A 50-year-old man on ICU with liver cirrhosis and AKI has a serum creatinine of 250 µmol/L. The hepatology team notes that serum creatinine may undere...

Question

A 50-year-old man on ICU with liver cirrhosis and AKI has a serum creatinine of 250 µmol/L. The hepatology team notes that serum creatinine may underestimate the severity of AKI in cirrhosis. Why?

Accepted Answer

Cirrhotic patients have reduced creatinine production due to reduced muscle mass (sarcopenia) and reduced hepatic conversion of creatine to creatinine; they also have an increased volume of distribution (ascites, oedema) that dilutes creatinine - therefore a 'normal' or mildly elevated creatinine in cirrhosis may represent significantly impaired renal function

Answer

Creatinine is always accurate in cirrhosis

Answer

Creatinine is metabolised faster in cirrhosis

Answer

The laboratory assay is inaccurate in the presence of bilirubin

Answer

Creatinine only reflects tubular function

uk-fficm MCQ (SBA): Creatinine Unreliability in Cirrhosis

A 50-year-old man on ICU with liver cirrhosis and AKI has a serum creatinine of 250 µmol/L. The hepatology team notes that serum creatinine may underestimate the severity of AKI in cirrhosis. Why?