Yes, a high creatinine level indicates a very high likelihood of kidney disease, especially, when there are other indices of kidney failure in the patient.

In general, serum creatinine is well suited as an endogenous filtration marker in order to assess the renal performance, as it is almost completely removed from the blood by glomerular filtration (therefore reflecting the glomerular filtration rate, the golden standard in clinical monitoring of renal performance) and proximal tubular secretion, and only marginally reabsorbed, e.g. in healthy newborns or elderly people. Serum creatinine levels, however, are significantly influenced by age, sex, race, muscle mass, chronic illnesses, diet, and medications of the monitored patient. Consequently, in order to ascertain, for example, an acute impairment of the renal function, only the alteration of the serum creatinine level in comparison to the individual baseline level is meaningful (i.e. rise in serum creatinine in comparison to patients baseline serum creatinine level indicates kidney injury).

Dear Helena,

I think a comparison to the individual's baseline will be difficult if there is already an impairment of renal function at first presentation,in that case, there is no normal baseline to compare to.

Hi

Increased serum creatinine is in case of renal impairement related to a decrease of GFR. A more accurate information on the GFR can be obtained from a 24-hour creatinine clearance, which requires an accurate 24-hour urine collection and measurement of urine and serum creatinine. Please see reference below. Best regards, Michaela

http://emedicine.medscape.com/article/2054342-overview#a2

The comparison between baseline serum creatinine and serum creatinine after a kidney injury event can indeed be only applied if the baseline level is known. This is, for example, the case in acute kidney injury after cardiac surgery, where the baseline SCr is measured prior to the surgery. Otherwise, the glomerular filtration rate, which is based on the SCr level and which furthermore takes into account the information about the individual's sex, weight, and age (and potentially other factors depending on the used estimation equation), is probably the best marker for renal performance.

http://www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO_2012_CKD_GL.pdf

Hello Dear colleagues!

1. Creatinine is very good marker of renal function. But change of creatinine level is no clear symptom of kidney failure, for example, in patients with liver failure, in muscle deficiency.

2. Data collection on the level of creatinine (in outpatient) in many ways to simplify the evaluation of kidney injury in the development of events (hospitalization).

Sincerely yours

The KDIGO AKI guidelines have suggested that the baseline serum creatinine would be 0.8 mg/dl in elderly females , 1.0 mg/dl in young females & elderly males , 1.3 mg/dl in young males in non back individuals . A table highlights these data ( refer table 9 pg 29 ) . This is because females have lower muscle mass compared to males . For eg , a creatinine level of 1.3 mg/dl in an elderly female would be considered as high . It would be ideal if baselines figures can be obtained from patients based on regular check up . 

Hello Sami - are you talking about an acute situation or chronic (it makes a difference).

With respect to the discussion concerning baseline creatinine in an acute situation:

1. It doesn't matter if someone has Chronic disease already (and therefore elevated Cr).  What is important is having access to a steady state creatinine (either prior to surgery as suggested, or from medical records).  Preferably this value should have been measured in a non-acute setting 7d to 3months prior. However, practically, one takes what one can get.

2. There is some suggestion that in the absence of a baseline one can "back-calculate" a baseline creatinine using the MDRD equation.  In my opinion this works (poorly) in epidemiology but is not good practice for an individual patient.  I published on this and showed that a randomly generated baseline creatinine was just as good (or bad) [see attached]!

3. KDIGO acknowledged the problem by including as a definition of AKI a rise of creatinine of 0.3 mg/dL within any 48h period - eg in the absence of a baseline creatinine use the first measured hospital creatinine and monitor changes over 48h.  It is important to avoid using a creatinine value that may have been artificially lowered by recent administration of a bolus of fluids [another publication attached]

Article Back-Calculating Baseline Creatinine with MDRD Misclassifies...

 Sorry Sami - I hit the "Add answer" button before I'd finished.

I'd also not recommend 24h CrCl in the acute situation because (i) it takes too long and (ii) it only gives an indication of the average GFR over 24h. 

We've trialled a 4h CrCl which gives some good data.  We've also trialled a tool that uses the ratio of an estimated creatinine production to creatinine excretion.

Article Four hour creatinine clearance is better than plasma creatin...

Article A Simple Method to Detect Recovery of Glomerular Filtration ...