50 years follow-up on plasma creatinine levels after spinal cord injury

Abstract

Study design: Retrospective chart review. Objectives: To investigate the role of plasma creatinine (p-creatinine) in monitoring renal deterioration in patients up to 50 years after spinal cord injury (SCI). Setting: The Clinic for Spinal Cord Injuries, Rigshospitalet, Denmark. Methods: A total of 119 patients with a traumatic SCI during the years were included in the study. P-creatinine measurements, results from renography and glomerular filtration rate (GFR) measured with 51 Cr-EDTA clearance were obtained from medical records and analyzed using a linear mixed model and linear regression analyses. Results: When compared with median p-creatinine level in the first 5-year period after injury, the level of p-creatinine was stable throughout the first 30 years and decreased significantly after the 30th until 45th year post injury. Only patients with a functional distribution outside the 30-70% limits on renography or a relative GFR p51% of that expected had a significantly elevated level of p-creatinine. Significance was not found for patients with a distribution outside the 40-60% limits on renography or relative GFR p75%. By comparing Cr-EDTA clearance and p-creatinine in terms of exceeding the upper reference level, p-creatinine revealed 17% sensitivity, 100% specificity, 100% positive predictive value and 73% negative predictive value as a diagnostic test for renal deterioration defined as GFR p75%. Conclusion: P-creatinine decreases over time in patients with SCI with a level below the upper reference limit and is a poor detector of early renal deterioration in patients with SCI.

Effect of Recent Spinal Cord Injury on Wnt Signaling Antagonists (Sclerostin and Dkk-1) and Their Relationship With Bone Loss. A 12-Month Prospective Study

“…In addition, although previous experimental models have shown that the expression of sclerostin is highly up regulated by unloading and that mice lacking sclerostin expression are insensitive to unloading bone loss, it is interesting to note that treatment with sclerostin antibodies in mice submitted to unloading could not fully counteract the effects of unloading in bone . Conversely, the effects of Dkk‐1 antibodies on bone mass in the same rat model under unloading was associated with a marked increase in bone mass in this condition suggesting an important role of Dkk‐1 in mediating bone loss in unloading conditions.…”

“…As expected, phosphate serum levels were increased and creatinine values were decreased at baseline in SCI patients, being two well known features attributed to the loss of phosphorus from bones and muscle and the diffuse muscle atrophy that occurs after SCI. (1,28) At baseline (time-since-injury of 100 AE 33 days) SCI patients showed a marked increase of $ 3-fold in bone turnover markers (PINP and sCTx) compared to controls (Table 1), which remained significantly increased at 6 months of follow-up; at 12 months both markers decreased, and no significant differences were observed compared to the control group ( Figure 2). Conversely, bone ALP did not show significant differences compared to controls at either baseline or during follow-up.…”

Serum Creatinine Levels May Not Necessarily Reflect a True Renal Function to Adjust Amikacin Dose in Paraplegic Patient: A Case Report and Literature Review

“…There is no doubt about that determination of endogenous creatinine serum level is the most widely used indirect measure of glomerular filtration rate as it is convenient and cheap, although is of low sensitivity even to substantial renal function impairment in addition to problematic interpretation [9], so that serum creatinine that falls in the so-called "normal" value in a young, healthy individual may in an elderly patient indicate a significant reduction in GFR due to old age or disease state [10]. Long time follow-up on ability of plasma creatinine value in individuals, who have sustained spinal cord injury has already confirmed that plasma creatinine is a poor detector of early stage renal function deterioration [11] Meanwhile, progressive renal impairment after spinal cord injury is well documented [12] at least for acute stage of the injury and may be associated with many changes that can affect disposition of drugs such as aminoglycosides. Therefore, dosing of aminoglycosides in such patients can be challenging due to changes in some important pharmacokinetic parameters such as volume of distribution, clearance, and half-life of these drugs.…”

Evaluating estimated glomerular filtration rates of creatinine and cystatin C for male patients with chronic spinal cord injury

“…On multivariate analysis, age was also one of the factors related to overestimation of renal function using eGFRcre. Some reports describe that serum Cre decreases over time in SCI patients, despite an increasing risk of developing renal insufficiency [23]. Extensive loss of muscle mass with increasing age in SCI patients is thought to be the biggest reason for the decrease in serum Cre.…”