A. C. STORM ET AL.
Open Access OJNeph
219
A literature search of PubMed, Cochrane Reviews, and
the United States Renal Data System (USRDS) failed to
reveal case reports or data sets with a creatinine level as
high as our patient. The USRDS records show that over
the past 15 years, less than only 1.28% of all new ESRD
cases have a reported initial creatinine over 20 mg/dl [10 ].
Their data also include no values over 30 mg/dl indicat-
ing that the reported case herein could be the highest
createnine (53 mg/dl) in the literature. Despite this re-
cording the high level, the patient’s functional status and
clinical outcome were remarkably stable out of propor-
tion to the chemical evidence of his azotemia. It is possi-
ble that this patient has a chronic single functioning kid-
ney which was affected by either essential hypertension
or chronic glomerulopathy. More likely, he may have
focal and segmental glomerulosclerosis related to a small
kidney and chronic hyperfiltration. However, renal bi-
opsy was contraindicated due to advanced and irreversi-
ble nature of the kidney disease and the presence of a
single functio n i ng ki d ney .
In summary, we report what appears to be the highest
recorded serum creatinine in a surviving uremic patient.
This finding implies that creatinine itself may h ave a mi-
nimally pathophysiologic effect on uremic patients.
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Abbreviations
eGFR: estimate glomerular filtration rate.
COPD: chronic obstructive pulmonary disease.
USRDS: United States Renal Data System.
ESRD: End stage renal disease.
BUN: Blood urea nitrogen.
AST and ALT : liver enz y mes.
CPK: creatinine kinase.
PTH: parathyroid hormone.
ANA: anti-nuclear antibody.
ANCA: anti-neutrophil cytoplasmic antibodies.
BMI: body mass index.