Serum and Urinary Creatinine in Children with Severe Protein Malnutrition

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Abstract
Nine children hospitalized with kwashiorkor had very low initial urinary excretions of creatinine which increased sharply during the first week of treatment. The magnitude and rates of these increases were too great to be accounted for by a change in muscle mass. The initial serum creatinine concentrations, although not initially elevated, decreased markedly parallel to the increase in urinary excretion. Endogenous creatinine clearances per square meter of body surface were consequently very reduced on admission and increased rapidly during the first week of treatment. In patients followed up for periods varying from two to six months after initiation of treatment and who were clinically recovered, serum creatinine levels remained much lower (0.46 to 0.57 mg. per 100 ml.) than the average for a group of sixteen well nourished control subjects (0.78 mg. per 100 ml.). The average clearance for the latter children was only 68 per cent of the value found for healthy adults; it appears therefore, that creatinine clearance in children does not represent true glomerular filtration. A practical conclusion from the results is that the figure for twenty-four-hour urinary excretion of creatinine during or soon after the acute phase of kwashiorkor, is not reliable for the estimation of muscle mass.

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