Serum Creatinine Trajectories in Kidney Disease

Abstract

Creatinine is the end product of the metabolism of creatine phosphate, a by-product of skeletal muscle metabolism. It is excreted mainly via the kidneys, primarily by glomerular filtration. It is therefore the most widely used blood assay to measure the presence and progression of chronic kidney disease. The real-time monitoring of serum creatinine translations at the individual patent level, the so-called serum creatinine trajectories, offers a fascinating methodology of the study of kidney function and disease. In this review, we have examined and analyzed the serum creatinine trajectories in kidney disease, ranging from acute kidney injury (AKI) with its multifarious rainbow spectrum of renal outcomes in AKI, through the titillating vicissitudes of the different patterns of CKD to ESRD progression including a description of the syndrome of rapid-onset end-stage renal disease (SORO-ESRD) and the syndrome of late-onset renal failure from angiotensin blockade (LORFFAB) to the serum creatinine trajectories of some specific renal syndromes including adult polycystic kidney disease, HIV nephropathy, and sickle cell disease. These patients represent representative cases of the named renal states as managed at the Renal Unit of the Mayo Clinic Health System, Eau Claire, Northwestern Wisconsin, USA, and the Renal Clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. We surmise that the study of individual patient-level serum creatinine trajectories, an evolving area of current nephrology practice, can indeed provide additional diagnostic and prognostic insights in the management of the nephrology patient.