Serum Creatinine Levels May Not Necessarily Reflect a True Renal Function to Adjust Amikacin Dose in Paraplegic Patient: A Case Report and Literature Review

Abstract

To estimate glomerular filtration rate as an indicator of kidney function, clearance of endogenous creatinine is usually used despite its unreliability due to influence of several factors including age, gender, muscle mass and interferences within methods. Although there is emergence of better markers like serum cystatin-C, creatinine clearance continues to be used routinely as a marker of renal function to date. In the present case study we describe only slightly elevation of serum creatinine associated with high serum drug concentration 27 mg/L “trough” and 41 mg/L “peak”, respectively in a paraplegic patient treated with initially reduced dose (500 mg/day) of an aminoglycoside antibacterial drug (amikacin). The relatively little increment of serum creatinine in this case might be related to underlying pathology resulting in low production of creatinine, which does not essentially reflect the true renal function. Methodological challenges during GFR estimation and risk of renal impairment in Spinal Cord Injury (SCI) patents are also discussed in context with literature review.