Correlation between glycated hemoglobin A1c,urinary microalbumin,urinary creatinine,β2 microglobulin,retinol binding protein and diabetic retinopathy

BACKGROUND Retinopathy is the most common microvascular disease of type 2 diabetes,and seriously threatens the life,health and quality of life of patients.It is worth noting that the development of diabetic retinopathy(DR)can be hidden,with few symptoms.Therefore,the preliminary screening of diabetic patients should identify DR as soon as possible,delay disease progression,and play a vital role in its diagnosis and treatment.AIM To investigate the correlation between glycated hemoglobin A1c(HbA1c),urinary microalbumin(U-mALB),urinary creatinine(U-CR),mALB/U-CR ratio,β2 microglobulin(β2MG),retinol binding protein(RBP)and DR.METHODS A total of 180 patients with type 2 diabetes mellitus attending the Second People’s Hospital of Hefei from January 2022 to August 2022 were retrospectively enrolled by ophthalmologists.Based on whether they had combined retinopathy and its degree,68 patients with diabetes mellitus without retinopathy(NDR)were assigned to the NDR group,54 patients with non-proliferative DR(NPDR)to the NPDR group,and 58 patients with proliferative DR to the PDR group.General data,and HbA1c,mALB,β2MG,RBP,mALB/U-CR and U-CR results were collected from the patients and compared among the groups.Pearson's correlation method was used to analyze the correlation between HbA1c,mALB,β2MG,RBP,mALB/U-CR and U-CR indices,and multiple linear regression was applied to identify the risk factors for DR.Receiver operator characteristic(ROC)curves were also drawn.RESULTS The differences in age,gender,systolic and diastolic blood pressure between the groups were not statistically significantly(P>0.05),but the difference in disease duration was statistically significant(P<0.05).The differences in fasting blood glucose,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,total cholesterol,and triglyceride between the groups were not statistically significant(P>0.05).HbA1c in the PDR group was higher than that in the NPDR and NDR groups(P<0.05).The levels of mALB,β2MG,RBP,mALB/U-CR and UCR in the PDR group were higher than those in the NPDR and NDR groups(P<0.05).Multiple linear regression analysis showed that disease duration,HbA1c,mALB,β2MG,RBP,mALB/U-CR and U-CR were risk factors for the development of DR.The ROC curve showed that the area under the curve(AUC)for the combination of indices(HbA1c+mALB+mALB/U-CR+U-CR+β2MG+RBP)was 0.958,with a sensitivity of 94.83%and specificity of 96.72%,which was higher than the AUC for single index prediction(P<0.05).CONCLUSION HbA1c,mALB,mALB/U-CR,U-CR,β2MG and RBP can reflect the development of DR and are risk factors affecting PDR,and the combination of these six indices has predictive value for PDR.

Determination of Creatinine in PETs and Laboratory Calculations of the Peritoneal Dialysis Adequacy

Since our Department for Dialysis performs the Peritoneal Equilibration Test （PET） to monitor peritoneal dialysis adequacy, our Laboratory has been asked to collaborate on calculating clearances and transport characteristics of patients. This collaboration is ongoing since 2003, despite the Baxter-PD Adequest software having appeared. Our aim is to emphasize the importance of the laboratory in the selection of formulas and specifically in solving the problem of determining creatinine concentration in PETs, and to recommend the cooperation between the laboratory and the dialysis department. Since creatinine determination is encumbered by recommendations for correcting elevated creatinine levels because of the influence of glucose in PETs, we compared results of dialysates determined as serum and as urine. Until now we had 86 patients on continuous ambulatory peritoneal dialysis （CAPD）. Method for determining patients＇ creatinine remains Jaffe kinetic uncompesated although the analyzers and the corresponding reagenses were changed in the laboratory. We have achieved the complete cooperation and confidence in the result, and with the PET test performed strictly according to the protocol, increasingly better results for clearences, Kt/V and transport characteristics. All this helps with treatment planning and analyzing patients＇ quality of life.

