University of Duhok

College of Science
Department of Biology
Second Stage

Biochemistry

Lecturer: Mrs. Kazheen Hassan

Estimation of Creatinine

Prepared by: Dalal Idrees Omer

Submission date: 2/7/2020

Table of Contents

Abstract: 3
Introduction: 5
Aminoglycosides and Interference 8
Other Drugs 9
Methods used to analyze creation 10
Creatinine Jaffe Reaction Principle 10
Creatinine Sample 10

Creatinine Reagents 11

Procedure 11

Creatinine Reading 12

Creatinine Calculations 13

Kinetic analyses modes (Automated method) 13

AUTOMATED METHOD 14

ESTIMATION OF CREATININE IN URINE 14

Interpretation 16

References 24

2
Abstract:
Creatinine is one of the most common analyte used as the indicator of glomerular
filtration rate (GFR) and kidney function. In 1886, Jaffe reported a reaction of
creatinine and picric acid in an alkaline medium forming complex having
absorbance maxima at 520 nm. The reaction has been brought to use for the
measurement of creatinine by Folin and Wu in 1919. Since then, Jaffe’s reaction
has been used for estimation of creatinine in serum and urine sample. For more
than 90 years, this method is in use for the measurement of creatinine
concentration due to its simplicity and low cost. Creatinine is produced as the
byproduct of creatine metabolism and is transported through bloodstream to the
kidneys for excretion. Malfunctioning of kidney is reflected by lowering of the
amount of creatinine in urine and rise of its level in blood. Creatinine levels in
blood and urine also indicate the creatinine clearance, accounting for GFR.
Creatinine readings indicate the total kidney GFR which is the sum of filtration
rates of all functional nephrons. Early structural damage to the renal cells involving
reduction in functional nephron number may not affect an individual’s total GFR
as remaining renal units may perform compensatory function, enabling the kidneys
to maintain kidney function temporarily even after the loss of functional tissue.
Thus, creatinine/GFR may not indicate the early damage to kidney tissue. Jaffe
also elaborated the interference in alkaline picrate reaction by number of organic
compounds (e.g. acetone, glucose) which has been described as
pseudochromogens. Still, creatinine remains the gold standard for measuring the
glomerular filtration rate and kidney functioning. And Jaffe method remains the
default method for estimation of creatinine. In last century, many caveats in this
method were reported which we have indicated in brief in this article. Recently we
have reported an interference by streptomycin (an aminoglycoside) in high doses
which act as false positive in Jaffe reaction [1]. It is known from literature that
aminoglycosides can be nephrotoxic and may potentially affect kidney function. If
3
it is so, then, nephrotoxicity due to high dose of aminoglycosides (say
streptomycin) can never be correctly estimated as defect in excreting out creatinine
would be masked by the false positive Jaffe reaction given by streptomycin.

Antibiotics like cephapirin, cefazolin, cefamandole, cephalothin, and cefoxitin

have been shown to interfere with creatinine determination at various
concentrations [1, 2]. Phenacemide and cephalothin may interfere either positively
or negatively with the determination of creatinine by the Jaffé reaction [3] .
Cephalosporin antibiotics have been shown to form non-creatinine chromogen with
alkaline picrate reagent and produce false positive results for creatinine. Serum
creatinine and creatinine clearance values are positively interfered by cefoxitin in
the Jaffé reaction, the routine laboratory method of creatinine measurement. Both
invitro and invivo analysis suggest the same [4].

Many biomolecules like bilirubin, glucose, acetone etc. are also known to interfere
with the Jaffe method of creatinine estimation and therefore the method has gone
through modifications [5]. To overcome the effect of interference specific
enzymatic method of creatinine estimation has been also developed [6]. But in-
spite of various modification of the Jaffe method and development of the specific
enzymatic method for creatinine estimation, the classical alkaline picrate method
remains popular in India.

