Hey guys! Jon here with NRSNG.com and NursingStudentBooks.com.
Thank you so much for visiting; for checking out this video. Today, I wanna talk about
Creatinine. Okay, on the recent video we just covered what BUN was. Today, we re gonna cover
basically what Creatinine is. If you had the chance to watch that BUN video, it might be
helpful in understanding the difference and how these two play in together. Also, I wanna
let you know about our new app that s coming out: RNCrush! If you go to RNCrush.com, you
can learn more about that. It is a mobile app for nursing students to help them study
for NCLEX but it is developed as a game. So, it s very different from what s out there
and it s a great way to help you prepare without stressing about studying and things like that.
Alright. So, today, like I said, we re gonna talk about Creatinine. What is Creatinine? Well, like I said, we
just talked about what BUN was, so let s talk, let s dive into what creatinine is. Creatinine
is a by product of something called creatine. Now, certainly, you ve heard of creatine.
Creatine is produced in the liver, primarily, and it is used in our muscle tissue. Basically,
it plays a role in ATP formation during muscular effort. So, think of creatine as contributing
to ATP to help our muscles with this quick force of energy that they need. Now, when
that creatine has been used, what happens is, is it becomes converted into creatinine.
Okay. So, creatinine is the by product of creatine, and this creatinine is not used
by the body, it needs to be taken out of the body. We have to get rid of this creatinine.
We have to dump it out. We have to throw it in the garbage. Okay, so, the way that we
throw that in the garbage is it travels through the bloodstream to the kidney, alright, let
s pretend that s a kidney, okay. Within the kidney, we know that inside the kidneys, we
have these little glomeruli. The glomeruli are those little ball-shaped structures in
the pyramids and what these glomeruli do is the creatinine comes in, that creatinine is
filtered out in those glomeruli, and it is taken into the ureters and becomes excreted
in the urine. Okay, so, let s walk through this one more time, really quick. Creatine
is used by the muscles and it helps in ATP. When we ve used up that creatine, it becomes
creatinine, that creatinine travels through the bloodstream, into the glomeruli, and the
glomeruli filter that out and dump it, okay, in our urine. So, because it s filtered to our glomeruli,
it s actually filtered at a very high percentage, or in another word to say that would be, it
s not re-absorbed, or very very very little of it becomes re-absorbed. So, creatinine,
we actually try to get rid of it entirely from our body, and we do that through our
glomeruli. So, one number that we will look at to determine how well our kidneys are able
to excrete creatinine is gonna be GFR. Okay, Glomerular Filtration Rate. And that s a number
that we oftentimes use to kind of determine renal function because that number is going
to, in a large way, tell us how much the kidneys are able to excrete creatinine. Okay? So,
the number that we re looking for, optimal number would be 100. Okay? We really want
our patients to be greater than 60. A number around 60 would indicate Stage I, Stage II
CKD (Kidney Disease) and that s according to Renal.org. Okay? If we have a number between
30 – 59, that s going to indicate Stage III Kidney Disease. And if our number is less
than 30, that s gonna indicate Stage IV, oops, how do you write IV, like that, IV to V Kidney
Disease. Okay, so, does that makes sense? I hope that makes sense. So, creatinine is
excreted from the body in the kidneys but more specifically it s filtered out in the
glomeruli. So, we can use GFR (Glomerular Filtration Rate) as an indicator of how well
the kidneys are filtering that out, and we re hoping for a number between 100 and 60.
