amounts of muscle protein are released, a possible trigger of elevated creatinine in the blood. Furthermore, inflammation of the kidney, such as glomerulonephritis (inflammation of the glomeruli) or nephritis (inflammation of the kidney), contribute to an increase in serum creatinine.
Chronic kidney failure is also associated with elevated creatinine levels. Possible causes of chronic kidney failure are advanced diabetes leading to kidney damage, chronic pyelonephritis (chronic pyelonephritis), kidney cysts, kidney damage from prolonged ingestion of kidney-damaging painkillers, and hypertension (hypertension), which over a longer period is mainly diastolic ( lower) value is increased.
Symptoms of elevated creatinine levels
If the glomerular filtration rate (GFR) is above 60, the creatinine remains within the normal range, that is, it is compensated by the body and sufferers have no complaints. At GFR values between sixty and forty, creatinine levels rise to about two milligrams per deciliter, with fatigue, loss of performance, loss of appetite, and high blood pressure.
There is talk of a decompensation at a glomerular filtration rate of forty to fifteen, with the creatinine increasing to the value of ten milligrams per deciliter and this leads to physical weakness, weight loss and pruritus (itching).
Terminal renal insufficiency lowers the GRF to less than fifteen. The creatinine level increases to more than ten milligrams per deciliter. The uremia (occurrence of urinary substances in the blood) is a life-threatening condition. Due to the increase in urine poisoning, abdominal pain, nausea, vomiting and diarrhea occur, often accompanied by pulmonary edema, pericarditis, brain damage and even coma. When deciding whether dialysis is necessary, the creatinine value is always taken into account.
therapy
The treatment depends primarily on the underlying disease. In the case of existing kidney diseases, especially in renal insufficiency (underactive or poor kidneys), a specific diet is urgently needed. The goal is to deliver less protein, which improves filter performance and also produces less toxic waste products such as urea, uric acid and creatinine. The amount of protein intake depends on the severity of the kidney failure, ie the glomerular filtration rate. It is important that the affected patients still take enough calories with a reduced amount of protein, so that no malnutrition arises, which in turn reduces performance, increases the susceptibility to disease and ultimately reduces life expectancy.
If kidney failure progresses, it has far-reaching consequences on the quality of life of patients. For example, sufferers suffer from chronic loss of appetite and mood swings through to the resulting poisons up to depression. An individualized diet, which should also be tasty and easy for the patient, is therefore an important component of the treatment. Also, salt and fluid intake must be tailored to the disease. Targeted nutritional therapy therefore remains essential in the control of elevated creatinine levels. (Sw)
Picture 1: Gerd Altmann