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Kidney Diseases

Change in serum creatinine level in 18 months

12/05/2006

Question:

My husband, age 47, saw a nephrologist today, who was waiting on lab reports from 2005 and 2004, to determine if my husband`s serum creatinine level had been around 1.5 or 1.6 in those years, as it is currently 1.6 (as of August 2006). The nephrologist said it would be more worrisome if my husband`s creatinine level was normal prevously but has now spiked up---compared with holding steady at around 1.5 or 1.6.

We finally got the lab values from previous years. In April 2005, my husband`s serum creatinine was 1.3; in February 2004 it was 1.2. In February 2003 it was 1.3. We obtained these reports after the appointment with the nephrologist, so we were unable to ask about the significance of this.

What would cause an increase in serum creatinine over 18 months` time? How significant is the increase from 1.3 (still above ideal normal) to 1.6, with a GFR now of 50? By the way, when his blood test was repeated one month after his initial one this year, his creatinine was 1.5. Repeated a month later as part of a 24-hour urine collection, it was again 1.6.

My husband has no outward symptoms of kidney disease, but the nephrologist did prescribe 2.5 mg./day of Lisinopril to control his proteinuria (298 mg in a 24-hour period). His b.p. without medication is normally about 135/80, which the nephrologist said is too high. The doctor wants him to go on a low-protein diet and undergo renal ultrasound and a cystoscopy for results on an IVP from August of 2005 that showed "a possible chronic inflammatory process" in the bladder. He had chosen not to undergo the cystoscopy before now. His primary care doctor did not report to him the precise language of the IVP report. He only told my husband that he recommended a cystoscopy.

Any thoughts you have, particularly on the spike in his serum creatinine, would be greatly appreciated.

Answer:

Although you provide a wealth of information it sounds to me as if your doctor is still in the process of evaluating the cause of the renal problem. An increase in creatinine(mg/dl) from 1.3 to 1.6 is indeed significant. There are many causes of renal failure including causes that are indirectly related to renal disease (inflammation and scarring of the kidney) such as obstruction of urine outflow by prostate enlargement. The goal systolic BP should be less than 130mmHg in someone with renal disease. I am not enthusiastic about a low protein diet for treating his kidney problem although some doctors do use it and there is evidence that it is potentially beneficial in certain renal conditions.

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Response by:

Thomas   Zipp, MD Thomas Zipp, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University