Cystatin C and serum creatinine in estimating acute kidney injury of shock patients

BACKGROUND： Serum creatinine （SCr） is the most commonly used parameter to estimate renal function impairement, but there are some shortcomings. Many factors including age, gender, drug, diet, muscle mass and metabolic rate can in？ uence SCr, leading to an inaccurate estimation of kidney impairment. Studies have shown that cystatin C （CysC） is not affected by factors such as muscle mass, age, gender, diet, in？ ammation or tumor. The present study was undertaken to compare the sensitivity of CysC and SCr in evaluating renal function impairment at early stage of shock.METHODS： Seventy-one patients aged 38.3±21.4 years, who had been treated at the Emergency Medicine Department of the First Affiliated Hospital, Sun Yat-sen University between February 2006 and June 2007, were studied. They were divided into groups A, B, C, and D according to the shock time. Serum sample was drawn from each patient at 1, 2, 3, 4 hours after shock to determine SCr and CysC. CysC and SCr were determined again at 72 hours and 7 days after shock.RESULTS： CysC increased earlier than SCr in the 71 patients, and CysC decreased slower than SCr when shock was corrected. CysC increased at 1 hour after shock. There was a negative correlationship between CysC, SCr and glomerular filtration rate （GFR）, especially at early stage of shock.CONCLUSIONS： There is renal injury at early stage of shock. CysC is more sensitive than SCr in assessing renal function at the early stage of shock.

Difficulties in diagnosing acute kidney injury post liver transplantation using serum creatinine based diagnostic criteria

Renal function in patients with advanced cirrhosis is an important prognostic factor for survival both prior to and following liver transplantation. The importance of renal function is reflected by the introduction of the model for end stage liver disease(MELD) score, which includes serum creatinine. The MELD score has been shown to predict the short term risk of death for transplant wait listed patients and is currently used by many countries to allocate liver transplants on the basis of severity of underlying illness. Changes in serum creatinine are also used to stage acute kidney injury. However prior to liver transplantation the serum creatinine typically over estimates underlying renal function, particularly when a colorimetric Jaffe based assay is used, and paradoxically then under estimates renal function post liver transplantation, particularly when immunophyllins are started early as part of transplant immunosuppression. As acute kidney injury is defined by changes in serum creatinine, this potentially leads to over estimation of the incidence and severity of acute kidney injury in the immediate post-operative period.

Determination of creatinine level in patient blood samples by Fourier NIR spectroscopy and multivariate analysis in comparison with biochemical assay

In this paper,in vivo spectra from 23 patients'blood samples with various Creatinine(Cr)concentration levels ranging from 0.96 to 12.5 mg/dL were measured using Fourier transform near-infrared spectrometer(FT-NIRS)and spectrum quantitative analysis method.Since Cr undergoes passive filtration,it serves as a key biomarker of kidneys function via the estimation of glomerular filtration rate.Thus,increased blood Cr concentration reflects impaired renal func-tion.After spectra pre processing and outlier exclusion,a spectral model was developed based on partial least squares regression(PLSR)method,wherein Cr concentrations correlated with filtered NIR spectra across several peaks,where Cr is know n to absorb NIR light.Several statistical metrics were applied to estimate the model efficiency during data analysis.Comparison of spectra-derived concentrations to reference Cr measurements by the current gold-standard Jaffe's method held in hospital lab revealed a Cr prediction accuracy of 1.64 mg/dL with good corre-lation of R=0.9.Bland-Altman plots were used to compare between our calculations and ref-erence lab values and reveal minimal bias between the two.The finding presented the potential of FT-NIRS coupled with PLSR technique for Cr determination.

