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  1. paul smith
  2. General Nephrology Questions
  3. Friday, 16 August 2019
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my question is related to fluctuation of serum creatinine levels.

i am a 64 year old male with hypertension, which is well controlled with losartsan 100mg and amlodipine 10mg averaging 110/75. all other blood and urine results are normal and kidney ultrasound is normal. no protein in urine. acr ratio is less than 1. i eat a low salt, low meat diet and i am not overweight.

my only abnormal results are serum creatinine 110-126 and egfr less than 60.

for the last 14 years my serm creatinine has fluctuated between 110 and 126 mmol. this of course affects my egfr ranging from 50 to 62.

my creatinine can go from 110-116 for two or three years and then to 123-128 for two or three years then can come down again. my PCP said that my bp meds themselves can elevate the serum creatinine levels.

it was at 110 at age 58. at age 60 it went to 118. for the last three years it has gone to 126. it has effectively been unchanged at 126 for the last three or four years. it has done this before and then declines again. however since age is a component of the egfr calculation, my gfr is now 50.


my PCP said it is within the range of normal physiological variation or could be “ lab variation”. apparently the lab calculation can vary by 20 mmol so it is not true decline in kidney function.

the nephrologist wouldnt confirm ckd but stated that a strict interpretation of staging puts me at stage 3A.

my PCP will not admit to a CKD diagnosis, he says other than creatinine, my other indicators are normal but wants strict blood pressure control as that is what is affecting my kidneys.

needless to say, this has been psychologically devastating.i suffer from health anxiety and the thought of kidney failure and dialysis has caused depression and keeps me awake at night.

do i have ckd? is this creatinine fluctuation within normal range? can the lab measurement vary by 20 mmol? does creatinine have a phsyiological variation? is it normal for creatinine to bump up for two or three years then come back down again or is this just the lab variation?
Responses (3)
Accepted Answer Pending Moderation
Hello,

I would not be concerned about impending kidney failure - not at all.

The fact that your urinary protein is zero and that your creatinine is not progressively rising, I would not rate your risk of kidney failure as significant whatsoever. Creatinine fluctuation can indeed happen, especially when taking losartan. In fact, if you plot your tests in the KFRE equation (https://ukidney.com/nephrology-resources/kidney-failure-risk-calculator), your risk of kidney failure in the next 2 and 5 years is essentially 0%. And assuming your results remain in their current ranges (as they have for last 14 years), there is no reason to be believe this will change over time. When performing blood tests, ensure that you are well-hydrated as this one fact can influence your creatinine level, especially when taking losartan. Also, ensure that you refrain from smoking, have good cholesterol control and ideally avoid NSAIDs.

I can only base my opinion on the information provided and your health-care provider might arrive at different conclusions once you have provided an entire history and had a physical examination performed. As always, this forum provides general medical information only and is limited to educational use only. Please discuss the above remarks with your health-care provider.

Dr. Jordan Weinstein
  1. more than a month ago
  2. General Nephrology Questions
  3. # 1
Accepted Answer Pending Moderation
Thank you so much Doctor. Is lab variation a cause for creatinine fluctuation?
  1. more than a month ago
  2. General Nephrology Questions
  3. # 2
Accepted Answer Pending Moderation
Thank you so much Doctor. Is lab variation a cause for creatinine fluctuation?

Yes, but I usually quote 10% variance.

j
  1. more than a month ago
  2. General Nephrology Questions
  3. # 3
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