Reciprocal serum creatinine concentration and chronic kidney disease
- Anthony Bleyer, MD, MS
Anthony Bleyer, MD, MS
- Professor of Internal Medicine/Nephrology
- Wake Forest University School of Medicine
- Section Editors
- Gary C Curhan, MD, ScD
Gary C Curhan, MD, ScD
- Section Editor — Chronic Kidney Disease
- Editor-in-Chief emeritus
- Clinical Journal of the American Society of Nephrology
- Professor of Medicine
- Harvard Medical School
- Richard H Sterns, MD
Richard H Sterns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Professor Emeritus
- University of Rochester School of Medicine and Dentistry
Calculation of the creatinine clearance to estimate glomerular filtration rate (GFR) is based upon the fact that creatinine is freely filtered and not reabsorbed. Thus, if creatinine secretion is ignored, all of the filtered creatinine (equal to the product of the GFR and the serum creatinine concentration [SCr]) is equal to all of the excreted creatinine (equal to product of the urine creatinine concentration [UCr] and the urine flow rate). Thus:
GFR x SCr = UCr x V
GFR = [UCr x V]/SCr
If muscle mass remains constant, then creatinine production and therefore creatinine excretion (UCr x V) will be relatively constant. Thus, the last equation can be simplified to the GFR being directly proportional to the reciprocal of the serum creatinine concentration. In the clinic, monitoring the reciprocal serum creatinine concentration over time is an effective means of evaluating temporal changes in renal function.
The methods required to use the reciprocal serum creatinine concentration to follow changes in renal function over time will be reviewed here. A graph is also provided to help the clinician in performing this task. A detailed discussion of the use of the serum creatinine concentration and the creatinine clearance to estimate GFR, including drugs that interfere with either creatinine secretion or the assay used to measure the serum creatinine, is presented separately. (See "Assessment of kidney function".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Levey AS. Measurement of renal function in chronic renal disease. Kidney Int 1990; 38:167.
- Levey AS, Greene T, Schluchter MD, et al. Glomerular filtration rate measurements in clinical trials. Modification of Diet in Renal Disease Study Group and the Diabetes Control and Complications Trial Research Group. J Am Soc Nephrol 1993; 4:1159.
- Kasiske BL, Andany MA, Danielson B. A thirty percent chronic decline in inverse serum creatinine is an excellent predictor of late renal allograft failure. Am J Kidney Dis 2002; 39:762.
- Kopple JD, Gao XL, Qing DP. Dietary protein, urea nitrogen appearance and total nitrogen appearance in chronic renal failure and CAPD patients. Kidney Int 1997; 52:486.
- Fesler P, Mimran A. Estimation of glomerular filtration rate: what are the pitfalls? Curr Hypertens Rep 2011; 13:116.
- Mitch WE, Walser M, Buffington GA, Lemann J Jr. A simple method of estimating progression of chronic renal failure. Lancet 1976; 2:1326.
- Mitch WE. Measuring the rate of progression of renal insufficiency. In: Contemporary Issues in Nephrology: Progressive Nature of Renal Diseases, Mitch WE, Brenner BM, Stein JH (Eds), Churchill Livingstone, New York 1986. Vol 14, p.167.
- Rutherford WE, Blondin J, Miller JP, et al. Chronic progressive renal disease: rate of change of serum creatinine concentration. Kidney Int 1977; 11:62.
- Viberti GC, Bilous RW, Mackintosh D, Keen H. Monitoring glomerular function in diabetic nephropathy. A prospective study. Am J Med 1983; 74:256.
- Bleyer AJ. A reciprocal graph to plot the reciprocal serum creatinine over time. Am J Kidney Dis 1999; 34:576.