Serum creatinine asymptomatic increase

Mild and usually asymptomatic proteinuria, leukocyturia, microscopic hematuria, or moderate increases in serum creatinine were observed in 15-25% of patients (20). There was moderate deterioration of glomerular and tubular renal function in most interferon alfa-treated patients assessed prospectively with a number of renal function markers (263). 

Biochemical effects of interleukin-6 included asymptomatic increases in liver function tests, transient proteinuria, and increased serum creatinine concentrations. Reductions in serum albumin and cholesterol concentrations, and increases in blood glucose concentrations were dose-related (SEDA-21, 376) (2). 

The decline in kidney function usually occurs within the first few days of therapy, and may be detected after only a few doses or, more rarely, later in the course of treatment [7-17]. Patients may be asymptomatic, but nausea, vomiting, and abdominal, back, or flank pain are common, while oliguria is uncommon. The rise in the serum creatinine concentration is usually modest, and dialysis has only rarely been necessary [18, 19] Most patients recover kidney function within 3 to 14 days of stopping acyclovir therapy, reducing the dose, or increasing hydration [7, 8,10-17, 20]. Chronic renal dysfunction has been only rarely attributed to oral acyclovir use Urinalysis usually shows mild proteinuria, microscopic hematuria, and variable degrees of pyuria. Birefringent needle-shaped crystals may... 

Patients with chronic renal impairment because of diminished renal prostaglandin production may also be at increased risk of NSAID-induced renal failure. NSAID-induced acute kidney injury has been documented in patients with asymptomatic, but mild chronic renal failure, defined as a recruitment serum creatinine between 133 pmol/L and 265 pmol/L (1.5 and 3.0 mg/dl) [45]. Baseline excretion of urinary prostaglandin and 6-keto-prostaglandin F was quantitatively lower in the individuals who developed NSAID-induced renal decompensation than in those who did not. Upon initiation of ibuprofen, urinary prostaglandin excretion fell in all patients, but trough concentrations were quantitatively lower in the subset of patients who experienced acute kidney injury. 

There are four potential clinical presentations for acute CSA nephrotoxicity asymptomatic increases in serum creatinine (SCr) without overt renal dysfunction, acute kidney injury, delayed graft function after renal transplantation and recurrent or de novo hemolytic uremic syndrome (Table 2). 

Asymptomatic increases in serum creatinine Acute renai faiiure... 

Mild <7 Asymptomatic Peak urinary flow rate <10 mL/s Postvoid residual urine volume >25-50 mL Increased BUN and serum creatinine... 

Figure shows how the GFR must fall to about half its normal value before a significant increase in serum creatinine becomes apparent. Flence. a normal serum creatinine (i.e. within the reference range) does not necessarily mean all is well. The reference intervals will vary with age and body si/e. For example, consider an asymptomatic person who shows a scrum creatinine of 130 pmol/l ... 

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