Understanding Your Lab Values: Creatinine test

Image by scribbletaylor via Flickr

According to a recent study, reported at the annual meeting of American Society of Nephrology in San Diego. primary care physicians are failing to diagnose chronic kidney disease, especially in women.

Study leader Dr. Maya Rao of Columbia University in New York says primary care doctors typically order a blood test called creatinine to measure kidney function, but this alone is not a particularly accurate measure of kidney function.

Glomerular filtration rate (GFR) is the best test to measure your level of kidney function and determine your stage of kidney disease.
You can calculate your Glomerular Filtration Rate (GFR), by entering results of your blood creatinine test, your age, race, gender and other factors.

The distribution of creatinine test results in 6434 people is shown on the right (NHANES 2006 study, weighted for USA demographics, graph by WolframAlpha)

The typical reference ranges in adult males are 0.7 to 1.2 mg/dL according to Wikipedia and 0.6 to 1.2 milligrams (mg) per deciliter (dl) according to medicinenet. In adult females, it's 0.5 to 1.1 milligrams per deciliter (wikipedia) or 0.5 to 1.1 mg/dl (medicinenet). LabCorps lists normal values between 0.57 and 1.00 mg/dL. (see also reference values for other medical tests and Aurametrix blog on liver tests). Men tend to have higher levels of creatinine because they generally have more skeletal muscle mass than women. Muscular young or middle-aged adults may have more creatinine in their blood than the norm for the general population. Vegetarians have been shown to have lower creatinine levels. Creatinine tends to be slightly lower in pregnancy. It increases with height and body weight. While a baseline serum creatinine of 2.0 mg/dL (150 μmol/l) may indicate normal kidney function in a male body builder, a serum creatinine of 0.7 mg/dL (60 μmol/l) can indicate significant renal disease in a frail old woman.

Infants have normal levels of about 0.2 or more, depending on their muscle development. In people with malnutrition, severe weight loss, and long standing illnesses the muscle mass tends to diminish over time and, therefore, their creatinine level may be lower than expected for their age.

A person with only one kidney may have a normal level of about 1.8 or 1.9. Creatinine levels that reach 2.0 or more in babies and 10.0 or more in adults may indicate severe kidney impairment and the need for a dialysis machine to remove wastes from the blood.

In the United States, creatinine is typically reported in mg/dL, while in Canada and Europe μmol/litre may be used. 1 mg/dL of creatinine is 88.4 μmol/l.

Creatinine is a waste product in your blood that comes from muscle activity. It is normally removed from your blood by your kidneys, but when kidney function slows down, the creatinine level rises.

Aurametrix is developing decision support systems to help you evaluate personal health risks, decide on preventative measures, estimate cost/benefits of performing diagnostic tests. Better tools for a healthier world.

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Vinegar and Water Diet

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Vinegar and Water Diet was made popular in 1820 by Lord Byron - so says the Fad Diet Timeline (Fad Diets Throughout the Years) article by the American Dietetic Association.

Some people found this diet can do miracles, while others had side effects without any positive results and called it a scam.

The primary reason that this diet works could be that you are told to eat moderate portions, watch the nutritional composition of the food you eat, and get exercise. Just doing those alone is often enough to stimulate your body to maintain a healthy weight, if not lose weight.

Yet, there could be properties in the vinegar that will help you lose weight.

One of the premises of the Apple Cider Vinegar Diet is that taking small amounts of apple cider vinegar daily suppresses appetite and assists in weight loss. Apple Cider Vinegar is also said to reduce glucose levels, treat acid reflux disease and cure acne, among other things. There also were ungrounded claims of cider vinegar to be a special source of various B vitamins and amino acids.


There have been clinical studies, on both rats and humans, suggest apple cider vinegar does make one feel fuller. Many people agree about apple cider vinegar’s ability to suppress appetite (at least because of the taste), but more research is needed. Various other claims of benefits are not supported by research but there is some support for apple cider vinegar’s role in lowering glucose and cholesterol levels and increasing HDL (good) cholesterolin people. Apple cider vinegar was shown to reduce serum triglyceride (TG) levels and increased HDL-cholesterol in diabetic animals.

