Highest Serum Creatinine Ever Reported? Here's Your Answer!

ER Doc: Dr Happy, I have a patient for you with a creatinine of 25.
Dr. Happy: Hmmmm.
Dr. Happy : Dr Renal, I have a patient with a creatinine of 25.
Dr Renal: Hmmmm.
Dr. Happy: Dr Dermatology, I have a patient with a creatinine of 25.
Dr Dermatology: What's a creatinine?

Just kidding about the dermatologist.  Everyone knows dermatology only has two rules and neither of them involve creatinine.  Rule number one:  If it's wet, make it dry.  Rule number two:  If it's dry, make it wet.  As for the creatinine of 25?  This was not a known kidney dialysis patient. This was one for my record box. That was a Holy Creatinine Batman Moment. That is impressive. Renal failure is one of those illnesses you can't fake. There is no gray zone. There is real pathology. I'm weak. I'm dizzy. I'm in pain. Those are all subjective complaints, so often present with normal objective data.

Acute renal failure? Not subjective. It's measurable. There is no gray zone. This is the kind of lab value that you talk about for years to come with other doctors who say "I had this patient once with a creatinine of 20". That's when you pull out the "I had a patient once with a creatinine of 25." And everyone says "Whoah. That's incredible." This is one of those situations. It's like an honor badge in medicine to have experienced extreme lab values.  

Let me put it in simple terms, a creatinine is a by product of protein metabolism. Your muscles are constantly turning over their protein. We can measure this by-product in the blood. It is excreted from the body in our urine. So, if your kidneys don't work quite right, the creatinine in your blood goes up. It is how we measure kidney function. A normal kidney circulates about 120 ml/min. A normal creatinine in the blood is about 1.  Poor creatinine clearance means poor urine output.  

For every doubling of your blood creatinine, your filtration rate of your kidneys is cut in half. That is the quick and dirty method. There are creatinine clearance formulas for figuring all this out, but  this is the quick and dirty.

So:
  • Serum creatinine going from 1--->2 means your filtration goes from 120--->60
  • Serum creatinine going from 2--->4 means your filtration goes from 60--->30
  • Serum creatinine going from 4--->8 means your filtration goes from 30--->15
  • Serum creatinine going from 8--->16 means your filtration goes from 15--->7
  • Serum creatinine going from 16--->32 means your filtration goes from 7--->3 ml/min
When your filtration rate gets below the magic number of about 10 ml/min, you are looking at kidney dialysis. There is no way around that. Your kidneys have lost their ability to clear fluid and toxins from your body and to manage your blood salts. That's what the dialysis machine does. It filters your blood through special really expensive membranes that try and mimic the magic of the human kidney. Who knows, someday somebody may use stem cell research to create artificial biological membranes that can work the same way as the human kidney.

This value of 25 represents my highest creatinine ever.  What is the highest reported creatinine in the English literature.  I tried to find the answer.  One case report from July, 2012 in the journal Hemodialysis International claims to take the win with a creatinine of 61.3 mg/dl successfully managed with hemodialysis.  You must have a subscription to view the article in full.  

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10 Outbursts:

  1. It doesn't beat your 25, but I had a patient admitted once as a "social admit" and the ER did absolutley nothing with this guy. No labs, no iv, no films, no nothing. He comes to me and we do a CBC and BMP for the heck of it and his creatinine comes back as 14. I then had to explain to the oncall at 9pm why this guy who was a "social admit" was actually in ARF and no one knew about it.

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  2. McCain and Palin oppose all stem cell research. Think about it.

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  3. Actually, anon, although McCain is strongly against embryonic stem cell research - using embryos conceived solely for this purpose, as well as cloning - he supports federal funding for stem cell research using adult cells, cord blood or amniotic fluid.

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  4. Stem Cell Schmem Cell, just take the Kidneys from those lazy F's on welfare, I mean on Death Row.

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  5. My second month in private practice I had a patient presented to my office with a creat of 25.

    As he weakened over months, his wife couldn't get him to go to the doctor, she had to wait until he could no longer resist.

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  6. what was the potassium?

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  7. *boggle*

    One wonders how that's even compatible with life.
    /jo

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  8. I enjoy your blog, and I also enjoy keeping track of my personal lab records. I hate to break it to you, but as a nephrologist in practice for 25 years, my personal record for creatinine is 56 - pt walking, talking, had HIV nephropathy...

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  9. HELP!!!!, I am presently a dialysis patient and is dreading to be out of it soon. I was given a condition by my nephrologist that I have to bring down my Creatinine to 200 so then she will advice me to stop doing dialysis, at present, my crea level ranges between 399 - 800 (depending on every week I have it check). I am trying so hard to bring it down...I need HELP on the HOW's, like what food to eat, drinks to take,any available supplements or regimen to excersice just to bring it down. I am luckly not diabetic nor hypertesive. I hope to hear from your expert advice soon. Thanks!

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  10. the highest creatinine that I have seen during my renal fellowship was 62.

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