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Concentrations of Serum creatinine in blood of patients visiting Tamimi, Al baida and Alabyar Hospitals

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Abstract

Serum creatinine is usually used in the valuation of renal function to detect and diagnosis of conditions with impaired renal function. Blood of 232 patients was collected and analyzed from Al-tameamy Hospital- Tameamy town, Al- abyar Hospital- Alabyar city and Al baida laboratory- Baida city during the period 3rd July to 7th August 2016. Most of patients belonged to the age group >=50 years age (43.1%), followed by patients of 30 - 39 years and < 20 of age (15.1%) equally. 7 (03.0%) were abnormal creatinine among whom the male represented and females 12 (5.20%). 19 patient's serum with high levels creatinine, 12 (5.20%) were from females and 7(03.0%) were from males. Most of them belonged to the age group >=50 years of age (6.9%), followed by patients of 40-49 years of age (9%). Total of 55 males' participant, most of abnormal scr was belonged to the age group >=50 years (7.1%).total of 55 females' participant, out of 12 (9.0%) that were identified as abnormal creatinine, 40-49 years age groups registering as the highest group with abnormal creatinine levels (1.5%) followed by < 20 years age groups (7%). The value of serum creatinine in detection of levels of kidney function is imperfect, especially in the earlier impairment and in patients with other disease.


Concentrations of Serum creatinine in blood of patients visiting
Tamimi, Al baida and Alabyar Hospitals


Nour Al-Huda M. Al-Awkali. Department of Medical Laboratories, Higher Institute of Professions, Slouk. Libya.
Email: noornooor1973@gmail.com 
Muftah S. Najm. Faculty of Medicine and Oral and Dental Surgery. University of Benghazi, Libya.
Email: muftahnajem@gmail.com.

Ibrahim A. Al-Suwaie. Central Diagnostic and Follow-up Clinic for Diabetes Patients 
Maree D Ali. Department of medical laboratories. Higher Institute of Comprehensive Professions, Sluk, Libya.
Email: eldokally@gmail.com 
Miloud Amari. College of Public Health. Benghazi University 
Al-Rida M Al-Awkali. Central pharmacy. Ministry of Health. Derna, Libya 
Muftah A Nassib. Associate Professor, Department of Microbiology, Faculty of Science, Omar Al-Mukhtar
University, Al-Bayda, Libya 
Abeer M Al-Awkali. Veterinary clinic. Ministry of Health. Derna, Libya. 
Nisreen Miloud Al-Awkali. Department of Surgery. El Hawary Hospital. Benghazi, Libya 
Khadija S. A. Ghafir. Master's degree in environmental sciences. Faculty of Environmental Resources Sciences.
Omar Al-Mukhtar University, Al-Bayda, Libya 

