High Creatinine But NO Symptoms? | How To Approach Elevated Creatinine in OPD

Hinzugefügt: 2026-05-29

[00:00:00]The creatinine more than eight, but patient had still good urine output. No pulmonary edema, no breathlessness.

[00:00:07]Patient only had severe occipital headache and BP was dangerously elevated.

[00:00:13]220 by 140. A 38-year-old male presents to my clinic after doing a routine master health checkup. His creatinine came back more than eight, but surprisingly no swelling, no breathlessness, no decrease in urine output. Creatinine does not always correlate with symptoms. So, how do we approach this patient? First, never trust a single value blindly. Double verify the lab report. Sometimes laboratory errors can happen. Then, ask the most important question, is this acute or is this chronic? Because creatinine alone will never tell you the duration of kidney injury. Now, look for important clinical clues. Long-standing diabetes, undiagnosed hypertension, painkiller abuse, heavy protein intake, foamy urine, obstructive symptoms. Then, examine the patient properly. Check blood pressure carefully. Look for hypertensive retinopathy or papilledema.

[00:01:13]Assess volume status. Look for signs of uremia. Before referring to a nephrologist, every doctor, irrespective of specialty, should know these basic tests. Complete blood count. Hemoglobin may be low because kidneys produce erythropoietin. Renal function test with electrolytes, especially potassium. If potassium is above 5.5, monitor closely.

[00:01:34]If it crosses six or ECG changes appear, admit immediately and treat hyperkalemia first. Then, [music] urine routine. Look for proteinuria, RBCs, RBC casts. RBC casts may suggest glomerular disease.

[00:01:49]Then, urine albumin creatinine ratio. If elevated significantly, it suggests proteinuric kidney disease. Next, ultrasound abdomen. Kidney size matters.

[00:02:00]Bilateral small kidneys usually suggest chronic irreversible disease. But remember, in diabetes, amyloidosis, polycystic kidney disease, HIV nephropathy, kidneys may still appear normal or even enlarged. Then, ECG because hyperkalemia kills silently.

[00:02:17]Look for tall tented T waves, widened QRS, bradycardia. Finally, check >> [music] >> HbA1c, calcium, phosphorus, bicarbonate.

[00:02:29]Calcium becomes low because vitamin D activation decreases. Phosphorus becomes high because excretion decreases. Low bicarbonate suggests metabolic acidosis.

[00:02:38]This is how we approach a patient presenting with high creatinine.

[00:02:42]Tomorrow, how to differentiate acute kidney injury from chronic kidney disease.