Approach to managing elevated creatinine.

OBJECTIVE To describe a systematic approach to finding the underlying cause of an elevated creatinine level. QUALITY OF EVIDENCE This diagnostic approach is based on a synthesis of information from reference works on nephrology, articles found through a MEDLINE search, and the author's personal experience. MAIN MESSAGE Elevated creatinine levels suggest the differential diagnosis of renal failure (RF). History and a complete physical examination are important, keeping in mind that RF is often asymptomatic in the early stages. After repeating the creatinine test to verify results, baseline tests should be ordered to identify the cause of the RF. Comparing results of serial tests is essential for determining whether RF is acute or chronic, stable or progressive. An ultrasound scan is particularly useful for eliminating an obstructive cause; the size of the kidney can indicate whether disease is acute or chronic. Complementary blood tests and imaging studies might be useful. CONCLUSION Diagnosing and managing RF can appear complex, but a systematic approach will help you find the cause and treat the condition.