Construction of Au@Metal-organic framework for sensitive determination of creatinine in urine

Creatinine level in urine is an important biomarker for renal function diseases,such as renal failure,glomerulonephritis,and chronic nephritis.The Au@MIL-101(Fe)was prepared by in situ growth of Au nanoparticles in MIL-101(Fe)as a selective SERS substrate.The Au@MIL-101(Fe)offers the great local surface plasmon resonance(SPR)effect due to gold nanoparticles aggre-gation inside metal-organic frameworks.The framework structure could enrich trace target samples and drag them into SPR hot spots.The optimal Au@MIL-101(Fe)composite substrate is used for analyzing creatinine in urine and the limit of detection is down to 0.1μmol/L and a linear relationship is ranging from 1μmol/L to 100μmol/L.

Measurement of serum cystatin C,creatinine clearance and urea micro-albumin as renal function evaluation indicators in cancer patients during chemotherapy with platinum

Objective:Chemotherapy drugs such as platinum may cause damage to the renal function,creatinine clearance(Ccr),as a "golden standard" indicator in clinical evaluation of renal function,was limited in application due to complicated detection steps.By detecting the expression of serum Cystatin C(Cys C),Ccr and urinary micro-albumin(UMA),this study was designed to analyze and discuss their roles and status in renal function evaluation for cancer patients before and after chemotherapy with platinum.Methods:We retrospectively reviewed 110 patients who receiving platinum-containing protocols or non-platinum-containing ones,and got the expression of Cys C,Ccr(was calculated by Cockcroft-Gault equation) and UMA,then analyzed whether there were differences for Cys C,Ccr and UMA in those patients;for patients with mildly impaired renal function(Ccr between 50-75 mL/min),whether there were differences for Cys C and UMA before and after chemotherapy with platinum.Results:There was statistical significance for Ccr,Cys C and UMA in patients who receiving platinum-containing protocols(85.01 ± 28.40) vs(76.79 ± 26.63) mL/min,(1.49 ± 0.50) vs(1.80 ± 0.84) mg/L and(14.30 ± 9.15) vs(16.90 ± 10.95) mg/L,P = 0.00,0.00 and 0.01),and no statistical significance for those receiving non-platinum-containing ones(89.45 ± 29.69) vs(86.78 ± 27.96) mL/min,(1.51 ± 0.78) vs(1.63 ± 0.73)mg/L and(17.31 ± 10.46) vs(16.59 ± 8.33) mg/L,P = 0.45,0.07 and 0.57);and there were also significant differences for Cys C for patients with mildly impaired renal function before and after chemotherapy(1.68 ± 0.55) vs(2.04 ± 0.68) mg/L,P = 0.03),while no statistical significance for UMA for the same ones(21.11 ± 10.06) vs(21.22 ± 8.81) mg/L,P = 0.93).There were statistical significance both for Cys C and UMA before and after chemotherapy in platinum-containing group,but the AUC for Ccr and Cys C is greater than that for UMA(P < 0.02).Conclusion:Cys C and UMA can both access renal dysfunction early after chemotherapy,but Cys C is more sensitive than UMA in reflecting early renal dysfunction,so Cys C can replace Ccr and become a reliable indicator in the assessment of renal function for cancer patients before and after chemotherapy especially with platinum.

Area under the curve of methotrexate and creatinine clearance are outcome - determining factors in primary CNS lymphomas

Although high-dose methotrexate(HD-MTX)is the most effective drug against primary CNS lymphomas(PCNSL),outcome-de-termining variables related to its administration schedule have not been defined.The impact on toxicity and outcome of the area under thecurve(AUC(MTX)),dose intensity(DI(MTX))and infusion rate(IR(MTX))of MTX and plsamatic creatinine clearance(CL(crea))was investigated in a retrospective series of 45 PCNSL patients treated with three different HD-MTX-basedcombinations.Anticon-vulsants were administered in 31 pts(69%).Age>60 years,anticonvulsant therapy,slow IR(MTX)(

Indirect determination of serum creatinine reference intervals in a Pakistani pediatric population using big data analytics

