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Hou H, Liu Y, Li X, Liu W, Gong X. Rapid electrodeposition of Cu nanoparticle film on Ni foam as an integrated 3D free-standing electrode for non-invasive and non-enzymatic creatinine sensing. Analyst 2024; 149:2905-2914. [PMID: 38572989 DOI: 10.1039/d4an00162a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
High cost, inherent destabilization, and intricate fixing of enzyme molecules are the main drawbacks of enzyme-based creatinine sensors. The design of a low-cost, stabilizable, and enzyme-free creatinine sensing probe is essential to address these limitations. In this work, an integrated three-dimensional (3D) free-standing electrode was designed to serve as a non-enzymatic creatinine sensing platform and was fabricated by rapid electrodeposition of a dense copper nanoparticle film on nickel foam (Cu NP film/NF). This low-cost, stable, easy-to-fabricate, and binder-free Cu NP film/NF electrode has abundant active sites and excellent electrochemical performance. Cyclic voltammetry measurements show a wide linear range (0.25-24 mM), low detection limit (0.17 mM), and high sensitivity (306 μA mM-1 cm-2). The developed sensor shows high recovery of creatinine concentration in real urine. Besides, it has better specificity, reproducibility, and robustness in detecting creatinine. These excellent results suggest that a non-enzymatic creatinine sensor based on an integrated 3D free-standing Cu NP film/NF electrode has good potential for non-invasive detection of urinary creatinine.
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Affiliation(s)
- Hongming Hou
- School of Mechanical Engineering, Sichuan University, Chengdu 610065, China.
- Innovation Method and Creative Design Key Laboratory of Sichuan Province, Chengdu 610065, China
| | - Yifan Liu
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Xianglong Li
- School of Mechanical Engineering, Sichuan University, Chengdu 610065, China.
- Innovation Method and Creative Design Key Laboratory of Sichuan Province, Chengdu 610065, China
| | - Wenbo Liu
- School of Mechanical Engineering, Sichuan University, Chengdu 610065, China.
| | - Xiaoli Gong
- School of Materials Science and Engineering, Sichuan University, Chengdu 610065, China
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2
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Bock F, Isermann B. Does it matter how we measure urinary creatinine in patients taking SGLT2 inhibitors? Nephrol Dial Transplant 2024; 39:739-741. [PMID: 38218592 DOI: 10.1093/ndt/gfae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Indexed: 01/15/2024] Open
Affiliation(s)
- Fabian Bock
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Berend Isermann
- Institute of Laboratory Medicine, Clinical Chemistry, and Molecular Diagnostics, University Hospital Leipzig, Leipzig University, Leipzig, Germany
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Li B, Thompson S, Igot K, King R, Doogue M, Florkowski C. Artefactually low creatinine by Beckman Coulter enzymatic method due to immunoglobulin M paraprotein interference. Ann Clin Biochem 2023; 60:423-427. [PMID: 37482625 DOI: 10.1177/00045632231190507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
An 81-year-old man was admitted to hospital with symptomatic coronavirus disease (COVID-19) infection. He had a background of progressive chronic inflammatory demyelinating polyneuropathy associated with Waldenstrom's macroglobulinaemia. His plasma creatinine on four separate samples was inconceivably low (all ≤13 μmol/L), as measured by a Beckman Coulter enzymatic assay) after being 72 μmol/L 3 months earlier. On further investigation, his serum immunoglobulin M (IgM) was 15.4 g/L and his plasma creatinine measured by Roche enzymatic and Roche Jaffe methods was 62 μmol/L and 64 μmol/L, respectively. This was consistent with results post dilution studies and polyethylene glycol (PEG) precipitation on the Beckman Coulter assay. There was no evidence of similar interference when reviewing creatinine results from 10 other patients with IgM paraproteinaemia who had been tested in our laboratory. Clinicians and laboratorians are reminded that enzymatic creatinine is not free from interferences. IgM paraprotein negative interference of enzymatic creatinine is rare and specific to a patient's IgM and assay combination, but should be considered in patients with an unexplained low enzymatic creatinine result. Useful investigations to identify an interference include dilution studies, PEG precipitation and measuring creatinine on an alternative method such as Jaffe, mass spectrometry or an enzymatic method from a different platform.
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Affiliation(s)
- Bobby Li
- Te Whatu Ora - Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
- Biochemistry, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Simon Thompson
- Te Whatu Ora - Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
- Biochemistry, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Kareen Igot
- Te Whatu Ora - Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
- Biochemistry, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Richard King
- Te Whatu Ora - Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
- Biochemistry, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Matthew Doogue
- Te Whatu Ora - Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
- Clinical Pharmacology, Christchurch Hospital, Christchurch, New Zealand
| | - Chris Florkowski
- Te Whatu Ora - Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
- Biochemistry, Canterbury Health Laboratories, Christchurch, New Zealand
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4
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Ting HY, Ting IPL, Lo SC, Loh TP. Falsely low serum creatinine caused by immunoglobulin M paraprotein interference with enzymatic method. Pathology 2022; 54:959-962. [PMID: 35527046 DOI: 10.1016/j.pathol.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/18/2022] [Accepted: 01/24/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Huong Yew Ting
- Department of Pathology, Miri General Hospital, Sarawak, Malaysia.