4
Introduction:
Estimation of creatinine has numerous applications. We audit the assurance of
urinary creatinine as a legitimate file of fulfillment of 24-h pee assortment, the
clinical utility of the assurance of creatinine freedom proportions, and estimation
of the proportion of the leeway of explicit analyses, for example, amylase, to the
proportion of freedom of creatinine.(1)

Creatine is orchestrated by the body in a two-advance procedure including the

underlying amalgamation of guanidinoacetate, which takes place in the kidneys,
little intestinal mucosa, pancreas, and presumably the liver. The response among
glycine and arginine is catalyzed by a transaminase, which is dependent upon
criticism restraint by expanded creatine levels. Creatinine is framed by an
unconstrained and irreversible transformation from creatine and creatine
phosphate. Arrangement of creatinine is sensibly steady, and about 2% of entire
body creatine is so changed each 24 h. Creatinine creation rate along these lines
remains around the equivalent from day to day except if the bulk changes. It isn't
modified fundamentally by sickness, sepsis, injury or fever, nor by the condition of
hydration; in any case, can expanded protein admission bring about increments in
creatinine creation of the request for 10%.Plasma creatinine levels are controlled
by the creatinine creation rate and by the pace of end in the glomerular filtrate, for
example the creatinine leeway. In the consistent express, the paces of creatinine
creation and end are rise to and can be assessed as the item of pee creatinine
fixation and pee stream rate. Of the numerous elements of the kidney that could be
resolved, estimation of the GFR is the most broadly utilized renal capacity test.?
This rate gets its significance from the way that it is identified with the overall
mass of practical renal tissue and subsequently to the quantity of working
nephrons.(2)

5
In the course of the most recent decade we have seen a change in accentuation in
the strategies used to gauge creatinine. The expanded use of motor creatinine
strategies has been mostly due to changing accentuation of the instrumentation
utilized, with a move away from the control by persistent stream investigation in
the late 1960s and mid1970s. The possibility of improved explicitness with
dynamic techniques has likewise impacted this change. (2)

In skeletal and heart muscle, testis, and cerebrum the genuine creatine midpoints
from 83 to 96 percent of the evident creatine in any case, in other tissues, for
example, the intestinal muscle, pancreas, spleen, lung, and liver, the genuine
creatine adds up to just 16 to 65 percent of the obvious worth. It was additionally
discovered that the centralization of creatinine was most elevated in muscle, testis,
and mind, what's more, significantly lower in kidney, pancreas, lung, and liver.
The centralizations of creatine and creatinine were generally corresponding in the
various tissues, showing an interre1a. Relationship of these two mixes in digestion.
The focus of creatinine in the spleen, lung, liver, and pancreas was a lot of lower
than in a ultra-filtrate of plasma; this recommends these tissues are worried about
the change of creatinine into creatine or other mixes. There is a diminished pace of
discharge of creatinine, uric corrosive, and chlorides after exercise. After
demanding solid exercise there is no expansion in the discharge of creatinine
however creatine discharge happens. Since creatinine might be changed into
creatine within the sight of additional water in the tissues and since exhausted
muscles take up extra water, it is intelligent to anticipate that the creatinuria of
activity may have its source to some degree in the creatinine of the tissues.(3)

We have checked numerous different anti-infection agents and medication particles

which we have found not to altogether meddle with the Jaffe response. This

6
incorporates cisplatin, deriphylline, levofloxacin and phenytoin. They have been
checked for obstruction up to centralization of 10 mg/ml. We are announcing the
impedance investigation of these medications through this letter and affirming that
they don't cooperate with Jaffe reagent to deliver bogus chromogen. Left over
serum and pee tests have been gathered haphazardly for use and the convention
given in reference has been followed. (4)

7
Aminoglycosides and Interference

Aminoglycosides are commonly used antibiotics that are well recognized

as nephrotoxic agents. If, it interferes with Jaffe reaction then there may
be a false positive elevation of creatinine that may wrongly suggest the
clinician to stop the life saving medicine even in a valid indication. But
recently it is observed that aminoglycoside antibiotics does not produce
false chromogen with Jaffe reagents at therapeutic dosage but
streptomycin in high doses interferes positively with Jaffe method of
creatinine estimation [1]. So, in higher dose exposure of streptomycin to
human subjects’ serum/urine creatinine estimation by Jaffe method has to
be interpreted in terms of available streptomycin concentration. So if,
actual concentration of creatinine is 53 micromoles/litre, then in presence
of 10 mg/ml streptomycin in serum, the apparent concentration would be
nearly doubled i.e. around 106 micromoles/liter.