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

Abstract
Serum creatinine is usually used in the valuation of renal function to detect and diagnosis of conditions with
impaired renal function. Blood of 232 patients was collected and analyzed from Al-tameamy Hospital- Tameamy
town, Al- abyar Hospital- Alabyar city and Al baida laboratory- Baida city during the period 3rd July to 7th August
2016. Most of patients belonged to the age group >=50 years age (43.1%), followed by patients of 30 - 39 years and
< 20 of age (15.1%) equally. 7 (03.0%) were abnormal creatinine among whom the male represented and females
12 (5.20%). 19 patient's serum with high levels creatinine, 12 (5.20%) were from females and 7(03.0%) were from
males. Most of them belonged to the age group >=50 years of age (6.9%), followed by patients of 40-49 years of
age (9%). Total of 55 males' participant, most of abnormal scr was belonged to the age group >=50 years
(7.1%).total of 55 females' participant, out of 12 (9.0%) that were identified as abnormal creatinine, 40-49 years age
groups registering as the highest group with abnormal creatinine levels (1.5%) followed by < 20 years age groups
(7%). The value of serum creatinine in detection of levels of kidney function is imperfect, especially in the earlier
impairment and in patients with other disease.
Key words: concentration, creatinine, blood.
Introduction
Chronic kidney disease (CKD) is one of the major public health problems.12 Chronic renal failure induces a
slow and continuing failure of kidney function. It is usually a result of difficulties from additional severe medical
condition. Dissimilar acute renal failure, which occurs rapidly and unexpectedly, chronic renal failure occurs slowly
- over a period of weeks, months, or years - as the kidneys gradually stop working, leading to end-stage renal
disease (ESRD).1 And known as one of the major public health problems.2 This increases is owing to numerous
factors, the elongated long life and the greater presence of cardiovascular pathology, specially diabetes mellitus and
hypertension are leading causes of chronic renal failure epically in elderly patients and entry into a regular dialysis
program in Spain.3,4 Hypertension may destruction the blood vessels in the kidney and effect the secretion of waste
product. Waste may secrete in extra cellular fluid and more increase the blood pressure finally leading to ESRD
(end-stage renal disease). G-protein coupled and Ca2+ dependent kinases are responsible for the control of blood
pressure. Mutations may cause changes in receptors, which in turn increase blood pressure.9, 10 Libya has a high
incidence risk factor for chronic kidney disease such as hypertension, obesity and diabetes.13, 14 Creatinine
measurement Creatinine is mostly formed from creatine and phosphocreatine in skeletal muscle. In various
patients, Creatinine is produced in the muscles by the non-enzymatic changes of creatine and phosphocreatinine.
The liver has a vital role in the gathering of creatinine through methylation of guanidine aminoacetic acid. The
normal serum creatinine level is 0.5 to 1.0 mg/d.11 Renal function valuation is done through plasma creatinine
determination.5. Creatinine is freely excreted through kidneys makes it useful to read kidney function. Serum
creatinine is used in the detection and valuation of acute kidney damage and chronic kidney disease.6 Limitations of
serum creatinine as a sign of kidney function should be measured.7Most common methods of measuring serum
creatinine are based on Jaffé reaction. Creatinine reacts with picrate in an alkaline medium and the resulting
orange-red complex is measured spectrophotometrically. Several factors are found to interfere with creatinine
assays; glucose and ketoacids and protein in serum.8 Aim of this study was to measure renal function by plasma
creatinine levels in Libyan patients.
Material and Methods
Blood of 232 patients was collected Diabetes from Al-tameamy Hospital- Tameamy town, Al-
abyar Hospital- Alabyar city and Al baida laboratory- Baida city during the period 3rd July to 7th August 2016. 5
ml of the blood was obtained from each patient; blood was placed in plain tube containing clot activator. Clotted
blood was centrifuge to separate serum and was used for bio systems Spain.
Creatinine valuation


Creatinine was valued by the Jaffe reaction, a calorimetric method in which creatinine forms a yellowish orange
compound in alkaline solution with picric acid. This colored compound is determined photometrically. The strength
of created colored is directly related to the quantity of creatinine in the sample and determined photometrically
using biosystems BT-350 system, bio Tina GMBH Germany, biosystems BT-350, Fugifilm system.
Normal range of females: 0.6-1.1 mg/dl
Normal range of males: 0.9-1.3 mg/dl.
Statistical Analysis:
Analysis was done by the standard deviation function is STDEV, and the test uses is T- test.
Results
A total of 232 serums of diabetic patients was analyzed. These patients were randomly selected and their serum
creatinine level was checked. There were 98 (42.2%) serum samples from male patient and 134 (57.8%) from
female patient.
4.1 Distribution of age groups by gender.
Most of the patients belonged to the age group >=50 years age (43.1%), followed by patients of 30 - 39 years and <
20 of age (15.1%) equally as shown in Table 1.
Table. 1 Distribution of age groups by gender.
Gender
age group
in years
SEX
Total
Male
Female
No.
%
%
%
< 20
13
5.6
9.5
15.1
20 - 29
11
4.7
7.8
12.5
30 - 39
13
5.6
9.5
15.1
40 - 49
15
6.5
7.8
14.2
>=50
46
19.8
23.3
43.1
Total
98
42.2
57.8
100.0
4.2 creatinine concentrations distributions according to age groups of the study population.
Of 232 serum sample, 7 (03.0%) were abnormal creatinine among whom the male represented and females 12
(5.20%).
Table. 2 creatinine concentrations distributions according to age groups of the study population.
Creatinine
level
SEX
Total
Male
Female
No.
%
No.
%
No.
%
Less than normal level
32
13.8
55
23.7
87
37.5
Normal level
59
25.4
67
28.9
126
54.3
Abnormal level level
7
03.0
12
5.2.0
19
08.2
Total
98
42.2
134
57.8
232
100.0
4.3 Distribution of creatinine concentration levels by age groups