BACKGROUND The indirect methods of reference intervals(RI)establishment based on data mining are utilized to overcome the ethical,practical challenges and the cost associated with the conventional direct approach.AIM To generate RIs for serum creatinine in children and adolescents using an indirect statistical tool.METHODS Data mining of the laboratory information system was performed for serum creatinine analyzed from birth to 17 years for both genders.The timeline was set at six years from January 2013 to December 2018.Microsoft Excel 2010 and an indirect algorithm developed by the German Society of Clinical Chemistry and Laboratory Medicine’s Working Group on Guide Limits were used for the data analysis.RESULTS Data were extracted from 96104 samples and after excluding multiple samples for the same individual,we calculated RIs for 21920 males and 14846 females,with stratification into six discrete age groups.CONCLUSION Serum creatinine dynamics varied significantly across gender and age groups.

Urinary Creatinine Concentrations and Its Explanatory Variables in General Chinese Population:Implications for Creatinine Limits and Creatinine Adjustment

Objective The study aimed to analyze the applicability of the World Health Organization’s exclusionary guidelines for Urinary creatinine(Ucr)in the general Chinese population,and to identify Ucr related factors.Methods We conduct a cross-sectional study using baseline data from 21,167 participants in the China National Human Biomonitoring Program.Mixed linear models and restricted cubic splines(RCS)were used to analyze the associations between explanatory variables and Ucr concentration.Results The geometric mean and median concentrations of Ucr in the general Chinese population were 0.90 g/L and 1.01 g/L,respectively.And 9.36%samples were outside 0.3-3.0 g/L,including 7.83%below the lower limit and 1.53%above the upper limit.Middle age,male,obesity,smoking,higher frequency of red meat consumption and chronic kidney disease were associated significantly with higher concentrations of Ucr.Results of the RCS showed Ucr was positively and linearly associated with body mass index,inversely and linearly associated with systolic blood pressure,diastolic blood pressure,triglycerides level,and glomerular filtration rate,and were non-linearly associated with triiodothyronine.Conclusion The age-and gender-specific cut-off values of Ucr that determine the validity of urine samples in the general Chinese population were recommended.To avoid introducing bias into epidemiologic associations,the potential predictors of Ucr observed in the current study should be considered when using Ucr to adjust for variations in urine dilution.

Potential effect of Silybum marianum L. and Cistus ladaniferus L.extracts on urine volume, creatinine clearance and renal function

Objective:To investigate the diuretic and renal effects of Silybum marianum L.and Cistus ladaniferus L.in normal rats.Methods:Four groups of rats were used in each experiment.The first group received water,the second group received Cistus ladaniferus L.extract(100 mg/kg b.wt),the third group received Silybum marianum L.extract(100 mg/kg b.wt),and the fourth group received furosemide(10 mg/kg b.wt).Variables including urine volume,plasma and urine sodium,potassium and creatinine,and creatinine clearance were measured.Two experiments were conducted.A single dose of each intervention was used and the variables were measured during 24 h,and the interventions were given daily for a total of 8 d and the variables were measured during various intervals.Results:The single dose of each plant extract increased urine volume at all-time intervals and increased urine sodium and potassium excretion without affecting plasma sodium and potassium(P<0.05).On the day 8 after daily administration,the plant extracts induced a significant diuresis and natriuresis without affecting serum electrolytes(P<0.05),while furosemide caused hypokalemia.Both plant extracts significantly increased creatinine clearance(P<0.05).Conclusions:Silybum marianum L.and Cistus ladaniferus L Increase creatinine clearance and have a significant diuretic effect without affecting serum electrolytes.Silybum marianum L.is more potent than furosemide or Cistus ladaniferus L.