8
Other Drugs

We have checked many other antibiotics and drug molecules which we

have found not to significantly interfere with the Jaffe reaction. This
includes cisplatin, deriphylline, levofloxacin and phenytoin. They have
been checked for interference up to concentration of 10 mg/ml. We are
reporting the interference study of these drugs via this letter and
confirming that they do not interact with Jaffe reagent to produce false
chromogen. Left over serum and urine samples have been collected
randomly for use and the protocol given in reference has been followed
[7].

Today, we have a long list of interfering substances of Jaffe method that

affects creatinine estimation but the method is popular perhaps for its
inherent simplicity but in the clinical context of drugs like
aminoglycosides, cisplatin, phenytoin, deriphyllin or levofloxacin,
alkaline picrate method may not be made redundant due to false
chromogen formation. We, hereby, stress on the need of innovation in
field of diagnosis of kidney damage, improvement in methods of
creatinine estimation and recommend a boost in research to study
potential interfering agents of alkaline picrate method used for creatinine
estimation in the scenario of rapidly developing new drug molecules.

9
Methods used to analyze creation

1. Jaffe method(Manual method)

Disadvantage: non creatinine chromagen interfere with the reaction e.g.

protein , glucose, Ketones, Pyruvate, Bilirubin……

2. Kinetic analyses modes(Automated method)

Creatinine Jaffe Reaction Principle

PFF + Saturated picrate acid

(alkaline media) NaOH

Creatinine picrate orange red complex

(absorbed at 510 nm)

Creatinine Sample

Serum or Plasma

Protein free filtrate: to avoid non creatinine chromagen interfering with

the reaction

10
Creatinine Reagents

Saturated picrate acid

Creatinine standard -1 mg% NaOH-5%

Sodium tungstate solution – 10% H2SO4

Procedure

Preparation of PFF

In a centrifuge tube take;

1. 1 ml of DW

2. 1 ml serum

3. 1 ml of sodium tungstate

4. 1 ml of H2SO4

11
Mix and centrifuge for 5 min. to obtain clear supernatant PFF

Blank Stand.

Sample :PFF --- ---

DW 4 ml 3 ml

Standard (0.01mg/ml) -- 1 ml

NaOH 1 ml 1 ml

Sat. Picric acid 1 ml 1 ml

Mix

Incubate at Room Temp. for 10 min.

Read the OD test & Stand. against the blank at 510 nm

Creatinine wavelength 510 nm

Creatinine Reading

Read the sample against its blank at 510 nm

O.D. =…………..

12
Creatinine Calculations

According to Beer Lambert law

𝑪𝑺𝑻𝑫
𝑪𝑻 = 𝑶𝑫𝑻 𝒙
𝑶𝑫𝑺𝑻𝑫

𝑶𝑫𝑻 𝒙 𝑨𝒎𝒐𝒖𝒏𝒕 𝒐𝒇 𝒔𝒕𝒂𝒏𝒅𝒂𝒓𝒅

𝑺𝒆𝒓𝒖𝒎 𝑪𝒓𝒆𝒂𝒕𝒊𝒏𝒊𝒏𝒆 (𝒎𝒈%) = 𝒙 𝟏𝟎𝟎
𝑶𝑫𝑺𝑻𝑫 𝒙 𝑽𝒐𝒍𝒖𝒎𝒆 𝒐𝒇 𝑺𝒂𝒎𝒑𝒍𝒆
𝒎𝒈
𝑪𝒐𝒏𝒄. = ⋯ … … . .
𝒍

Kinetic analyses modes (Automated method)

KINECTIC METHOD: - they were developed in a quest

both for specificity and for faster and automate

analysis .Rate is measured:

• Faster
• More specific
• Most widely used
• Implemented on various automated instruments.
• JAFFE’S KINETIC ASSAY
• ENZYMATIC KINETIC ASSAY
13
AUTOMATED METHOD

• In this method also Jaffe’s reaction principle is used but defined

experimental condition, by using special type of spectrophotometer or
autoanalyser, equipped with a thermocuvette. Jaffe’s reaction is carried out
at 30 degree centigrade as follows:
• First reading is recorded at 20 sec. Most of the interfering non-creatinine
chromogens react with alkaline picrate reagent fast and are recorded after 20
seconds.
• Creatinine and alkaline picrate react relatively slowly after 20 seconds,upto
80 secondsHence second reading is noted after 80 seconds.
• Same procedure is used for a standard.