That number can decrease with age. Okay? And then another indicator that we can use,
is we can look up the lab value Creatinine Clearance. And the way to do that is they
look at Urine Creatinine and they look at Serum Creatinine. And by looking at those
two numbers, how much is in the urine versus how much is in the blood, they can kinda take
that number and come up with what s called Creatinine Clearance. And that s another way
of them saying, okay, there s all these creatinine in the blood and there s only this much in
the urine, so, we know that the body is not able to get rid of that creatinine and that
can give them a good idea of Kidney Disease as well. Okay? Now, let s talk about how BUN and Creatinine
are related. So, we have our BUN and we have our creatinine. Okay, both BUN and Creatinine
are nitrogenous waste products. Okay, so, basically, BUN is the breakdown product of
protein, okay. So, let s say, it s protein broken down in the liver. And creatinine is
the breakdown product of creatine in the muscles. Okay, and they are both sent to the kidneys
and what happens here, is in the kidneys, BUN can actually be re-absorbed in states
of hypoperfusion. So if our kidney sensed that they are not getting enough blood flow,
they re gonna re-absorb some of that BUN, that urea nitrogen, that urea. But, the difference
here is that Creatinine cannot be re-absorbed. Re-absorbed. The glomeruli, their job is to
completely rid the body of creatinine basically. And, that s why our normal value for creatinine
is so low, our normal value is 0.6 – 1.2 mg/dL. Okay. And, our BUN is gonna be about 10 times
that number, it s gonna be 10 to 20 times our number for creatinine. Okay? And so, with
that in mind, with that fact in mind, BUN can be re-absorbed and creatinine cannot,
let s move on to the next subtopic here. And so like I said, the normal number, the
normal ratio of BUN : Creatinine is about 10:1 to about 20:1. Okay, that number is called
our BUN Creatinine Ratio. Okay. Now, why would this number be useful? Okay. It all comes
down to the fact that BUN is re-absorbed, creatinine is not. Okay? So, because of that,
like I just said, because BUN can be re-absorbed in states of hypoperfusion, we look at our
BUN Creatinine Ratio to say, okay, well, the patient has a really high BUN instead of jumping
to the conclusion that that patient might be in renal failure. We look at the BUN to
Creatinine Ratio, and in instance where BUN is high but they have normal creatinine, that
would be instances like volume depletion. Okay? So, essentially, an increased ratio,
it means decreased blood flow to the kidneys. Okay? So, let s say we have an increased BUN
to Creatine Ratio. Okay, let s say our number is 30 : 1, or whatever. Okay. So, for number
or something like 30 : 1, that s gonna tell us that we have decreased blood flow to the
kidneys. Okay, this would occur in situations like CHF. Okay. We re not perfusing our body,
we re not perfusing our kidneys. Okay, so our BUN is getting re-absorbed but we re still
losing that creatinine. Situations like dehydration, increased protein and G.I. Bleed. So, your
doctors are gonna be, they are gonna be really smart at these. They re gonna look at the
BUN, they re gonna look at the creatinine. And instead of jumping into any sort of conclusion,
they re gonna say, okay, first of all, let s look at our BUN Creatinine Ratio, let s
look at other signs, because they might not be able to see. This is a way that they can
probably catch this disease processes early. They can get them in advance rather than waiting
until the signs would all set in. Okay, so, in an instance with elevated BUN
Creatinine Ratio, we re talking about volume depletion type issues. Okay? Now, when will
we have decreased BUN to Creatinine Ratio? Okay. Let s think about that. So BUN, this
Urea Nitrogen is basically formed in the liver, okay? So, what types of diseases would cause
our BUN to Creatinine Ratio to go down? Let s say it goes down to 7 : 1. Okay? Think about
it. What would cause some of those issues. Okay. Things that would cause that are gonna
be things Liver Disease, okay. Malnutrition, malnutrition
like decreased protein. Okay, so remember,
BUN is a by product of protein metabolism. So, if our protein metabolism is down and
protein metabolism occurs in the liver. So, if our liver is not able to metabolize protein,
it s not gonna be creating this BUN. Okay? So, because of that, we re gonna have a decreased
BUN to Creatinine Ratio, cause creatinine is still doing everything that it should be
doing. Basically, it s being created in the muscle tissue and being taken to the glomeruli
and being excreted as it should. So, it s going to continue to go up. However, our BUN
is not, or situations of malnutrition decreases protein intake. If we re not having protein
coming in, the liver has nothing to, it has no reason to create this Urea Nitrogen. So,
it s not going to create that. And because of that, our BUN is going to decrease. Okay,
so, it s important to not just look at one number or the other, but to look at this BUN
Creatinine Ratio and think through the process. BUN is a by product of protein metabolism
that occurs in the liver and it can be re-absorbed. Creatinine, on the other hand, is by product
of creatine breakdown, occurs in muscle, and it cannot be re-absorbed. Okay, so that s really basically would be
BUN Creatinine. That s kinda what you need to know. If you want to reach out to me, contact
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