Clinical appraisal of creatinine clearance as a measurement of glomerular filtration rate.

The plasma creatinine and the endogenous creatinine clearances are two of the most commonly used tests in clinical medicine to assess glomerular filtration rate. However, the contribution that tubular secretion of creatinine has on the total endogenous creatinine clearance (Ccr) is not generally known, nor are the effects renal insufficiency has on the tubular secretion of creatinine. To assess the above, 123 human subjects, with a wide range of renal function, underwent simultaneous Ccr and inulin clearances (Cin). The results indicate that: (1) Ccr approximates Cin only when Cin is normal; (2) a normal plasma creatinine of Ccr is not measurable evidence of a normal Cin; and (3) with progressive decline in Cin, there is progressive increase in the tubular secretion of creatinine, leading to a progressive disparity between Ccr and Cin.