Evaluation of a handheld creatinine measurement device for real-time determination of serum creatinine in radiology departments

AIM: To assess the feasibility/accuracy of a commercial handheld device in the context of increased demand for point-of-care serum creatinine (SCr) determination. METHODS: In this institutional review board-approved, prospective study, 401 patients referred for contrastenhanced computed tomography were included at two centres. Capillary (c)SCr was determined using two devices A+B and venous (v)SCr was determined in the centre's laboratory. Method comparison statistics for both centres and for vSCr<>1.2 mg/dL, receiver operating characteristic analysis, negative predictive values (NPV), sensitivity and specificity were calculated pre-/ post-curve offset correction with vSCr. RESULTS: Pearson's coefficients for cSCr vs vSCr were: centre 1-A:0.93/B:0.92; centre 2-A:0.85/B:0.82 (all P < 0.0001). Overall correlation was better for vSCr > 1.2 mg/dL. The area under the receiver operating characteristic curves showed a high accuracy for cSCr, but the device underestimated SCr, which was confirmed by Bland-Altman plot. Addition of the offset correction factor to the original data from centre 1 resulted in an improvement in sensitivity for detecting patients at risk (> 1.2 mg/dL), whilst maintaining acceptable specificity and improving NPV. CONCLUSION: This study showed the feasibility of SCr determination using the evaluated handheld device in a routine clinical setting. The device showed high sensitivity and high NPV, but may significantly underestimate SCr without offset correction to local laboratories.

Diffuse transmitted spectroscopy in conjunction with spectral peak averaging as a potential tool for noninvasive creatinine screening

Creatinine(Cr)is a biochemical waste molecule generated from muscle metabolism and primarily cleared from the bloodstream by the kidneys.If kidney function declines,Cr levels in the blood tend to increase.Therefore,Cr serves as an indicator of kidney function.In this work,we present a simple method for the rapid screening for impaired renal function based on the subject's Cr concentration.In our setup,broadband white light is delivered to a finger clamp through a fiber-optic cable to illuminate the patient's finger.The light is transmitted through the finger and collected by a second optical fiber coupled to a visible-near-infrared(VisNIR)spectrometer which covers the spectral range from 400nm to 1100nm.During the calibration process,the transmitted spectra acquired from 60 patients were measured.An average was calculated using the peak level of the transmitted,diffused intensity at three different wavelengths to create a"Cr intensity index".Patients were divided into five groups according to their Cr concentration levels,ranging from 1 mg/dL to 13 mg/dL.Our observations indicated that each group featured a unique spectral fingerprint.Next,we tested the index on 20 patients not included in the cali-bration procedure(unknown samples).We were able to classify patients into groups according to their Cr level with moderate prediction accuracy(R^(2)=0.55)and mean screening error of up to 16%.Future efforts will evaluate the accuracy of this approach with larger patient populations representing a broad range of Cr concentration.Still,this preliminary work is an essential step toward developing this useful noninvasive Cr screening platform using NIR light spectroscopy.

Impact of creatinine methodology on glomerular filtration rate estimation in diabetes

AIM To evaluate the influence of creatinine methodology on the performance of chronic kidney disease(CKD)-Epidemiology Collaboration Group-calculated estimated glomerular filtration rate(CKD-EPI-eGFR) for CKD diagnosis/staging in a large cohort of diabetic patients. METHODS Fasting blood samples were taken from diabetic patients attending our clinic for their regular annual examination, including laboratory measurement of serum creatinine and eGFR.RESULTS Our results indicated an overall excellent agreement in CKD staging(kappa = 0.918) between the Jaffé serum creatinine-and enzymatic serum creatinine-based CKDEPI-eGFR, with 9% of discordant cases. As compared to the enzymatic creatinine, the majority of discordances(8%) were positive, i.e., associated with the more advanced CKD stage re-classification, whereas only 1% of cases were negatively discordant if Jaffé creatinine was used for eGFR calculation. A minor proportion of the discordant cases(3.5%) were re-classified into clinically relevant CKD stage indicating mildly to moderately decreased kidney function(< 60 m L/min per 1.73 m^2). Significant acute and chronic hyperglycaemia, assessedas plasma glucose and Hb A1 c levels far above the recommended glycaemic goals, was associated with positively discordant cases. Due to a very low frequency, positive discordance is not likely to present a great burden for the health-care providers, while intensified medical care may actually be beneficial for the small number of discordant patients. On the other hand, a very low proportion of negatively discordant cases(1%) at the 60 m L/min per 1.73 m^2 eGFR level indicate a negligible possibility to miss the CKD diagnosis, which could be the most prominent clinical problem affecting patient care, considering high risk of CKD for adverse patient outcomes. CONCLUSION This study indicate that compensated Jaffé creatinine procedure, in spite of the glucose-dependent bias, is not inferior to enzymatic creatinine in CKD diagnosis/staging and therefore may provide a reliable and cost-effective tool for the renal function assessment in diabetic patients.