Out of a total of 232 clinical specimens investigated. The rate of high creatinine levels was 08.2%. Of these
19 patient's serum with high levels creatinine, 12 (5.20%) were from females and 7(03.0%) were from males. Most
of them belonged to the age group >=50 years of age (6.9%), followed by patients of 40-49 years of age (9%) as
shown in Table 3.
Table. 3 Distribution of creatinine concentration levels by age groups
Creatinine
age group
in years
Less than
normal
level
< 0.6
Normal
level
0.6 - 1.3
Abnormal
level
>+1.3
Total
No.
%
No.
%
No.
%
No.
%
< 20
16
6.9
18
7.8
1
4
35
15.1
20 - 29
17
7.3
12
5.2
00
0.0
29
12.5
30 - 39
14
6.0
21
9.1
00
0.0
35
15.1
40 - 49
13
5.6
18
7.8
2
9
33
14.2
>=50
27
11.6
57
24.6
16
6.9
100
43.1
Total
87
37.5
126
54.3
19
8.2
232
100.0
4.4 Distribution of creatinine concentration levels for male participant by age groups
Total of 55 males' participant, the males, most of abnormal Scr was belonged to the age group
>=50 years (7.1%).
Table. 4 Distribution of creatinine concentration levels for male participant by age groups
Male age
group
in years
Less than
normal
level
< 0.6
Normal
level
0.6 - 1.3
Abnormal
level
>+1.3
Total
No.
%
No.
%
No.
%
No.
%
< 20
9
9.2%
4
4.1%
0
0.0
13
13.3%
20 - 29
6
6.1%
5
5.1%
0
0.0
11
11.2%
30 - 39
5
5.1%
8
8.2%
0
0.0
13
13.3%
40 - 49
5
5.1%
10
10.2%
0
0.0
15
15.3%
>=50
7
7.1
32
32.7
7
7.1
46
46.9
Total
32
32.7%
59
60.2%
7
7.1%
98
100.0%
4.5 Distribution of creatinine concentration levels for Female participant by age groups.
According to sex, total of 55 females' participant, out of 12 (9.0%) that were identified as abnormal creatinine,
40-49 years age group registering as the highest group with abnormal creatinine levels (1.5%) followed by < 20
years age group (7%).
Table. 5 Distribution of creatinine concentration levels for Female participant by age groups
Female age
group
Less than
normal
< 0.6
Normal
level
0.6 - 1.3
Abnormal
level
>+1.3
Total


