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Low Serum Creatinine Levels in Severe Hepatic Disease
Toshikazu Takabatake, MD;
Hiromichi Ohta, MD;
Yoh-ichi Ishida, MD;
Hiromoto Hara, MD;
Yasuyuki Ushiogi, MD;
Nobu Hattori, MD
Arch Intern Med. 1988;148(6):1313-1315.
Abstract
• For five years, eight patients had abnormally low serum concentrations of creatinine. All patients presented with severe hepatic failure, which was due to fulminant hepatitis in seven patients and to advanced primary biliary cirrhosis in one patient. The serum urate (as uric acid) concentration was also low in seven patients. Endogenous creatinine clearance was increased in all patients (2.38 to 14.75 mL/s [143 to 885 mL/min]). However, inulin clearance measured in four patients was reduced (25 to 32 mL/min) and the creatinine-to-inulin clearance ratio ranged from 4.5 to 9.9. This range can be explained largely by an increased tubular secretion of creatinine related to body fluid expansion caused by a large fluid infusion. Renal function would be extremely overestimated when assessed from serum concentrations or clearance of creatinine in such patients.
(Arch Intern Med 1988;148:1313-1315)
Author Affiliations
From the First Department of Internal Medicine, Kanazawa (Japan) University.
Footnotes
Accepted for publication Oct 27, 1987.
Reprint requests to First Department of Internal Medicine, School of Medicine, Kanazawa University, 13-1, Takara-machi, Kanazawa 920, Japan (Dr Takabatake).
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