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It was noted that his creatinine fluctuated quite dramatically ( Figure 1) and specifically became more elevated after weekends at home, away from the hospital. An enzymatic creatinine was performed (to exclude methodological interference in routine creatinine measurement as the urea was disproportionately low) which confirmed the elevated creatinine. Urine protein–creatinine ratio was negligible at 1.6 mg/mmol (0–30). The patient returned the following week with a creatinine of 329 μmol/L and urea 3.9 mmol/L. The patient was discharged with a plan to return for review and possible biopsy the following week if renal function not returned to baseline. A urine sample was sent for protein quantification, and citalopram was stopped. In view of slightly abnormal liver function tests, a drug reaction with tubulointerstitial nephritis was considered in the differential diagnosis (recent starting of citalopram). Blood anti-nuclear antigen and anti-neutrophil cytoplasmic antibodies levels were normal. An ultrasound showed normal bladder and kidneys (right 10.6 cm and left 10.8 cm). Liver function tests were slightly deranged (bilirubin 7 μmol/L and alanine transferase 102 U/L).
#HIGHC CREATPONE LEVELS LIVER FUNCTIONS FULL#
His full blood count showed a mildly elevated WCC at 11.3 (neutrophilia), and repeat renal function appeared to be improving (sodium 142 mmol/L, potassium 4.9 mmol/L, urea 4.7 mmol/L and creatinine 251 μmol/L).
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He was mildly hypertensive at 130/70, and urinalysis revealed blood and protein. On examination, he was noted to be quite muscular but was euvolaemic with normal chest and abdominal examination. He admitted to occasionally taking creatine supplementation but at the time of presentation had not taken any for 2 months. He was self-employed as a business manager and did body building for a hobby. There was no NSAID usage, and he vehemently denied illicit drug use. He had been to Thailand 4 months previously and had a diarrhoeal illness for 1 week, but no other symptoms including weight loss, dry eyes, rash, joint pains or arthralgia were elicited. He had started citalopram 3 months earlier after suffering from an acute episode of depression at which time his creatinine was 109 μmol/L.Ī detailed history yielded little extra information. His GP had checked his bloods 5 days previously as part of routine screening for his repeat prescription of citalopram and found his creatinine elevated at 338 μmol/L, equating to an estimated GFR of 18 as calculated by the laboratory.
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Anabolic steroids, boldenone, disproportionately high creatinine Case reportĪ 37-year-old male admitted to hospital was referred to the medical take due to perceived abnormal renal function.