Most of the time when we are consulted for an inpatient with a rising creatinine, the assumption is that the kidney is to blame. However, there is an important list of non-renal conditions which can increase either BUN or creatinine independently of low GFR.An elevated BUN without AKI can occur in the following situations:
1. G.I. bleeding (because digested blood is a source of urea nitrogen).
2. excessive protein intake or a catabolic state.
3. steroid use.
4. TPN.
5. multiple boluses of iv albumin given.
An elevated creatinine (structure pictured above) without AKI can also occur, though less commonly than an elevated BUN without AKI. Recall that a percentage of creatinine clearance occurs via secretion; therefore, drugs which inhibit creatinine secretion such as Bactrim, probenecid, or Pepcid can increase serum creatinine without actually affecting the GFR. Furthermore, intense exercise can transiently increase the creatinine. Finally, some chemicals (e.g., nitromethane, used as a component of types of fuels and solvents) can interfere with the assay by which creatinine is detected in the laboratory.
No comments:
Post a Comment
Renal Fellow Network encourages comments and discussion regarding the posts. Do not post any comments that are commercial or advertising in nature. Posts will be deleted if commercial or advertising comments are made. Internet users commenting on the Renal Fellow Network must post information which is true and correct to their knowledge. Sources to health/medical claims must be provided when relevant. Moderators reserve the right to erase, without notification, any comment they would judge inappropriate.