“Doctor when should I worry about creatinine levels?” – seeing patients in our dialysis center in Bangalore makes it one of the commonest questions that I am asked.
Like to most questions in life the most correct answer is “it depends.” But since that answer is unlikely to be of much help in real life I will answer it in a little more detail.
But before that: a few basic facts about creatinine. Creatinine is a waste product that is removed from the body by the kidneys through urine. Muscles are the most important source of creatinine. Also, it is removed from the body only by the kidneys. Hence it is a good marker of kidney function because the levels of creatinine in blood begin to rise when the functioning of the kidneys is decreased.
The normal level in the blood in people in good health is 0.6-1.4 mg/dl. The test is often called as “serum creatinine” test in medical terms. For the understanding of the common man serum creatinine means nothing but blood creatinine test. The normal levels vary slightly from lab to lab and are generally lower in women compared to men.
To be honest, I wouldn’t advocate that people should worry excessively about their creatinine values. Some worry/anxiety may be ok as it will lead one to take proper care. But excessive worry is counter productive as it hinders proper treatment of the kidney condition and takes one away from good health.
So coming back to our question of when to worry about creatinine levels.
Here are the situations when one needs to “worry” about creatinine levels:
1. You don’t know your creatinine levels at all
2. When creatinine values are very high and dialysis is needed
3. When creatinine levels are above normal for a long time
4. When creatinine values are increasing rapidly
You don’t know your creatinine levels at all
This is probably the situation that worries me the most. Of course the patient hasn’t done the test and hence is unaware of her creatinine values.Most likely she is not aware that there is anything wrong. So, this is a situation in which the patient is not worried but the doctor is.
Kidney failure is asymptomatic(a word that the COVID-19 pandemic has made very famous) even upto its advanced stages. So, unless one is aware of one’s blood creatinine report, kidney failure may not be diagnosed till it is very advanced.
Does that mean that every healthy person needs to get the blood test for creatinine regularly?
The answer to that is “NO.” But there are a few well known risk factors for kidney failure. People harbouring any of them should definitely test their creatinine levels periodically.
What are these risk factors that need regular creatinine testing?
The most important ones are :
1. Diabetes: even if it has been diagnosed recently
2. High blood pressure
3. Obesity
4. Smoking
5. Family history of kidney failure
6. Heart disease
So anyone with with the above risk factors should definitely check her creatinine levels regularly. How frequently? Generally once a year should be enough. People with multiple risk factors or with already elevated blood creatinine will need more frequent testing.
It has happened so many times that I have suggested creatinine testing for someone with these risk factors and absolutely no symptoms and they turned out to have high creatinine levels.
When creatinine levels are very high and dialysis is needed
Higher the creatinine lesser the kidney function. Creatinine level by itself doesn’t decide when dialysis will be needed. So, someone with a creatinine level of 4.0 mg/dl may need dialysis and another person with 8 mg/dl may not. However, in a given patient the likelihood of dialysis increases as creatinine levels increase.
As a general rule I advise my patients to start thinking about dialysis once creatinine levels are above 4 mg/dl. Of course, it is only a rule of thumb and many patients will not need dialysis till the creatinine is much higher. But it is always good to prepare in advance and 4.0 is the level at which this communication/preparation should start.
When creatinine levels are above normal for a long time
A creatinine level above normal for more than 3 months means chronic kidney disease(CKD) is present. This is a disease which progresses over months, years and even decades.
Hence regular follow-up with a kidney specialist (nephrologist) is needed, at least once in three months. Unfortunately, in the early stages because creatinine levels are not dramatically abnormal, CKD gets neglected until it’s too late.
Avoid doing this and take maximum care in the early stages because this can slow the progression in the long run.
When creatinine levels are increasing rapidly
Creatinine levels can be normal or slightly abnormal for a long time and then start increasing rapidly.
The main question to answer in such a scenario is whether the damage is reversible or not? In both the situations some very critical decisions regarding treatment have to be taken. In such a situation very detailed investigation including urine and blood tests, ultrasound scanning, kidney biopsy, etc may be needed.
Dialysis may also be needed at least temporarily. Hence it is important to see a nephrologist when creatinine levels start to rise rapidly.
So, there you have it. Four situations when one has to take proper care of one’s kidney health based on blood creatinine test.
Also blood creatinine levels tell more about your kidney function than ultrasound scan which may be reported as “bilateral renal parenchymal disease” but gives very little information about kidney function.
Some numbers :
- 15% of Indians(that’s almost 20 crore people!) have chronic kidney disease. Unfortunately, a vast majority are unaware of it. The easiest way to diagnose early is to be aware of the risk factors mentioned above and test regularly.
