Increased Creatinine

Physiology

  • Determinants of Cr
    • Rate of Cr production
    • Apparent volume of distribution for Cr
    • Rate of Cr elimination
  • Use of Cr to determine estimate GFR in the ICU is limited, as Cr is not in a steady-state
  • Use of Cr lacks sensitivity and underestimates the degree of kidney dysfunction in critically ill patients
    • Increases in serum Cr lag behind reductions in GFR

Etiology

  • Primary Renal Disease
  • Drugs
    • Cimetidine (Tagamet) (see Cimetidine, [[Cimetidine]]): decreased tubular secretion of creatinine
    • Dronedarone (Multaq) (see Dronedarone, [[Dronedarone]]): likely due to a partial inhibition of tubular organic cation
    • Sulfamethoxazole-Trimethoprim (Bactrim, Septra) (see Sulfamethoxazole-Trimethoprim, [[Sulfamethoxazole-Trimethoprim]]): decreased tubular secretion of creatinine
      transporters
  • Toxins

References

  • Dronedarone: a new antiarrhythmic agent. Drugs Today 2006;42:75-86
  • Effect of dronedarone on cardiovascular events in atrial fibrillation. N Engl J Med 2009;360:668-678