Creatinine, Blood and Estimated Glomerular Filtration Rate (eGFR)

Creatinine, Blood and Estimated Glomerular Filtration Rate (eGFR) is a topic covered in the Davis's Lab & Diagnostic Tests.

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Core Lab Study

Synonym/Acronym:

Cr, SCr

Rationale

To assess kidney function found in acute kidney injury and chronic kidney disease (CKD), related to drug reaction and disease such as diabetes.

A small group of studies in this manual have been identified as Core Lab Studies. The designation is meant to assist the reader in sorting the basic “always need to know” laboratory studies from the hundreds of other valuable studies found in the manual—a way to begin putting it all together.

Normal, abnormal, or various combinations of core lab study results can indicate that all is well, reveal a problem that requires further investigation with additional testing, signal a positive response to treatment, or suggest that the health status is as expected for the associated situation and time frame.

Creatinine (Cr) is included in the basic metabolic panel (BMP), comprehensive metabolic panel (CMP), general health panel, and renal function panel. Panels are used as general health and targeted screens to identify or monitor conditions such as bone disease, diabetes, hypertension, kidney disease, liver disease, or malnutrition. Serum creatinine (SCr) is also ordered with the urine creatinine clearance test.

Patient Preparation

There are no food, fluid, or medication restrictions unless by medical direction. Instruct the patient to refrain from excessive exercise for 8 hr before the test.

Normal Findings

Method: Spectrophotometry for Cr; immunoturbidometry for cystatin C.

Creatinine
AgeConventional UnitsSI Units (Conventional Units × 0.0884)
Newborn–11 mo0.17–0.42 mg/dL15–37 mmol/L
1–5 yr0.19–0.51 mg/dL17–45 mmol/L
6–10 yr0.26–0.61 mg/dL23–54 mmol/L
11–14 yr0.35–0.86 mg/dL31–76 mmol/L
15 yr–Adult male0.61–1.21 mg/dL54–107 mmol/L
15 yr–Adult female0.59–1.04 mg/dL52–92 mmol/L
Estimated Glomerular Filtration Rate (eGFR) Many laboratories now report blood Cr and cystatin C values with the corresponding eGFR.
AgeConventional Units
Less than 18 yrsNote: The eGFR equation generally recommended for individuals under 18 yrs of age is the Bedside Schwartz formula and is based on Cr levels and height in centimeters.
18–70 yrsGreater than or equal to 60 mL/min/body surface area
Greater than 70 yrValues in older adults remain relatively stable, after a period of decline related to loss of muscle mass during the transition from adult to older adult.
Cystatin C
AgeConventional UnitsSI Units (Conventional Units × 74.9)
Adult0.56–1.2 mg/L41.9–89.9 mmol/L
BUN/Cr Ratio10:1 to 20:1
Values vary among laboratories due to differences in instrumentation.

Critical Findings and Potential Interventions

Adults

Potential critical finding is greater than 7.4 mg/dL (SI: 654.2 micromol/L) (patient not on dialysis).

Children

Potential critical finding is greater than 3.8 mg/dL (SI: 336 micromol/L) (patient not on dialysis).

Timely notification to the requesting health-care provider (HCP) of any critical findings and related symptoms is a role expectation of the professional nurse. A listing of these findings varies among facilities.

Consideration may be given to verification of critical findings before action is taken. Policies vary among facilities and may include requesting immediate recollection and retesting by the laboratory or retesting using a rapid point-of-care testing instrument at the bedside, if available.

Chronic renal insufficiency is identified by Cr levels between 1.5 and 3 mg/dL (SI: 132.6 and 265.2 micromol/L); CKD is present at levels greater than 3 mg/dL (SI: 265.2 micromol/L).

Possible interventions may include renal or peritoneal dialysis and organ transplant, but early discovery of the cause of elevated Cr levels might avoid such drastic interventions.

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Core Lab Study

Synonym/Acronym:

Cr, SCr

Rationale

To assess kidney function found in acute kidney injury and chronic kidney disease (CKD), related to drug reaction and disease such as diabetes.

A small group of studies in this manual have been identified as Core Lab Studies. The designation is meant to assist the reader in sorting the basic “always need to know” laboratory studies from the hundreds of other valuable studies found in the manual—a way to begin putting it all together.

Normal, abnormal, or various combinations of core lab study results can indicate that all is well, reveal a problem that requires further investigation with additional testing, signal a positive response to treatment, or suggest that the health status is as expected for the associated situation and time frame.

Creatinine (Cr) is included in the basic metabolic panel (BMP), comprehensive metabolic panel (CMP), general health panel, and renal function panel. Panels are used as general health and targeted screens to identify or monitor conditions such as bone disease, diabetes, hypertension, kidney disease, liver disease, or malnutrition. Serum creatinine (SCr) is also ordered with the urine creatinine clearance test.

Patient Preparation

There are no food, fluid, or medication restrictions unless by medical direction. Instruct the patient to refrain from excessive exercise for 8 hr before the test.

Normal Findings

Method: Spectrophotometry for Cr; immunoturbidometry for cystatin C.

Creatinine
AgeConventional UnitsSI Units (Conventional Units × 0.0884)
Newborn–11 mo0.17–0.42 mg/dL15–37 mmol/L
1–5 yr0.19–0.51 mg/dL17–45 mmol/L
6–10 yr0.26–0.61 mg/dL23–54 mmol/L
11–14 yr0.35–0.86 mg/dL31–76 mmol/L
15 yr–Adult male0.61–1.21 mg/dL54–107 mmol/L
15 yr–Adult female0.59–1.04 mg/dL52–92 mmol/L
Estimated Glomerular Filtration Rate (eGFR) Many laboratories now report blood Cr and cystatin C values with the corresponding eGFR.
AgeConventional Units
Less than 18 yrsNote: The eGFR equation generally recommended for individuals under 18 yrs of age is the Bedside Schwartz formula and is based on Cr levels and height in centimeters.
18–70 yrsGreater than or equal to 60 mL/min/body surface area
Greater than 70 yrValues in older adults remain relatively stable, after a period of decline related to loss of muscle mass during the transition from adult to older adult.
Cystatin C
AgeConventional UnitsSI Units (Conventional Units × 74.9)
Adult0.56–1.2 mg/L41.9–89.9 mmol/L
BUN/Cr Ratio10:1 to 20:1
Values vary among laboratories due to differences in instrumentation.

Critical Findings and Potential Interventions

Adults

Potential critical finding is greater than 7.4 mg/dL (SI: 654.2 micromol/L) (patient not on dialysis).

Children

Potential critical finding is greater than 3.8 mg/dL (SI: 336 micromol/L) (patient not on dialysis).

Timely notification to the requesting health-care provider (HCP) of any critical findings and related symptoms is a role expectation of the professional nurse. A listing of these findings varies among facilities.

Consideration may be given to verification of critical findings before action is taken. Policies vary among facilities and may include requesting immediate recollection and retesting by the laboratory or retesting using a rapid point-of-care testing instrument at the bedside, if available.

Chronic renal insufficiency is identified by Cr levels between 1.5 and 3 mg/dL (SI: 132.6 and 265.2 micromol/L); CKD is present at levels greater than 3 mg/dL (SI: 265.2 micromol/L).

Possible interventions may include renal or peritoneal dialysis and organ transplant, but early discovery of the cause of elevated Cr levels might avoid such drastic interventions.

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