- 2 lakh Indians develop kidney failure requiring dialysis every year. Again, most of them are recognised too late. The above measure of periodic testing will help in recognizing the people with severe kidney failure early. They can then prepare properly for dialysis.
Hello My creatinine level is :
122 umol and Gfr 59
I am diabetic patient last 6 month and taking Metformin and Fenofibrate for TG ,
My kidney function is okey ?
Hi. Thanks for the comment. A lot more information is needed to give proper advice. Please consult a nephrologist nearby and follow their advice.
I am a diabetic for last twenty years. Now I am about 66 yrs old. Recent blood test shows higher level of creatine and RA factor. Liver function test also shows little above optimum levels.
Whom should I consult?
Endocrinologist?
Nephrologist ?
Physician ?
You can start with a nephrologist. Thanks for the comment.
In 25 with diabetes and creatinine is 1.43 is that high and is it normal
Please look at the normal range for your lab. If it is above that, then it is high.
Serum creatine 1.5 women it is high
It is above normal range. You need to see a nephrologist.
My creatinine level is 1.43. frequent swelling on knee and pain on saulger occurs
Kindly. Suggest for treatment.
Hi. Thanks for the comment. The blog post is meant for educational purposes. I do not provide specific medical advice on the blog as it will not be fair to the person seeking the advice. Please consult a nephrologist nearby who can guide you.
My recently creatine level 1.22 & Blood urea 21mg/dl before 2year .0.86
Can recheck in a month. If increasing then please get evaluated by a nephrologist.
Hi my daughter just took a creatinine test and the results on the urine dip were 0-10. She has just been in hospital with kidney infection. Should I be worried?
Urine creatinine is not a very useful test for kidney ailments. Blood creatinine is.
I had test done today and my Creatinine came back 100mg/dl.My
chart is flagged due to this. Was wondering if it is something I need
to worry about or not.
In the blood or urine?
Hi. My creatinine levels in the past year have run from 1.11 to 1.4. I was wondering how often would a blood test be appropriate to see if it’s gone up or down. My most recent test was January 10. Is 5 weeks a good interval. Thanks in advance.
A shorter interval initially and then tailored as per individual needs.
I am 42years male, hypertensive on medications . i had creative test for 3 months consecutively with this result (1.18, 1.3 and 1.48)mg/do. Should i worry
There is an increasing trend. Need to see a nephrologist.
URIC ACID REMAINS HIGH >7.5 AND LAST 10 YEARS CREATINIE LEVEL REMAINS 1.3 TO 1.4. RFT SHOWS NORMAL. PLEASE ADVICE
A low purine diet and some basin medications should be enough. Can consult a physician/nephrologist.
My creative level is low.59, should I be concerned?
Depends on a few factors but low creatinine is generally not a big problem.
Hi my gfr is 25 and my creatine is 2.
Need to be on regular follow up with a nephrologist.
Serum cratinine 1.0 mg/dl is normal or not?
Depends on the lab’s normal range. At most labs it would be normal.
I only see articles showing the High Creatinine levels, mine is low. Anything to worry about? A sister died from kidney disease–nephritis.
My creatnine 3.78
What precautions to take
Sugar control if diabetic, BP control, proper diet, regular follow-up with a nephrologist — these are what you need. Regards.
Creat 1.43, egfr 40. I have been pushing fluids, now bladder urgency all day long. Going on 3 mos with similar numbers. What now?
If stable for a few months, it’s a good sign. Drinking too much water may prove counterproductive. Consult your physician. Regards.
Hi! Iam 45 years old women.My serum creatinine level is 1.18 and E.S.R. 40 mm. Is it normal or not? Should I be concerned?
Depends on the lab range but it is not very high. You can consult a physician/nephrologist if you have any doubt.
My creatinine level is 1.4 and i am 54 years old should i worry and is there a way thering it to normal rangs
thanks
It’s little bit on the higher side. Needs basic evaluation (urine for protein, ultrasound scan, etc) and regular follow-up.
Creatinine went from baseline of 1.6 to 3.1, then 4.2 within 3 days. I’m in the hospital now, but I’m wondering what could cause such a rapid increase.
There could be a host of reasons– infection, dehydration, medications, etc. Please talk to your nephrologist about the way forward.
What precautions should I take if my creatinine increases slightly? What does being a little on the dry side mean ?
The most important is to be on regular follow-up with a nephrologist. Control blood sugars and blood pressure adequately if you have diabetes, hypertension. Avoid unnecessary medication. Being on the dry side means consuming a reasonable amount of water and not too much of it.
Creatinine went from a baseline of 2.6 to 2.8 and I see a nephrologist regularly. Is there any other test to test kidney function? Does lisinopril increase creatinine levels? In my case, My creatine always increases when the lisinopril dose that i take increases.