Chief Physician of Xun Zhou Nephrology
We found that the normal range of serum creatinine provided by various hospitals is not It is exactly the same. The high normal value of serum creatinine in some hospitals is set as 83 μmol/L, the normal high value of serum creatinine in some hospitals is set as 97 μmol/L, and the normal high value of serum creatinine in some hospitals is set as 115 μmol/L. What is the normal range for serum creatinine? It made my friends with kidney disease more and more confused. If 83 μmol/L or 97 μmol/L is used as the highest standard of the normal range of serum creatinine, then the serum creatinine of 100 μmol/L is considered to exceed the standard, that is, renal dysfunction; if 115 μmol/L is used as the highest standard of the normal range of serum creatinine, Then serum creatinine of 100 μmol/L is considered normal, that is, normal renal function. Because of this, when kidney disease patients find that their serum creatinine test reaches about 100 μmol/L, they are always worried that they will develop uremia in the future.
So, if the serum creatinine reaches about 100μmol/L, will it be possible to develop uremia in the future?
Or should we first find out what the normal range of serum creatinine is? Although the normal reference ranges vary from hospital to hospital, there is still a relatively common reference range. Generally speaking, the normal reference range of serum creatinine is 53-115 μmol/L for men; 44-97 μmol/L for women; 26.5-70.7 μmol/L for children. Accordingly, it can be said that when the serum creatinine reaches about 100 μmol/L, the vast majority of patients exceed the standard. Especially for female or child patients, when the serum creatinine has reached about 100 μmol/L, it indicates that the renal function of the patient has been damaged. For male patients, when the serum creatinine reaches about 100 μmol/L, the renal function of most patients is normal.
According to the normal reference range of serum creatinine, some patients with renal disease whose serum creatinine reaches about 100μmol/L can make Diagnosis of renal failure. If acute kidney injury is diagnosed, as long as the cause can be identified and treated in time, the patient’s serum creatinine can be reversed, so the possibility of developing uremia in the future is very small. This is not the focus of today’s discussion. Let’s focus on the kidneys first. For patients with chronic kidney disease whose serum creatinine reaches about 100 μmol/L and is diagnosed with chronic renal insufficiency, will they develop uremia in the future?
Prior to this, physicians and patients with kidney disease require further testing, measurement or estimation of glomerular filtration rate (GFR). ) or creatinine clearance (CCr). Many doctors choose the simplest way to estimate GFR, the CKD-EPI formula. However, we found that the difference in GFR obtained by this formula is also very large depending on age and gender, and the same serum creatinine reaches 100 μmol/L.
For example, a 14-year-old male juvenile nephropathy patient, estimated by serum creatinine of 100 μmol/L, can get The eGFR obtained is 96.93ml/min, which is obviously wrong, because if the serum creatinine of a 14-year-old male patient has reached 100μmol/L, which is mostly renal failure, the GFR cannot be normal;
Another example is a 30-year-old male patient with kidney disease, estimated by serum creatinine of 100μmol/L, the eGFR obtained is 86.62ml/ min, the renal function is still normal, and it is chronic kidney disease stage 2; Young female patients with nephropathy, estimated by serum creatinine of 100μmol/L, obtained an eGFR of 65.08ml/min, the renal function decreased significantly, and they were also in stage 2 chronic kidney disease;
< p data-track="11"> Another example is an 80-year-old female patient with nephropathy, estimated with a serum creatinine of 100 μmol/L, the obtained eGFR is 45.80 ml/min, which is already in chronic kidney disease Stage 3 disease.
In this way, none of the adult patients aged 80 years and younger had a GFR below 45ml/min, which means that All of them are in the 2-3a stage of chronic kidney disease. If they can be actively treated, the urine protein can be lowered, and the blood pressure can be controlled to meet the standard, these patients will not easily develop into uremia in their lifetime. However, if the serum creatinine of children with nephropathy reaches 100 μmol/L, the risk of developing uremia in the future is very high. This is because the GFR derived from the CKD-EPI formula is inaccurate, or the estimated results do not truly reflect the glomerular filtration rate in patients with renal disease. When the glomerular filtration rate obtained does not match the condition, it can also be detected by other methods, such as endogenous creatinine clearance rate or dynamic renal imaging + glomerular filtration rate or ECT.
Go back to the question in the title of the articleOn the topic, it can be summed up in one sentence: For adult kidney disease patients with serum creatinine of about 100 μmol/L, as long as the primary disease is not a difficult disease (such as polycystic kidney disease, hereditary nephritis and diabetic nephropathy, etc.), and The urine protein can always be reduced to below 0.3-0.5 grams, and the blood pressure can always be controlled to meet the standard (90-130/60-80mmHg, the standard can be appropriately relaxed for older people). prone to uremia. In addition, another key point is whether patients can actively cooperate with treatment and scientific self-management.
The article was published simultaneously with the WeChat public account of “Kidney First” with the same name. The article is original by Zhou Xun and may not be reproduced without authorization.