TITLE:
A Surviving Patient with Record High Creatinine
AUTHORS:
Andrew C. Storm, Naing L. Htike, David A. Cohen, Robert L. Benz
KEYWORDS:
Survival; Outcome; Uremia; Mortality; Creatinine
JOURNAL NAME:
Open Journal of Nephrology,
Vol.3 No.4,
December
27,
2013
ABSTRACT:
Creatinine is a product of muscle protein breakdown
cleared by the kidneys at a constant rate. The glomerular filtration rate is
estimated based on serum creatinine. There is no definitive level of serum
creatinine which is itself incompatible with human survival. We
present the highest serum creatinine associated with survival based on a
thorough review of the literature. A 34-year-old male patient with baseline serum creatinine
of 1.2 mg/dl presented our emergency department with a six week history of new
onset of uremic symptoms. His past medical history was unremarkable. On exam,
he was in no distress. His BMI was 28. His exam was significant only for elevated
blood pressure and asterixis. His peak serum creatinine
was 53.9 mg/dl. The patient subsequently required maintenance hemodialysis and
later changed to long-term peritoneal dialysis. To our knowledge,
based on a thorough review of the literature using PubMed, Cochrane Database
and the United States Renal Data System (USRDS), this is the highest level of
serum creatinine ever reported. We conclude that serum creatinine itself is
non-lethal. It is more likely that other electrolyte and retained metabolic
abnormalities of renal failure frequently cause symptoms or death before
creatinine toxicity, if such a level exists, creatinine has
reached.