Gold-catalyzed addition reaction between creatinine and isatin:A sustainable and green chemistry approach for the diastereoselective synthesis of 3-substituted-3-hydroxyisatins

The aldolization of various isatins with creatinine under gold catalysis in water has been developed.The reaction is operationally simple as the products can be isolated by simple filtration without requiring tedious solvent extraction and column chromatographic techniques.The generality of this methodology is showcased through the reactions of a wide range of isatin derivatives with creatinine to afford the respective aldol products in excellent yields with complete syn‐selectivity.The scope of this chemistry is further extended to a tandem reaction involving isatins,creatinine and malononitrile to afford multicomponent products in excellent yields with complete anti‐selectivity.The antioxidant potency of the synthesized compound was assessed by a spectrophotometric method,which revealed that three compounds containing halogen atoms(2c,2d and2e)were the most active compared with the standard.

PERINATAL FETAL WELL-BEING MONITORING: A COMPARISON BETWEEN RANDOMIZED URINARY ESTRIOL/CREATININE AND SERUM FREE ESTRIOL DETERMINATION

Randomized urinary and blood samples were obtained from three hundred and ninety-two cases of late pregnancies simultaneously for comparison of the validity in perinatal fetal monitoring. The results of randomized urinary estriol/creatinine （RUE3/C） and serum free estriol （SFE3） tests revealed that Ⅰ. The coefficient of correlation between RUE3/C and SFE3 level were close in either normal or high-risk pregnancies （y=0.1477X+14.2368, r=0.4586, n=170; y=0.1724X+8.6698, r=0.5868, n=222, respectively, P【0.001）; 2.92%cases of the false positive rate of RUE3/C were corrected by SFE3 test. In cases of pregnancy-induced hypertension （PIH） the false positive rate of RUE3/C were highest in comparison with those in cuses of other high-risk pregnancies （53.6%）; 3. The correct rate of SFE3 test in prenatal predication of fetal well-being was significantly higher （95.6%） than that of RUE3/C （87.3%） （X2=17.77, P【0.001）. This paper suggests that RUE3/C can be used as a first line test for perinatal monitoring. When RUE3/C value is lower than normal, SFE3 test should be added to ensure the reliability of perinatal diagnosis, especially in PIH cases. Obviously, to use these two tests for perinatal fetal monitoring simultaneously is better than to use any one test alone.

Exploration of Urinary Creatinine to Determine the Carcass and Its Protein Weight in Beef Cattle

This study was aimed to explore the use of creatinine as indicator to predict carcass and its protein weight in beef cattle. Eight Ongole crossbred cattle with initial body weight ranged at 133.5-228 kg and age of 6-18 months were used in this study. The cattle were fed Napier grass ad libitum and concentrate feeding for three months prior to be slaughtered. Concentrate feeding was consisted of rice bran and soybean meal which was provided to fulfill dry matter requirement at 2.1% of body weight （BW）. The availability of creatinine for prediction indicator was done by evaluate the correlation between the amount of daily urinary creatinine and the carcass and its protein weight. Carcass and its protein weight were measured by slaughtering the cattle, and chemically analyzed for determining protein content of carcass. The results showed that creatinine excreted in urine have a strong correlation with the cattle body weight （r = 0.88）, carcass weight （r = 0.67）, body protein （r = 0.70） and carcass protein （r = 0.72）. The conclusion of this study is creatinine excreted in urine have a strong relationship with the carcass and its protein, and therefore could be used to predict the carcass and its protein weight of beef cattle.

