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Drugs that elevate the serum creatinine concentration

INTRODUCTION

An elevation in the serum creatinine concentration (SCr) usually reflects a reduction in the glomerular filtration rate and is associated with a concomitant rise in the blood urea nitrogen (BUN). (See "Assessment of kidney function".)

There are, however, a variety of settings in which the SCr can increase acutely independent of the GFR, and therefore, in which there is no true change in overall kidney function. This may be due to one of three factors: decreased creatinine secretion, interference with the serum assay, or enhanced creatinine production.

DECREASED SECRETION

In normal subjects, approximately 15 percent of the urinary creatinine is derived from secretion in the proximal tubule. This value can rise to as high as 50 percent in patients with advanced kidney disease and accounts for the overestimation of the true GFR by the creatinine clearance [1]. (See "Calculation of the creatinine clearance".)

Creatinine is an organic cation in the physiologic pH range and is secreted by the organic cation secretory pump that can be inhibited by other organic cations. Commonly used drugs that can interfere with creatinine secretion and therefore result in a self-limited and reversible rise in the SCr by as much as 0.4 to 0.5 mg/dL (35 to 44 micromol/L) without changing the true GFR include:

The antimicrobial trimethoprim (which is most often given in combination with sulfamethoxazole) [2].

   

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Literature review current through: Aug 2014. | This topic last updated: Dec 31, 2013.
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References
Top
  1. Shemesh O, Golbetz H, Kriss JP, Myers BD. Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney Int 1985; 28:830.
  2. Berg KJ, Gjellestad A, Nordby G, et al. Renal effects of trimethoprim in ciclosporin- and azathioprine-treated kidney-allografted patients. Nephron 1989; 53:218.
  3. Duncker D, Oswald H, Gardiwal A, et al. Stable cystatin C serum levels confirm normal renal function in patients with dronedarone-associated increase in serum creatinine. J Cardiovasc Pharmacol Ther 2013; 18:109.
  4. Hilbrands LB, Artz MA, Wetzels JF, Koene RA. Cimetidine improves the reliability of creatinine as a marker of glomerular filtration. Kidney Int 1991; 40:1171.
  5. Rocci ML Jr, Vlasses PH, Ferguson RK. Creatinine serum concentrations and H2-receptor antagonists. Clin Nephrol 1984; 22:214.
  6. Kemperman FA, Silberbusch J, Slaats EH, et al. Follow-up of GFR estimated from plasma creatinine after cimetidine administration in patients with diabetes mellitus type 2. Clin Nephrol 2000; 54:255.
  7. Tangri N, Alam A, Edwardes MD, et al. Evaluating cimetidine for GFR estimation in liver transplant recipients. Nephrol Dial Transplant 2010; 25:1285.
  8. Gallant JE, Parish MA, Keruly JC, Moore RD. Changes in renal function associated with tenofovir disoproxil fumarate treatment, compared with nucleoside reverse-transcriptase inhibitor treatment. Clin Infect Dis 2005; 40:1194.
  9. Jülg BD, Bogner JR, Crispin A, Goebel FD. Progression of renal impairment under therapy with tenofovir. AIDS 2005; 19:1332.
  10. Crane HM, Kestenbaum B, Harrington RD, Kitahata MM. Amprenavir and didanosine are associated with declining kidney function among patients receiving tenofovir. AIDS 2007; 21:1431.
  11. Vrouenraets SM, Fux CA, Wit FW, et al. Persistent decline in estimated but not measured glomerular filtration rate on tenofovir may reflect tubular rather than glomerular toxicity. AIDS 2011; 25:2149.
  12. Molitch ME, Rodman E, Hirsch CA, Dubinsky E. Spurious serum creatinine elevations in ketoacidosis. Ann Intern Med 1980; 93:280.
  13. Saah AJ, Koch TR, Drusano GL. Cefoxitin falsely elevates creatinine levels. JAMA 1982; 247:205.
  14. Mitchell EK. Flucytosine and false elevation of serum creatinine level. Ann Intern Med 1984; 101:278.
  15. Myers GL, Miller WG, Coresh J, et al. Recommendations for improving serum creatinine measurement: a report from the Laboratory Working Group of the National Kidney Disease Education Program. Clin Chem 2006; 52:5.
  16. Smith CH, Landt M, Steelman M, Ladenson JH. The Kodak Ektachem 400 Analyzer evaluated for automated enzymic determination of plasma creatinine. Clin Chem 1983; 29:1422.
  17. Noble MA, Harper B, Grant AG, Bernstein M. Rapid determination of 5-fluorocytosine levels in blood. J Clin Microbiol 1984; 20:996.
  18. Herrington D, Drusano GL, Smalls U, Standiford HC. False elevation in serum creatinine levels. JAMA 1984; 252:2962.
  19. Bell TW, Hou Z, Luo Y, et al. Detection of creatinine by a designed receptor. Science 1995; 269:671.
  20. Payne RB. Creatinine clearance: a redundant clinical investigation. Ann Clin Biochem 1986; 23 ( Pt 3):243.
  21. Hamilton RW, Gardner LB, Penn AS, Goldberg M. Acute tubular necrosis caused by exercise-induced myoglobinuria. Ann Intern Med 1972; 77:77.
  22. Oh MS. Does serum creatinine rise faster in rhabdomyolysis? Nephron 1993; 63:255.
  23. Gualano B, de Salles Painelli V, Roschel H, et al. Creatine supplementation does not impair kidney function in type 2 diabetic patients: a randomized, double-blind, placebo-controlled, clinical trial. Eur J Appl Physiol 2011; 111:749.