Creatinine and Creatinine Clearance

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Test Overview
Creatinine and creatinine clearance tests measure the level of the waste product creatinine (say "kree-AT-uh-neen") in
your blood and urine. These tests tell how well your kidneys are working.
Another substance, creatine (say "KREE-uh-teen"), is formed when food is changed into energy through a process
called metabolism . Creatine is broken down into creatinine. Your kidneys take creatinine out of your blood and pass it out
of your body in urine.
If your kidneys are damaged and can't work as they should, the amount of creatinine in your urine goes down while its
level in your blood goes up.
Three types of tests can be done.
Blood creatinine level
The blood creatinine level shows how well your kidneys are working. A high level may mean your kidneys are not
working as they should. The amount of creatinine in the blood depends partly on the amount of muscle tissue you have.
Men generally have higher creatinine levels than women.
Creatinine clearance
A creatinine clearance test measures how well creatinine is removed from your blood by your kidneys. This test gives
better information than a blood creatinine test on how well your kidneys are working. The test is done on both a blood
sample and on a sample of urine collected over 24 hours.
Blood urea nitrogen-to-creatinine ratio (BUN:creatinine)
The BUN test measures the amount of urea in your blood. Urea is a waste product made when protein is broken down in
your body. Urea is made in the liver and passed out of your body in the urine.
The levels of blood creatinine and blood urea nitrogen (BUN) can be used to find the BUN-to-creatinine ratio. This ratio
can help your doctor check for problems, such as dehydration, that may cause abnormal BUN and creatinine levels.
Why It Is Done
These tests are done:
To see if your kidneys are working normally.
To find out if your kidney disease is changing.
To see how well the kidneys work in people who take medicines that can cause kidney damage.
To check for severe dehydration . Dehydration generally causes BUN levels to rise more than creatinine levels. This
causes a high BUN-to-creatinine ratio. Kidney disease or blocked urine flow from your kidney causes both BUN
and creatinine levels to rise.
How It Is Done

Collecting the blood sample

The health professional drawing blood will:
Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger
so it is easier to put a needle into the vein.
Clean the needle site with alcohol.
Put the needle into the vein. More than one needle stick may be needed.
Attach a tube to the needle to fill it with blood.
Remove the band from your arm when enough blood is collected.
Put a gauze pad or cotton ball over the needle site as the needle is removed.
Put pressure on the site and then put on a bandage.
Collecting the 24-hour urine sample
 You start collecting your urine in the morning. When you first get up, empty your bladder but do not save this urine.
Write down the time that you urinated. This marks the beginning of your 24-hour collection period.
For the next 24 hours, collect all your urine. Your doctor or lab will usually provide you with a large container that
holds about 1 gal (4 L). The container has a small amount of preservative in it. Urinate into a small, clean container
and then pour the urine into the large container. Do not touch the inside of the container with your fingers.
Keep the large container in the refrigerator for the 24 hours.
Empty your bladder for the final time at or just before the end of the 24-hour period. Add this urine to the large
container, and record the time.
Do not get toilet paper, pubic hair, stool (feces), menstrual blood, or other foreign matter in the urine sample.
Results
Creatinine and creatinine clearance tests measure creatinine levels in your blood and urine. These tests give information
about how well your kidneys are working. The creatinine clearance value is found from the amounts of creatinine in the
urine and blood and from the amount of urine you pass in 24 hours. This value is the amount of blood cleared of creatinine
per minute, based on your body size.
Normal
These numbers are just a guide. The range for "normal" varies from lab to lab. Your lab may have a different range. Your
lab report should show what range your lab uses for "normal." Also, your doctor will evaluate your results based on your
health and other factors. So a number that is outside the normal range here may still be normal for you.
Blood creatinine and creatinine clearance footnote1

Blood Men: 0.6-1.2 milligrams per deciliter (mg/dL) or 53-

creatinine: 106micromoles per liter (mcmol/L)
Women: 0.5-1.1 mg/dL or 44-97 mcmol/L
Teen: 0.5-1.0 mg/dL
Child: 0.3-0.7 mg/dL

Creatinine Men (younger than age 40): 107-139 milliliters per minute
clearance: (mL/min) or 1.8-2.3 milliliters per second (mL/sec)
Women (younger than age 40): 87-107 mL/min or 1.5-1.8
mL/sec
Creatinine clearance values normally go down as you get
older. (Normal values go down by 6.5 mL/min for every 10
years past the age of 20.)

BUN-to-creatinine ratio footnote1

Adults: 6-25, with 15.5 being the best value

High values
High creatinine blood levels can be caused by:
Serious kidney damage or chronic kidney disease. Kidney damage can be caused by a life-threatening
infection, shock , cancer, or low blood flow to the kidneys.
Dehydration .
Muscle injury and conditions. These include crush injuries, burns,rhabdomyolysis , muscular dystrophy ,
polymyositis, and strenuous exercises.
Shock. This is low blood pressure with many causes including severe bleeding and very severe infection.
High creatinine clearance levels can be caused by carbon monoxide poisoning , hypothyroidism , and pregnancy.
High BUN-to-creatinine ratios occur with sudden (acute) kidney problems. This may be caused by shock or severe
dehydration. A very high BUN-to-creatinine ratio may be caused by bleeding in the digestive tract .
Low values
 Low blood creatinine levels can mean lower muscle mass caused by a disease, such as muscular dystrophy, or by
aging. Low levels can also mean some types of severe liver disease or a diet very low in protein. Pregnancy can also
cause low blood creatinine levels.
Low creatinine clearance levels can mean you have chronic kidney disease or serious kidney damage. Kidney
damage can be from conditions such as a life-threatening infection, shock, cancer, low blood flow to the kidneys, or
urinary tract blockage. Other conditions, such as heart failure and dehydration, can also cause low creatinine
clearance levels.
Low BUN-to-creatinine ratios may be linked with a diet low in protein, a severe muscle injury called
rhabdomyolysis, pregnancy, cirrhosis, or syndrome of inappropriate antidiuretic hormone secretion (SIADH).
SIADH sometimes occurs with lung disease, cancer, diseases of the central nervous system, or the use of certain
medicines.
What Affects the Test
You may not be able to have the test, or the results may not be helpful, if:
You take certain medicines, such as:
The antifungal medicine amphotericin B, cimetidine (Tagamet), phenytoin (Dilantin), quinine, quinidine,
procainamide, methyldopa, trimethoprim (Proloprim, Trimpex), or vitamin C (ascorbic acid).
Cephalosporin antibiotics, especially cefoxitin (Mefoxin), tetracycline antibiotics, and some diuretics .
You do some strenuous exercise 2 days before a creatinine clearance test.
You eat more than 8 oz (227 g) of meat, especially beef, in the 24 hours before a blood creatinine test or during a
creatinine clearance urine test.
You don't collect your urine for exactly 24 hours.