Underdiagnosis of chronic renal failure

An individual's plasma creatinine concentration is determined by its production from skeletal muscle (dependent on age, gender, and ethnicity) and its renal clearance due mainly to glomerular filtration. The inverse relationship between plasma creatinine and glomerular filtration rate means that small increments to a near normal plasma level correspond to much larger decrements in glomerular filtration rate. For example, a doubling of plasma creatinine within the normal range (from 60 to 120 ^mol/l) represents a halving of glomerular filtration rate. This subtle biochemical relationship and the absence of referable symptoms and signs means that cases of chronic renal failure may go unrecognized on the intensive care unit as easily as elsewhere.

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