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In my learning experience, I was taught that when a patient had an
acute renal event (contrast dye, shock, sepsis, etc) the serum
creatinine would rise about 1mg/dL per day if they were functionally
I would like to have literature supporting or refuting this concept.
I have been looking, but finding no love in the literature.
Help would be appreciated.
Dale Bikin, PharmD
1111 E. McDowell
Phoenix, AZ 85006
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I have never seen literature that gives an exact rate of increase in
secondary to your listed events. I doubt that you could quantify this
number due to great patient variability - age, underlying disease,
antecedent event, history and genetics.
At best you can observe and note and predict that the number will
the patient goes anuric.
Interesting to see if anyone has data.
Back to lurking
Robert G. Aucoin, Pharm D.
Clinical Pharmacy Spec - Peds/PICU
Department of Pharmacy
Our Lady of the Lake RMC
Baton Rouge, La 70808
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About changing serum creatinine. For how long do people say
it continues to rise 1 mg.dl/day? When does it end? Alan Segal, a
nephrologist at the University of Vermont, has an interesting way to
predict tomorrow's serum creatinine from data of today's serum
creatinine and the creatinine clearance. It is a new twist on our
method of estimating unstable CCr from 2 changing serum creatinines
and the patient's age, gender, height, and weight, as in
1. Jelliffe RW and Jelliffe SM: A Computer Program for
Estimation of Creatinine Clearance from Unstable Serum Creatinine
Levels, Age, Sex, and Weight. Math Biosci, 4: 17-24, 1972. This was
our first effort.
2. Jelliffe RW: Creatinine Clearance: Bedside Estimate. Ann
Int Med, 79: 604-605, 1973. This was a very simplified version
of #1 above.
3. Jelliffe R: Estimation of Creatinine Clearance in Patients
with Unstable Renal Function, without a Urine Specimen. Am. J.
Nephrology, 22: 3200-324, 2002. This is the best reference.
Dr. Segal's email is
It is interesting to see how the above method has not been
used or considered, as in the MDRD article of Levey et al, which
referred only to the bedside estimate (2 above) when creatinine is
stable, but not to the cited reference (1 above) from which it was
derived. The most recent modification is 3 above,, which you might
look at. For over 34 years now, we have built this into all our
USCPACK software, so we can specifically track unstable renal
function in acutely ill unstable patients, with regard to their drug
therapy (aminoglycosides, digoxin, vanco, etc). We would suggest it
is worth considering.
Using our USC*PACK software, I get, for a 70 in tall, 70 kg,
65 yr old man, for a change in serum creatinine in 1 day,
from 1 to 2, CCr = 35.95 ml/min, or 33.32 ml.min.1.73 msq
2 to 3 20.57 19.06
3 to 4 13.97 12.95
4 to 5 10.31 9.56
Very best regards,
Roger W. Jelliffe, M.D. Professor of Medicine,
Division of Geriatric Medicine,
Laboratory of Applied Pharmacokinetics,
USC Keck School of Medicine
2250 Alcazar St, Los Angeles CA 90033, USA
Phone (323)442-1300, fax (323)442-1302, email= jelliffe.aaa.usc.edu
Our web site= http://www.lapk.org
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