in years
No.
%
No.
%
No.
%
No.
%
< 20
7
5.2%
14
10.4%
1
7%
22
16.4%
20 - 29
11
8.2%
7
5.2%
0
0.0
18
13.4%
30 - 39
9
6.7%
13
9.7%
0
0.0
22
16.4%
40 - 49
8
6.0%
8
6.0%
2
1.5%
18
13.4%
>=50
20
14.9
25
18.7
9
6.7
54
40.3%
Total
55
41.0%
67
50.0%
12
9.0%
134
100.0%
Discussion
The relationship between plasma creatinine and glomerular filtration shows how serious function
impairment, measured by creatinine clearance, is not translated into an increase of plasma creatinine levels. So, an
increase in plasma creatinine indicates an already important loss of glomerular filtration.14-15 Data from this study of
patients show that creatinine clearance is a much more reliable restriction for renal function study, especially in
elderly patients leading to various other dangerous diseases. The study shows SCr increases with age belonged to
>=50 years age groups (6.9%), followed by patients of 40-49 years age group (9%). Previous study was similar to
the present study; show an increase of serum creatinine with increasing the age.16 According to current study,
females were more creatinine values are higher than males, unlike to other study was reported males were more
affected by kidney disease than females.17
Conclusion
The value of serum creatinine in detection of levels of kidney function is imperfect, especially in
the earlier impairment and in patients with other disease. Many patient specific factors related to protein
metabolism and muscle mass change serum creatinine levels.
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Article
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Chronic kidney disease (CKD) is increasingly recognized as a global public health problem. There is now convincing evidence that CKD can be detected using simple laboratory tests, and that treatment can prevent or delay complications of decreased kidney function, slow the progression of kidney disease, and reduce the risk of cardiovascular disease (CVD). Translating these advances to simple and applicable public health measures must be adopted as a goal worldwide. Understanding the relationship between CKD and other chronic diseases is important to developing a public health policy to improve outcomes. The 2004 Kidney Disease Improving Global Outcomes (KDIGO) Controversies Conference on 'Definition and Classification of Chronic Kidney Disease' represented an important endorsement of the Kidney Disease Outcome Quality Initiative definition and classification of CKD by the international community. The 2006 KDIGO Controversies Conference on CKD was convened to consider six major topics: (1) CKD classification, (2) CKD screening and surveillance, (3) public policy for CKD, (4) CVD and CVD risk factors as risk factors for development and progression of CKD, (5) association of CKD with chronic infections, and (6) association of CKD with cancer. This report contains the recommendations from the meeting. It has been reviewed by the conference participants and approved as position statement by the KDIGO Board of Directors. KDIGO will work in collaboration with international and national public health organizations to facilitate implementation of these recommendations.
Article
To assess, by a house to house study, the prevalence of diabetes, impaired glucose tolerance (IGT) and their associated risk factors in Benghazi, Libya using 75 gram oral glucose tolerance test (OGTT) and ADA 1997 and WHO 1998 diagnostic criteria. A multistage cluster sampling was used to select the study population. A total of 314 men and 554 women underwent a standard 75 grams OGTT. The response rate was 77.7% for males and 89.2% for females. The overall prevalence of IGT was 8.5% (95% confidence interval (CI) 5.8 - 11.3) (men 8.6% 95% CI 7.7-9.6, women 8.5% 95% CI 5.0 -11.9), and that of diabetes was 14.1% (95% CI 10.9-17.1) (men 16.3% 95% CI 14.5-18.3 women 13.0% 95% CI 10.0 - 16.1). Diabetes was present in 19.4% (95% CI 15.4-20.5) (men 22.7% 95% CI 20.2-25.4, women 17.6% 95% CI 14.1-19.1) in 30-64 years age range. Prevalence of diabetes was slightly higher in urban than in rural areas (14.5% vs 13.5%). The prevalence of newly diagnosed diabetes in urban and rural areas were 3.6% and 7.3% respectively and that of known diabetes were 10.9% and 6.3% respectively. Associated risk factors with diabetes and IGT were age, family history of diabetes, hypertension, BMI, WHR and serum cholesterol. Diabetes is emerging as an important public health problem in Libya and should rank very high in the priority list of health planners.
G-protein-coupled receptor kinase 2 and hypertension: molecular insights and pathophysiological mechanisms
  • G Santulli
  • B Trimarco
  • G Iaccarino
Santulli G, Trimarco B and Iaccarino G. G-protein-coupled receptor kinase 2 and hypertension: molecular insights and pathophysiological mechanisms. 2013. High Blood Pressure Cardiovascular Prevention; 20(1): 5-12.
«Insuficiencia renal "oculta" por valoración de la función renal mediante la creatinina sérica
  • G Fernández-Fresnedo
  • De Francisco
  • Rodrigo E Pinera
  • C Herráez
  • I Ruíz
  • J C Arias
Fernández-Fresnedo G, De Francisco AL, Rodrigo E, Pinera C, Herráez I, Ruíz JC, Arias M: «Insuficiencia renal "oculta" por valoración de la función renal mediante la creatinina sérica». Nefrología 22 (2): 95-97, 2002.
Prediction of creatinine clearance from serum creatinine
  • D W Cockcroft
  • M H Gault
  • A S Levey
  • T Greene
  • G J Beck
  • A W Caggiula
  • J W Kusek
  • H N S Jabary
  • D Martín
  • M F Muñoz
  • M Santos
  • J Herruzo
  • R Gordillo
  • J Bustamante
Cockcroft DW, Gault MH: Prediction of creatinine clearance from serum creatinine. Nephron 16: 31-41, 1976. 13. Levey AS, Greene T, Beck GJ, Caggiula AW, Kusek JW, H . N. S. Jabary, D. Martín, M. F. Muñoz*, M. Santos, J. Herruzo, R. Gordillo and J. Bustamante. RENAL FUNCTION IN PATIENTS WITH ESSENTIAL HYPERTENSION. NEFROLOGÍA. Volumen 26. Número 1.