ESTIMATION OF CREATININE IN URINE

Dilute urine 1:100 with distilled water so that the creatinine values come within the
range of Lambert-Beer’ s law and the interfering substances get diluted. Urine
creatinine is then estimated by using Jaffe’s method.

14
Procedure

B S T
Dilute Urine --- --- 3 ml

Distilled
water 3 ml --- ---

Standard(0.
01 --- 3 ml ---
mg/ml)
NaOH 5% 1 ml 1 ml 1 ml

Sat.Picric
acid 1 ml 1 ml 1 ml

Mix for 15 min. at room temp.

Take OD at 520 nm. Calculate the result.

15
Interpretation

Increased values = (Azotemia)

1. Prerenal: systemic infection e.g. babesiosis

2. Renal: e.g. Amyloidosis, Glomerulosclerosis and Polycystic disease

3. Post renal: e.g. Ureteral obstruction

Decreased creatinine blood level

Muscle disease

Cachexia

Portosystemic shunts

16
CONCLUSION
Today, we have a not insignificant rundown of meddling substances of Jaffe
technique that influences creatinine estimation yet the strategy is famous maybe for
its natural straightforwardness yet in the clinical setting of medications like
aminoglycosides, cisplatin, phenytoin, deriphyllin or levofloxacin, soluble picrate
technique may not be made excess because of bogus chromogen development. We,
therefore, weight on the need of advancement in field of analysis of kidney harm,
improvement in strategies for creatinine estimation and prescribe a lift in
exploration to examine possible meddling specialists of antacid picrate strategy
utilized for creatinine estimation in the situation of quickly growing new
medication atoms.(4)

We recently built up an equation to gauge the individual carboplatin leeway (CL)

in light of serum creatinine (Scr) dictated by an enzymatic measure utilizing
creatinine amid hydrolase. A diagnostic examination had indicated methodical
contrasts between this technique and the regularly utilized Jaffé strategy (with Jaffé
Scr (in μM) =1.08×enzymatic Scr+1.6, as relapse condition). We played out a
pharmacokinetic planned clinical investigation utilizing the Jaffé examine to assess
the effect of the technique utilized for Scr estimation on the expectation of the
carboplatin CL. In forty patients, carboplatin dosing was performed by the Chatelut
recipe where the serum creatinine level was adjusted by the above condition. The
populace pharmacokinetics of carboplatin was examined utilizing the NONMEM
program to decide the individual carboplatin CL from a restricted testing
methodology. Because of the remedy of the Jaffé Scr, no noteworthy distinction
was seen between the directed and the ideal portion. Conversely, if no remedy of
the Scr was done, the patients would have been altogether under-dosed. In
addition, a covariate examination utilizing NONMEM gave a reliable outcome

17
indicating that Scr ought to be diminished by 11.6% when the Jaffé esteem is
utilized inside the Chatelut condition.(5)

All out chromogen, valid, and Auto Analyzer strategies for estimating serum and
pee creatinine by the Jaffe response were examined. A few elements affecting this
response were analyzed. These included frequency, clear, linearity, and states of
shading improvement. Changes of the three strategies were made and their
exactness, recuperation, and test steadiness decided. The obstruction of ketones
and glucose were estimated. At last, the qualities acquired by the three techniques
on similar examples of serum and pee were thought about measurably. (6)

The current investigation is a trial study to contrast the systematic strategies with
gauge serum creatinine. Forty serum tests every hyperbilirubinemia and hemolysis
was gotten in focal clinical research facility, organic chemistry division were
utilized for investigation. The serum creatinine was evaluated from each example
by dry science on Vitros 250 analyzer created by ortho clinical diagnostics and
further likewise by wet science by Jaffé Method. Serum tests having a place with
patients on different medication medicines were rejected from the investigation.
The Jaffé's strategy has advanced continuously through numerous stages
throughout the years. Prior strategies included the utilization of deproteinized
blood. Later creatinine was separated from basic meddling substances by
adsorption on aluminum silicate, for example, Lloyd's reagent, trailed by elution
and later rewarded with into antacid picrate arrangement. This improved the
explicitness of Jaffé's technique. Citation trade gums were additionally used for
this reason. The other system utilized was to gauge creatinine by Jaffé strategy at
both basic pH and after fermentation to a progressively unbiased ph. Since just
meddling substances respond at impartial pH, by the distinction an increasingly
precise outcome for creatinine could be built up.(7)