Creatinine, urea, uric acid, water and electrolytes renal handling in the healthy oldest old

Renal physiology in the healthy oldest old has the fol-lowing characteristics, in comparison with the renal physiology in the young： a reduced creatinine clear-ance, tubular pattern of creatinine back-fltration, pre-served proximal tubule sodium reabsorption and uric acid secretion, reduced sodium reabsorption in the thick ascending loop of Henle, reduced free water clear-ance, increased urea excretion, presence of medulla hypotonicity, reduced urinary dilution and concentra-tion capabilities, and fnally a reduced collecting tubules response to furosemide which expresses a reduced potassium excretion in this segment due to a sort of aldosterone resistance. All physiological changes of the aged kidney are the same in both genders.

Can Vaginal Washing Fluid Urea, Creatinine and Qualitative <i>&beta;</i>-hCG Diagnose Suspected Premature Rupture of Membranes?

Several markers have been studied to diagnose PROM but there is still limitation with a gold standard test for the diagnosis [1]. Objective: To evaluate and compare the accuracy of urea, creatinine and hCG in vaginal fluid washing for diagnosis of PROM and to determine cut off levels. Type of the study: Prospective study performed on pregnant women in their third trimester who are coming to Kasr El Ainy maternity outpatient clinic with history of fluid leakage. Patients and methods: 150 patients between 26 - 40 weeks were included in the study. Group I included 50 patients with clinically confirmed ROM, group II included 50 with unconfirmed ROM and 50 controls with no complaints (group III). All patients were subjected to speculum examination for amniotic fluid pooling, nitrazine paper test, vaginal fluid washing for measurement of creatinine, urea and β-hCG, and ultrasound examination. The results were compared as regards the 3 study groups. Results: There was no statistically significant difference among the 3 study groups as regards age, parity BMI, nor gestational age. There was a statistically significant difference in creatinine level among confirmed, suspected and control groups. Urea levels showed also a statistically significant difference among the three groups. There was a positive correlation between vaginal creatinine and urea and gestational age in the 3 groups (r = 0.43, and 0.51 respectively). There was a statistically significant difference between vaginal fluid wash urea and creatinine levels and β-hCG as sensitivity, specificity, positive and negative predictive values and accuracy for urea and creatinine were all 100% and for qualitative β-hCG 83%, 100%, 100%, 85.6%, and 91% respectively. Conclusion: Urea and creatinine in vaginal washings can be accurately used in diagnosing suspected PROM and are more accurate than β-HCG.

A Surviving Patient with Record High Creatinine

Creatinine is a product of muscle protein breakdown cleared by the kidneys at a constant rate. The glomerular filtration rate is estimated based on serum creatinine. There is no definitive level of serum creatinine which is itself incompatible with human survival. We present the highest serum creatinine associated with survival based on a thorough review of the literature. A 34-year-old male patient with baseline serum creatinine of 1.2 mg/dl presented our emergency department with a six week history of new onset of uremic symptoms. His past medical history was unremarkable. On exam, he was in no distress. His BMI was 28. His exam was significant only for elevated blood pressure and asterixis. His peak serum creatinine was 53.9 mg/dl. The patient subsequently required maintenance hemodialysis and later changed to long-term peritoneal dialysis. To our knowledge, based on a thorough review of the literature using PubMed, Cochrane Database and the United States Renal Data System (USRDS), this is the highest level of serum creatinine ever reported. We conclude that serum creatinine itself is non-lethal. It is more likely that other electrolyte and retained metabolic abnormalities of renal failure frequently cause symptoms or death before creatinine toxicity, if such a level exists, creatinine has reached.