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What Causes Elevated Serum Creatinine Levels?
Question: Age 62 yrs/167cms/ Wt = 70Kgs. Diabetic for 25yrs. Lipid levels are good. Physically fit and active. GFR = 55. In the past 16 months Serum CRT has increased from 1.4 to 1.5. Getting up once after retiring for the night to urinate in the past 6 months. Appetite good. No edema. Urine flow OK without blood, but frothing occasionally. Prostrate(mild enlargement)- Abdomen and Kidney sonography NAD. Bowel movement is good.No itching or weight loss. Had Hypertension in the past 2-3 yrs. Currently averaging 143/86. Taking Eritel LN40+ Diamicron XR60+Lipaglyn 4mg(morning). Afternoon Eurepa 1mg+Ecospirin75. Night TonactEZ + Eurepa 1mg +Inj Lantus@8 units. Am following a veg diet .I am worried about the CRT levels and want to understand the damage to my kidneys? Can this be reversed? My Liver profile is absolutely normal. Is the current drug therapy helpful ??
Brief Answer:
Possible DN.Needs drug intensification.
Detailed Answer:
Hi Sir,
I understand your concern.
I have carefully gone through all your attached reports.
The following lab abnormalities have been detected.
1.Elevated TSH-point towards hypothyroidism.
2.Elevated BUN and Sr CRT
+ -point towards intrinsic kidney damage.
Low GFR(<60).
3.Elevated blood pressure-Diabetics should maintain BP under 120/80 mm of hg.
4.Decreased ALP -probably related to hypothyroidism.
Now coming to your question pertaining to elevated CRT, this indicates ongoing renal damage.
The GFR has been less than normal .
This in view of long standing diabetes reflects Stage 3-4 Diabetic Nephropathy.
Diabetic nephropathy is a clinical syndrome characterized by the following:
1.Persistent albuminuria -loss of protein in urine.(FOR THIS YOU NEED A 24 URINE PROTEIN ESTIMATION).
2.Progressive decline in the glomerular filtration rate (GFR).
3.Elevated arterial blood pressure.
These changes in DN are irreversible and they ultimately lead to Chronic kidney disease/CKD.Currently based on the lab parameters you can be assigned Stage 1-2 CKD
With excellent control of blood sugar,Glycated Hb ,blood pressure and protein loss in urine via medications-Serum CRT can be brought down to normal range.
Its important that you get tested for urine albumin levels to assess protein loss.This test is pending in your case.
Currently you are placed on right medications to tackle DN and CKD.But these measures have to be intensified in order to achieve desired metabolic control.
Specific goals for prevention include the following:
1.Optimal blood glucose control (hemoglobin A 1c [HbA 1c] < 7%)
2.Control of hypertension (BP < 120/70 Hg)
3.Avoidance of use of potentially nephrotoxic substances such as analgesics and few antibiotics.
To conclude current, In my opinion drug therapy needs intensification.This has to be achieved by speaking to your Nephrologist.
Long Term monitoring is vital in your case.It includes
1.Regular outpatient visits.
2.Ensuring optimal glucose control,
3.Optimizing blood pressure,
4.And screening for other associated complications of diabetes (eg, retinopathy, diabetic foot, cardiovascular disease) are also crucial.
Post your further queries if any.
Thank you.
Possible DN.Needs drug intensification.
Detailed Answer:
Hi Sir,
I understand your concern.
I have carefully gone through all your attached reports.
The following lab abnormalities have been detected.
1.Elevated TSH-point towards hypothyroidism.
2.Elevated BUN and Sr CRT
+ -point towards intrinsic kidney damage.
Low GFR(<60).
3.Elevated blood pressure-Diabetics should maintain BP under 120/80 mm of hg.
4.Decreased ALP -probably related to hypothyroidism.
Now coming to your question pertaining to elevated CRT, this indicates ongoing renal damage.
The GFR has been less than normal .
This in view of long standing diabetes reflects Stage 3-4 Diabetic Nephropathy.
Diabetic nephropathy is a clinical syndrome characterized by the following:
1.Persistent albuminuria -loss of protein in urine.(FOR THIS YOU NEED A 24 URINE PROTEIN ESTIMATION).
2.Progressive decline in the glomerular filtration rate (GFR).
3.Elevated arterial blood pressure.
These changes in DN are irreversible and they ultimately lead to Chronic kidney disease/CKD.Currently based on the lab parameters you can be assigned Stage 1-2 CKD
With excellent control of blood sugar,Glycated Hb ,blood pressure and protein loss in urine via medications-Serum CRT can be brought down to normal range.
Its important that you get tested for urine albumin levels to assess protein loss.This test is pending in your case.
Currently you are placed on right medications to tackle DN and CKD.But these measures have to be intensified in order to achieve desired metabolic control.
Specific goals for prevention include the following:
1.Optimal blood glucose control (hemoglobin A 1c [HbA 1c] < 7%)
2.Control of hypertension (BP < 120/70 Hg)
3.Avoidance of use of potentially nephrotoxic substances such as analgesics and few antibiotics.
To conclude current, In my opinion drug therapy needs intensification.This has to be achieved by speaking to your Nephrologist.
Long Term monitoring is vital in your case.It includes
1.Regular outpatient visits.
2.Ensuring optimal glucose control,
3.Optimizing blood pressure,
4.And screening for other associated complications of diabetes (eg, retinopathy, diabetic foot, cardiovascular disease) are also crucial.
Post your further queries if any.
Thank you.
Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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