European Journal of Clinical Pharmacology

, Volume 28, Issue 5, pp 537–541

Overestimation of renal function in glucocorticosteroid treated patients

  • F. F. Horber
  • J. Scheidegger
  • F. J. Frey


Creatinine clearance is commonly used as a parameter for individualization of dosages of drugs primarily excreted by the kidney. Nomograms and equations have been developed for estimating creatinine clearance from serum creatinine concentration, body weight, age and sex. Glucocorticosteroids are said to cause proximal muscle wasting and therefore may be expected to cause a decrease in the creatinine production rate. The purposes of the present investigation were first to evaluate by a computed tomography the effect of long term treatment with prednisone on the mid-thigh muscle area, and second, to establish whether the presumed supposed decrease in muscle mass was associated with a decrease in the urinary creatinine excretion rate, and hence in a systematic error whenever a nomogram is used to predicte creatinine clearance in such subjects. Patients taking prednisone had smaller mid-thigh muscle areas than controls. A linear relationship between the mid-thigh muscle area and the observed urinary excretion of creatinine was found, suggesting that the muscle loss could account for the decrease in the urinary excretion rate of creatinine. The ratio of observed to predicted (by nomogram) urinary creatinine excretion was lower in patients than controls, resulting in a corresponding underprediction of creatinine clearance by nomograms in the patients taking prednisone.

Key words

glucocorticosteroids renal function mid-thigh muscle area nomogram creatinine clearance predicted creatinine clearance muscle wasting 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bjornsson TD (1979) Use of serum creatinine concentrations to determine renal function. Clin Pharmacokinet 4: 200–222Google Scholar
  2. 2.
    Bourdakos N, Wolf S (1962) Creatine and muscular dystrophy. Relationship of creatine-creatinine metabolism to diet and drugs. Arch Neurol 6: 439–450Google Scholar
  3. 3.
    Bürger MZ (1919) Beiträge zum Kreatininstoffwechsel: I. Die Bedeutung des Kreatininkoeffizienten für die quantitative Bewertung der Muskulatur als Körpergewichtskomponente. II. Die Kreatin- und Kreatininausscheidung: die Störungen des Muskelstoffwechsels. Z Ges Exp Med 9: 361–399Google Scholar
  4. 4.
    Cocchetto DM, Tschanz C, Bjornsson TD (1983) Decreased rate of creatinine production in patients with hepatic disease: Implication for estimation of creatinine clearance. Ther Drug Monit 5: 161–168Google Scholar
  5. 5.
    Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16: 31–41Google Scholar
  6. 6.
    Dettli L (1974) Individualization of drug dosage in patients with renal disease. Symposium on Individualization of Drug Therapy. Med Clin North Am 58: 977–985Google Scholar
  7. 7.
    Goldman R (1954) Creatinine excretion in renal failure. Proc Soc Exp Biol Med 85: 446–448Google Scholar
  8. 8.
    Grauer WO, Moss AA, Cann CE, Goldberg HI (1984) Quantification of body fat distribution in the abdomen using computed tomography. Am J Clin Nutr 39: 631–637Google Scholar
  9. 9.
    Graystone JE (1968) Creatinine excretion during growth. In: Cheek DB (ed) Human growth: body composition cell growth, energy and intelligence, vol 12. Lea & Febiger, Philadelphia, pp 182–197Google Scholar
  10. 10.
    Hallynck T, Soep HH, Thomis J, Boelaert J, Daneels R, Gillastre JP, De Rosa F, Rubinstein E, Hatala M, Spousta J, Dettli L (1981) Prediction of creatinine clearance from serum creatine concentration based on lean body mass. Clin Pharmacol Ther 30: 414–421Google Scholar
  11. 11.
    Heymsfield SB, Arteaga C, McManus C, Smith J, Moffitt S (1983) Measurement of muscle mass in humans: validity of the 24-hour urinary creatinine method. Am J Clin Nutr 37: 478–494Google Scholar
  12. 12.
    Hoagland CL, Gilder H, Shank RE (1945) The synthesis, storage and excretion of creatine, creatinine, and glycocoyamine in progressive muscular dystrophy and the effects of certain hormones on these processes. J Exp Med 81: 423–438Google Scholar
  13. 13.
    Horber FF, Scheidegger JR, Grünig BE, Frey FJ (1985) Evidence, that glucocorticoid induced myopathy is reversed by physical training. J Clin Endocrinol Metab (in press)Google Scholar
  14. 14.
    Hudsan H, Rapoport A (1968) Estimation of creatinine by the Jaffe reaction. A comparison of three methods. Clin Chem 44: 222–238Google Scholar
  15. 15.
    Hunter A (1928) Creatine and creatinine. Longmans, Green, New York, NYGoogle Scholar
  16. 16.
    Jelliffe RW (1973) Creatinine clearance: Bedside estimate. Ann Int Med 79: 604–605Google Scholar
  17. 17.
    McLaren DS, Loshkajian H, Kanawati AA (1970) Urinary creatinine and hydroxyproline in relation to childhood malnutrition. Br J Nutr 24: 641–651Google Scholar
  18. 18.
    Milhorat AT, Wolff HG (1937) Studies in diseases of muscle. I. Metabolism of creatine and creatinine in progressive muscular dystrophy. Arch Neurol Psychiatr 38: 992–1024Google Scholar
  19. 19.
    Müller R, Kugelberg E (1959) Myopathy in Cushing's syndrome. J Neurol Neurosurg Psychiatr 22: 314–319Google Scholar
  20. 20.
    Perkoff GT, Silber R, Typer FH, Cartwright GE, Wintrobe MM (1959) Studies in disorders of muscle: XII. Myopathy due to the administration of therapeutic amounts of 17-hydroxycorticosteroids. Am J Med 26: 891–898Google Scholar
  21. 21.
    Siersbaek-Nielsen K, Hans JM, Kampman J, Kristensen M (1971) Rapid evaluation of creatinine clearance. Lancet 1: 1133–1134Google Scholar
  22. 22.
    Talbot NB (1938) Measurement of obesity by the creatinine coefficient. Am J Dis Child 55: 42–50Google Scholar
  23. 23.
    Wheldon GD, Shorr E (1957) Metabolic studies in paralytic acute anterior poliomyelitits. I. Alterations in nitrogen and creatine metabolism. J Clin Invest 36: 942–965Google Scholar

Copyright information

© Springer-Verlag 1985

Authors and Affiliations

  • F. F. Horber
    • 1
  • J. Scheidegger
    • 1
  • F. J. Frey
    • 1
  1. 1.Medizinische Poliklinik, Department of Diagnostic RadiologyUniversity of BerneBerneSwitzerland

Personalised recommendations