18
The Vitros slides are dry, multi-layered scientific components covered on polyester
bolsters. The slide is made out of a few layers, for example, spreading layer,
scrounger layer, and reagent layer (s) and plastic or bolster layer. A little aliquot of
serum stored by means of mechanization on the slide and equitably circulated to all
the layers. The spreading layer contains proper substrate and parts for response.
The pace of progress estimated by reflectance spectrophotometry, optical thickness
of shaded complex framed is straightforwardly corresponding to the convergence
of creatinine in serum. The Vitros 250 created by ortho clinical diagnostics which
is a dry science framework includes enzymatic reagent framework for the
estimation of creatinine.(7)

Institutional ethical committee and granted approved permission statistics. Test of

significance, paired t-test applied, with p<0.05 considered as significant. In the
present study, the Tables 1 and 2 depict that there is an overestimation of serum
creatinine values when estimated by modified Jaffé’s method or wet chemistry in
icteric and hemolytic serum samples. The results are comparatively lower when
estimated by dry chemistry or enzymatic method developed by ortho clinical
diagnostics on Vitros 250 analyzer (Figures 1 and 2). The values of creatinine are
found to be both accurate and precise by the enzymatic method in icteric and
hemolytic serum samples.(7)

19
Estimation of estimated creatinine clearance (eCcr) on the basis of serum
creatinine, by Cockcroft-Gault formula. Consider a woman of 60-year age and 65
kg body weight (b.w.) with serum creatinine estimated as 2.1 mg/dL by wet
chemistry and 1.8 mg/dL by dry chemistry. Therefore, eCcr by dry
chemistry=(140-age) × b.w (kg) × 0.85 for females ÷ 72 × serum creatinine (mg/dl
by dry chemistry) = (140-60) × 65 × 0.85 ÷ 72 × 1.8=4420 ÷ 129.6=34.10
ml/min.eCcr by wet chemistry=(140-age) × b.w (kg) × 0.85 for females ÷ 72 ×
serum creatinine (mg/dl by wet chemistry) =(140-60) × 65 × 0.85 ÷ 72 × 2.1=4420
÷ 151.2=29.23 ml/min.(7)

It is obvious from the model thought about that the estimations of serum creatinine
are conversely identified with the evaluated freedom of creatinine. Exactness and
accuracy is kept up when serum creatinine is assessed by dry science when
contrasted with wet science which gives a higher incentive for a similar patient
considered. Serum creatinine has a sway on the estimations of evaluated creatinine
freedom that implies a higher estimation of assessed creatinine leeway possibly
expected by dry science than when determined by wet science. This has a
significant job in deciding the right medication measurements for renal patients.
The upside of embracing dry science for evaluating serum creatinine has further a
job in the instances of marginal patients suspected to experience the ill effects of
renal maladies. The act of utilizing dry science would ensure precise clinical
thought regarding the leeway of creatinine at the glomerulus which is fairly
belittled when the wet science is utilized for serum creatinine estimation. All these
points of interest learn that dry science is better than wet science in the estimation
of creatinine in serum.(7)

The exact mechanism of bilirubin interference in Jaffé’s method is not known but
the color of bilirubin affects the spectrum absorption with yellow color of picrate
used in creatinine estimation. In case of icteric samples when creatinine value is to
be established, the color produced due to bilirubin should be removed or
20
minimized. This is commonly done by oxidation of bilirubin to biliverdin by
oxidizing agents. In a recent study by Chaudhary et al. the oxidation of bilirubin is
carried out by preincubation with NaOH before estimation of creatinine.
Interference by Para proteins in IgG myeloma patients showed low values of serum
creatinine by Jaffé’s method but expected results by enzymatic methods. Acid
precipitation or dithiothreitol preincubation removed the rarefaction creatinine
estimation. The Jaffé’s method is vulnerable to chromogens such as cephalosporin
and ketones. A dichromatic rate technique at 510 nm as well as 600 nm is adopted
to establish the creatinine concentration in order to abolish typical interferents.The
Jaffe’s method may include potassium ferricyanide, which oxidizes bilirubin thus
reducing interference from icterus. Hyperproteinaemia (hypergammaglobinaemia,
hyperalbuminemia) may falsely increase creatinine values whereas
hypercholesterolemia and presence of dextran decreases creatinine values. (7)

