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Published ahead of print on April 23, 2009
J Am Soc Nephrol 20: 1217-1221, 2009
© 2009 American Society of Nephrology
doi: 10.1681/ASN.2008060617
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BRIEF COMMUNICATION

Reduced Production of Creatinine Limits Its Use as Marker of Kidney Injury in Sepsis

Kent Doi, Peter S.T. Yuen, Christoph Eisner, Xuzhen Hu, Asada Leelahavanichkul, Jürgen Schnermann and Robert A. Star

National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland

Correspondence: Dr. Robert A. Star, Renal Diagnostics and Therapeutics Unit, NIDDK, NIH, 10 Center Drive, Room 3N108, Bethesda, MD 20892-1268. Phone: 301-496-6325; Fax: 301-402-0014; E-mail: robert_star{at}nih.gov

Received for publication June 18, 2008. Accepted for publication December 26, 2008.

Although diagnosis and staging of acute kidney injury uses serum creatinine, acute changes in creatinine lag behind both renal injury and recovery. The risk for mortality increases when acute kidney injury accompanies sepsis; therefore, we sought to explore the limitations of serum creatinine in this setting. In mice, induction of sepsis by cecal ligation and puncture in bilaterally nephrectomized mice increased markers of nonrenal organ injury and serum TNF-{alpha}. Serum creatinine, however, was significantly lower in septic animals than in animals subjected to bilateral nephrectomy and sham cecal ligation and puncture. Under these conditions treatment with chloroquine decreased nonrenal organ injury markers but paradoxically increased serum creatinine. Sepsis dramatically decreased production of creatinine in nephrectomized mice, without changes in body weight, hematocrit, or extracellular fluid volume. In conclusion, sepsis reduces production of creatinine, which blunts the increase in serum creatinine after sepsis, potentially limiting the early detection of acute kidney injury. This may partially explain why small absolute increases in serum creatinine levels are associated with poor clinical outcomes. These data support the need for new biomarkers that provide better measures of renal injury, especially in patients with sepsis.






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Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673