A female client went to the clinic with a creatinine clearance of 200 mL/min. Which of the following conditions of the client can cause the increased level of this test?
A. Renal disease.
B. Dehydration.
C. Congestive heart failure.
D. History of high dietary protein intake.
Correct Answer: D. History of high dietary protein intake.
The normal creatinine clearance for a female is 88 to 128 ml/min. An increased creatinine clearance is often referred to as hyperfiltration and is most commonly seen during pregnancy or in clients with a large dietary protein intake. Dietary protein consumption increases serum creatinine level through protein catabolism rather than decreased clearance. Hence, serum creatinine may be less reliable for estimating GFR or estimating a glomerular hyperfiltration response in studies that manipulate dietary protein.
Option A: Creatinine clearance has been used for many decades to estimate GFR. It involves a 24-hour urine collection to measure creatinine excretion. As the same sample can be used to measure the protein excretion rate, creatinine clearance is often used for the initial evaluation of renal diseases, such as glomerulonephritis.
Option B: Dehydration generally causes BUN levels to rise more than creatinine levels. This causes a high BUN-to-creatinine ratio. Kidney disease or blocked urine flow from the kidney causes both BUN and creatinine levels to rise.
Option C: Congestive heart failure is seen with a decreased creatinine clearance. Low creatinine clearance levels can mean the client has chronic kidney disease or serious kidney damage. Kidney damage can be from conditions such as a life-threatening infection, shock, cancer, low blood flow to the kidneys, or urinary tract blockage. Other conditions, such as heart failure and dehydration, can also cause low clearance levels.