The concentrations of creatinine used were such that the readings obtained would
fall within the most sensitive range of the photoelectric calorimeter. The volumes
of the sample of the creatinine solution and, he reagents were selected arbitrarily so
that the determination could be carried out in a Klett-Summerson calorimeter tube
or in Pyrex or other test-tubes which could be adapted to the instrument, and so
that ordinary volumetric transfer pipettes may be used. The standard creatinine
solutions were prepared. (8) Creatinine concentration as follows: 2 ml. of the picric
acid solution and 1 ml. of the sodium hydroxide solution to be studied were added
to 2 ml. of a solution containing 20 y of creatinine. The mixture was allowed to
stand until the maximum color had developed. A blank determination in which
water was used in place of the creatinine solution was prepared simultaneously in
all cases. The color developed in both the standard solution and in the reagent
blank vas determined. (8)

Creatine is 80 per cent converted to creatinine at these concentrations by heating

the creatine-containing solution with picric acid in a boiling water bath for 45
21
minutes. This percentage conversion is of the same order of magnitude as that
obtained in the Folin autoclave method. These observations confirm those of
Albanesc and Wnngerin who found that 1 the color density in both these methods
was measured with the photoelectric calorimeter. Standard curves were also used
in both instances. (8)

Creatine in urine is determined by the procedure described above for creatinine

after heating 3 ml. of the creatine-containing solution with 1 ml. of 0.04 M picric
acid in an unstopped tube graduated at 5 ml. for 45 minutes in a vigorously boiling
water bath.’ After the solution has cooled to room temperature, 1 ml. of alkali is
added. The volume is then adjusted to 5 ml. with water. To calculate creatine as
creatinine the value obtained by difference in the usual manner is multiplied by
1.25. (8) The ideal conditions for the determination of any substance by a
colorimetric procedure are those which yield a color which is directly proportional
to the concentration of the substance to be determined. The data presented above
indicate that this ideal cannot be reached with this particular reaction regardless of
the conditions chosen. However, one may approximate this ideal condition over the
range of from 10 to 50 y of creatinine if procedures such as are described above
(i.e. dilution) or the Folin blood method is used. (8) It is possible, therefore, to use
a formula4 to calculate the creatinine concentration without introducing a very
great error, even though a linear relationship is not found to exist. (8)

A creatinine blood test quantifies the degree of creatinine in the blood. Creatinine
is a waste item that structures when creatine, which is found in your muscle,
separates. Creatinine levels in the blood can furnish your primary care physician
with data about how well your kidneys are functioning. Every kidney has a huge
number of little blood-sifting units called nephrons. The nephrons continually
channel blood through a minuscule group of veins known as glomeruli. These
structures channel squander items, overabundance water, and different pollutions
out of the blood. The poisons are put away in the bladder and afterward evacuated
22
during pee. Creatinine is one of the substances that your kidneys typically take out
from the body. Specialists measure the degree of creatinine in the blood to check
kidney work. Elevated levels of creatinine may demonstrate that your kidney is
harmed and not working appropriately. Creatinine blood tests are typically
performed alongside a few other research center tests, including blood urea
nitrogen (BUN) test and a fundamental metabolic board (BMP) or complete
metabolic board (CMP). These tests are finished during routine physical tests to
help analyze certain infections and to check for any issues with your kidney
work.(9)

Creatinine is estimated in milligrams per deciliter of blood (mg/dL). Individuals

who are progressively strong will in general have higher creatinine levels. Results
may likewise shift contingent upon age and sexual orientation. As a rule, be that as
it may, typical creatinine levels extend from 0.9 to 1.3 mg/dL in men and 0.6 to 1.1
mg/dL in ladies who are 18 to 60 years of age. Typical levels are generally the
equivalent for individuals more than 60. High serum creatinine levels in the blood
demonstrate that the kidneys aren't working appropriately. Your doctor may order a
creatinine blood test to assess your creatinine levels if you show signs of kidney
disease. If you have symptoms that include: fatigue and trouble sleeping, loss of
appetite, swelling in the face, wrists, ankles, or abdomen, lower back pain near the
kidneys, changes in urine output and frequency, high blood pressure, nausea, and
vomiting. Your serum creatinine is important to note that normal and abnormal
ranges can vary among labs because some use unique measurements or test
different samples. You should always meet with your doctor to discuss your test
results in more detail. They’ll be able to tell you if more testing is necessary and if
any treatment will be required. Vels might be somewhat raised or higher than
typical due to: (9).