Another interesting fact is that vinegar was shown to reduce counts of not-so-benefitial bacteria. Diluted solutions of various household sanitizers (apple cider vinegar, white vinegar, bleach, and a reconstituted lemon juice product) were tested for their effectiveness in reducing counts of inoculated Escherichia coli and naturally present aerobic, mesophilic bacteria on lettuce. (J Food Prot 2002,Oct,01;65(10):1646-50; (PMID: 12380754)) Of the sanitizers tested, 35% white vinegar (1.9% acetic acid) was the most effective in reducing E. coli levels (with a 5-log10 reduction after 5 min with agitation and after 10 min without agitation) and in reducing aerobic plate counts (with a >2-log10 reduction after 10 min with agitation).

Could apple cider vinegar be replaced with anything else to achieve the same effects?

Most dieters would answer no to this question. They would tell you to "be careful with which vinegar you use. White vinegar is good for many many thing, but don't drink it will remove all of the minerals and nutrients from your boby. Apple cider vinegar is the only one you want to ingest".

I may say this statement is rather too strong, but what about the actual chemical content?

Comparison of various vinegars shows that no chemical in particularly stands out - apple cider vinegar has a higher Manganese content, but that's about it.

Typical white distilled vinegar is at least 4% acidity and not more than 7%. Cider and wine vinegars are typically slightly more acidic with approximately 5-6% acidity.

Of course, there also could be a yeast and bacterial content - at least dead Acetic acid bacteria (these critters derive their energy from the oxidation of ethanol to acetic acid during respiration. They are Gram-negative, aerobic, and rod-shaped).
Commercially available vinegars, however, are well filtered (no mother of vinegar) and were reported to work in people's diets even if not organic and expensive types.


Usual apple cider vinegar substitutes are:

malt vinegar OR white vinegar (a good choice for pickles) OR wine vinegar (not for pickles)

lemon juice (as a flavoring or for acidulating water) OR lime juice (as a flavoring or for acidulating water) OR brandy (for deglazing pans) OR fortified wine (for deglazing pans and perking up sauces) OR wine (for deglazing pans and perking up sauces) OR ascorbic acid (mixed with water) OR amchoor OR tamarind paste

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Since vinegar can be made from anything with sugar, there are probably too many different types to count made in countries throughout the world. Each country may use starting materials native to their area and tailored to the specific tastes of the region.

Typical retail varieties of vinegar include white distilled, cider, wine (white and red), rice, balsamic, malt and sugar cane. Other, more specialized types include banana, pineapple, raspberry, flavored and seasoned (e.g., garlic, tarragon).
Are there Formal Standards for Vinegar?
The following varieties of vinegar are classified by a U.S. Food and Drug Administration (FDA) Compliance Policy Guide for labeling purposes according to their starting material and method of manufacturing:

•Cider vinegar or Apple vinegar is made from the two-fold fermentation of the juices of apples. Vinegar can be made from other fruits such as peaches and berries with the labels describing starting materials.


•Wine vinegar or Grape vinegar is made from the two-fold fermentation of the juice of grapes.


•Malt vinegar, made by the two-fold fermentation of barley malt or other cereals where starch has been converted to maltose.


•Sugar vinegar, made by the two-fold fermentation of solutions of sugar syrup or molasses.


•Spirit or distilled vinegar, made by the acetic fermentation of dilute distilled alcohol.


•Blended Vinegar made from a mixture of Spirit vinegar and Cider vinegar is considered a combination of the products that should be labeled with the product names in the order of predominance. It is also the product made by the two-fold fermentation of a mixture of alcohol and cider stock.


•Rice or Rice Wine vinegar (although not part of FDA’s Compliance Policy Guide) has increased in popularity over the past several years and is made by the two-fold fermentation of sugars from rice or a concentrate of rice without distillation. Seasoned rice or rice wine vinegars are made from rice with the “seasoning” ingredients noted on the label.


•Balsamic vinegar (also not a part of FDA’s Compliance Policy Guide) continues to grow in market share and “traditional” and “commercial” forms are available. The products are made from the juice of grapes, and some juice is subjected to an alcoholic and subsequent acetic fermentation and some to concentration or heating. See the “Today’s Vinegar” section of the Web site for more information regarding Traditional and Commercial Balsamic Vinegar.


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