Creatinine

The creatinine blood test is used to assess kidney function. It is frequently ordered along with a BUN (blood urea nitrogen) test or as part of a basic or comprehensive metabolic panel (BMP or CMP), groups of tests that are performed to evaluate the function of the body's major organs. BMP or CMP tests are used to screen healthy people during routine physical exams and to help evaluate acutely or chronically ill people in the emergency room and/or hospital. Sometimes, creatinine may be performed as part of a renal panel to evaluate kidney function.

Creatinine is a waste product produced by muscles from the breakdown of a compound called creatine. Almost all creatinine is filtered from the blood by the kidneys and released into the urine, so blood levels are usually a good indicator of how well the kidneys are working.

The kidneys are a pair of bean-shaped organs that are located at the bottom of the ribcage in the right and left sides of the back. Within them are about a million tiny blood filtering units called nephrons. In each nephron, blood is continually filtered through a microscopic cluster of looping blood vessels, called a glomerulus. The glomerulus allows the passage of water and small molecules but retains blood cells and larger molecules. Attached to each glomerulus is a tiny tube (tubule) that collects the fluid and molecules that pass through the glomerulus and then reabsorbs what can be used by the body. The remaining waste forms urine.

If the creatinine and BUN tests are found to be abnormal or if someone has an underlying disease that is known to affect the kidneys, such as diabetes or high blood pressure, then creatinine and BUN tests may be used to monitor for kidney dysfunction and the effectiveness of treatment. Blood creatinine and BUN tests may also be ordered to evaluate kidney function prior to some procedures, such as a CT (computed tomography) scan, that may require the use of drugs that can damage the kidneys.

Results from creatinine tests may be used in calculations that help assess kidney function:

• Blood creatinine measurements, along with age, weight, and sex, are used to calculate the estimated glomerular filtration rate (eGFR), which is used as a screening test to look for evidence of early kidney damage.
• Blood and urine creatinine levels may be used to calculate a creatinine clearance. This test measures how effectively the kidneys are filtering small molecules like creatinine out of the blood.

Urine creatinine may also be used with a variety of other urine tests as a correction factor. The concentration (or dilution) of urine varies throughout the day, with more or less liquid being released in addition to the body's waste products. Since creatinine is produced and removed at a relatively constant rate, the amount of urine creatinine can be compared to the amount of another substance being measured. This stable excretion rate is useful when evaluating both 24-hour urine samples and random urine samples. Examples include:

• Urine albumin/creatinine ratio (ACR). This more accurately determines how much albumin is escaping from the kidneys into the urine. It is used to screen people with chronic conditions, such as diabetes and high blood pressure (hypertension) that put them at an increased risk of developing kidney disease.
• Urine protein/creatinine ratio (UP/CR). This may be used to monitor a person with known kidney disease or damage or to screen people on a regular basis when they are taking a medication that may affect their kidney function.

Creatinine may be ordered routinely as part of a comprehensive or basic metabolic panel during a health examination. It may be ordered when someone is acutely ill and/or when a health practitioner suspects that a person's kidneys are not working properly. Some signs and symptoms of kidney dysfunction include:

• Fatigue, lack of concentration, poor appetite, or trouble sleeping
• Swelling or puffiness, particularly around the eyes or in the face, wrists, abdomen, thighs or ankles
• Urine that is foamy, bloody, or coffee-colored
• A decrease in the amount of urine
• Problems urinating, such as a burning feeling or abnormal discharge during urination, or a change in the frequency of urination, especially at night
• Mid-back pain (flank), below the ribs, near where the kidneys are located
• High blood pressure

The creatinine blood test may be ordered, along with a BUN test and urine albumin, at regular intervals when someone has a known kidney disorder or has a disease that may affect kidney function. Both BUN and creatinine may be ordered when a CT scan is planned, prior to and during certain drug therapies, and before and after dialysis to monitor the effectiveness of treatments.

Increased creatinine levels in the blood suggest kidney disease or other conditions that affect kidney function. These can include:

• Damage to or swelling of blood vessels in the kidneys (glomerulonephritis) caused by, for example, infection or autoimmune diseases
• Bacterial infection of the kidneys (pyelonephritis)
• Death of cells in the kidneys' small tubes (acute tubular necrosis) caused by, for example, drugs or toxins
• Prostate disease, kidney stone, or other causes of urinary tract obstruction
• Reduced blood flow to the kidney due to shock, dehydration, congestive heart failure, atherosclerosis, or complications of diabetes

Low blood levels of creatinine are not common, but they are also not usually a cause for concern. They can be seen with conditions that result in decreased muscle mass.

Levels of 24-hour urine creatinine are evaluated with blood levels as part of a creatinine clearance test.

Single, random urine creatinine levels have no standard reference ranges. They are usually used with other tests to reference levels of other substances measured in the urine. Some examples include the urine albumin test and urine albumin/creatinine ratio and the urine protein test.

Creatinine blood levels can also increase temporarily as a result of muscle injury and are generally slightly lower during pregnancy.

Some drugs may cause increased creatinine levels. Inform your healthcare provider of any drugs you are taking.