23
References
1) S Narayanan, Clinical Chemistry, Volume 26, Issue 8, 1 July 1980, Pages
1119–1126, https://doi.org/10.1093/clinchem/26.8.1119

2) Analytical Reviews in Clinical Biochemistry: The Estimation of Creatinine

Kevin Spencer

First Published January 1, 1986 Review Article Find in PubMed

https://doi.org/10.1177/000456328602300101

3) THE BIOCHEMISTRY OF CREATINE AND CREATININE!

By HOWARD H. BEARD

https://www.annualreviews.org/doi/pdf/10.1146/annurev.bi.10.070141.001333

4) Creatinine Estimation and Interference

Indian J Clin Biochem. 2013 Apr; 28(2): 210–211.

Published online 2013 Jan 26. doi: 10.1007/s12291-013-0299-y

5) Impact of the biochemical assay for serum creatinine measurement on the

individual carboplatin dosing: a prospective study

Author links open overlay panel F. Léger, S. Séronie-Vivien, J. Makdessi, I.

Lochon, J.P. Delord, C. Sarda, P. Canal, E. Chatelut

https://doi.org/10.1016/S0959-8049(01)00358-6

6) Estimation of Creatinine by the Jaffe Reaction : A Comparison of Three

Methods

Harry Husdan, Abraham Rapoport

24
Clinical Chemistry, Volume 14, Issue 3, 1 March 1968, Pages 222–238,
https://doi.org/10.1093/clinchem/14.3.222

Published: 01 March 1968

7) Estimation of Serum Creatinine by Routine Jaffé’s Method and by Dry

Chemistry in Icteric and Hemolytic Serum Samples

Padmanabhan Preeti*, and Jangle N Suresh

International Journal of Medical Research &

Health Sciences, 2017, 6(3): 68-7568

Available online at www.ijmrhs.com

8) ON THE COLORIMETRIC

DETERMINATION OF CREATININE BY THE JAFFE REACTION

Roy W. Bonsnes and Hertha H. Taussky

http://www.jbc.org/content/158/3/581.citation

Access the most updated version of this article at

9) Creatinine Blood Test

https://www.healthline.com/health/creatinine-blood#results

10) Syal K, Srinivasan A, Banerjee D. Streptomycin interference in Jaffe

reaction—possible false positive creatinine estimation in excessive dose exposure.
Clin Biochem. 2013;46(1–2):177–179. doi: 10.1016/j.clinbiochem.2012.10.031.
[PubMed] [CrossRef] [Google Scholar]

25
11) Hyneck ML, Berardi RR, Johnson RM. Interference of cephalosporins and
cefoxitin with serum creatinine determination. Am J Hosp Pharm.
1981;38(9):1348–1352. [PubMed] [Google Scholar]

12) Kroll MH, et al. How certain drugs interfere negatively with the Jaffe reaction
for creatinine. Clin Chem. 1985;31(2):306–308. [PubMed] [Google Scholar]

13) Durham SR, Bignell AH, Wise R. Interference of cefoxitin in the creatinine
estimation and its clinical relevance. J Clin Pathol. 1979;32(11):1148–1151. doi:
10.1136/jcp.32.11.1148. [PMC free article] [PubMed] [CrossRef] [Google
Scholar]

14) Lolekha PH, Jaruthunyaluck S, Srisawasdi P. Deproteinization of serum:

another best approach to eliminate all forms of bilirubin interference on serum
creatinine by the kinetic Jaffe reaction. J Clin Lab Anal. 2001;15(3):116–121. doi:
10.1002/jcla.1013. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

15) Moss GA, Bondar RJL, Buzzelli DM. Kinetic enzymatic method for
determining serum creatinine. Clin Chem. 1975;21(10):1422–1426. [PubMed]
[Google Scholar]

16) Lustgarten JA, Wenk RE. Simple, rapid, kinetic method for serum creatinine
measurement. Clin Chem. 1972;18:1419–1422. [PubMed] [Google Scholar]

26