| | | | - Shao Ching Lo
- Department of Pathology, Miri General Hospital, Sarawak, Malaysia
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore
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Flowers KC, Tuddenham E, Leiva A, Garrison L, Morris JE, Cromwell T, Boa FG. Negative interference from immunoglobulin M paraproteinaemia on the Roche enzymatic creatinine method. Ann Clin Biochem 2022; 59:205-210. [PMID: 35133213 DOI: 10.1177/00045632221074867] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although enzymatic creatinine methods are subject to fewer interferences than traditional Jaffe creatinine methods, every method in clinical chemistry has limitations. We report, for the first time in the literature, a case of an immunoglobulin M (IgM) paraproteinaemia causing an undetectably low creatinine result on the Roche enzymatic assay. This interference did not occur with other enzymatic creatinine methods produced by Abbott and Siemens or the Roche Jaffe, VITROS dry slide and liquid chromatography with tandem mass spectrometry (LC-MS/MS) creatinine methods. IgM interference was confirmed as patient serum precipitated with polyethylene glycol (PEG) and anti-IgM antiserum yielded detectable Roche enzymatic creatinine results comparable to unaffected methods. The patient's serum formed an obvious precipitate when mixed with reagent one of the Roche enzymatic creatinine method. This is in contrast to a report of positive interference from IgM paraproteinaemia in a different enzymatic creatinine method, which showed that a precipitate formed when mixing blood with reagent two. As each patient's paraprotein has a unique structure, it is possible that there are variations in the chemical characteristics of IgM paraproteins between patients. This, as well as IgM-class antibodies' tendency to form multimers and aggregates, can lead to unpredictable assay interferences and precipitation tendencies between different manufacturers of enzymatic creatinine reagents and their incubation steps. This case highlights the importance of continuing to question and investigates results that do not fit the clinical picture, especially as more laboratories switch from primarily using traditional Jaffe creatinine methods to enzymatic creatinine methods.
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Affiliation(s)
- Kade C Flowers
- Department of Clinical Blood Sciences, South West London Pathology, 4968St George's University Hospitals NHS Foundation Trust, London, UK
| | - Emma Tuddenham
- Department of Clinical Blood Sciences, South West London Pathology, 4968St George's University Hospitals NHS Foundation Trust, London, UK
| | - Anya Leiva
- 434486Parkshot Medical Practice, Richmond, UK
| | - Lisa Garrison
- Department of Clinical Blood Sciences, South West London Pathology, 4968St George's University Hospitals NHS Foundation Trust, London, UK
| | - Joanne E Morris
- Protein Reference Unit, South West London Pathology, 4968St George's Hospital, London, UK
| | - Tamsyn Cromwell
- Clinical Biochemistry and Immunology, Royal Sussex County Hospital, 8721University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Frances G Boa
- Department of Clinical Blood Sciences, South West London Pathology, 4968St George's University Hospitals NHS Foundation Trust, London, UK
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Potze W, Vos MJ, Engel H, Doornebal J. A conspicuous reduced plasma creatinine: the first presenting sign of Waldenstrom macroglobulinemia. Clin Chem Lab Med 2022; 60:e21-e24. [PMID: 34480845 DOI: 10.1515/cclm-2021-0742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/29/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Wilma Potze
- Department of Nephrology, Isala Clinics, Zwolle, The Netherlands
| | - Michel J Vos
- Department of Laboratory Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk Engel
- Department of Laboratory Medicine, Isala Clinics, Zwolle, The Netherlands
| | - Joan Doornebal
- Department of Nephrology, Isala Clinics, Zwolle, The Netherlands
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Ma L, Zhao Z, Racine-Brzostek SE, Yang HS. A rare case of persistent pseudohypobicarbonatemia arising from chemistry analyzer-specific interference. Clin Chim Acta 2021; 519:308-310. [PMID: 34051269 DOI: 10.1016/j.cca.2021.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Major discrepancies between concentrations of serum total carbon dioxide (tCO2) obtained from chemistry analyzers and calculated bicarbonate from blood gas analyzers should prompt laboratory investigation. Here, we present a rare case of pseudohypobicarbonatemia unrelated to the common causes such as hypertriglyceridemia and hyperproteinemia, but was caused by a low concentration of paraproteins. CASE A 75-year-old man with persistent fevers was found to have a low concentration of serum tCO2 (<10 mmol/l) with a normal pH and calculated bicarbonate concentrations (23.5 mmol/l) from the blood gas analyzer. His serum tCO2 concentrations remained critically low throughout hospitalization without any evidence of acidosis. Serum tCO2 levels were measured via Siemens ADVIA Chemistry XPT system. RESULTS Mixing studies revealed non-linearity of serum tCO2, suggesting the presence of interfering substances. Triglyceride concentrations were normal. Serum electrophoresis revealed a 0.4 mg/dl M-protein. The patient's serum tCO2 concentrations were repeated on different chemistry analyzer platforms - including Siemens, Roche, and Abbott - which demonstrated that the interference was specific to the Siemens chemistry analyzer. Serum tCO2 was significantly elevated after ultrafiltration of paraprotein, which confirmed the root cause of pseudohypobicarbonatemia. CONCLUSION Laboratory professionals should be aware that spuriously low serum tCO2 concentrations may result from unique interfering substances, such as paraproteins, that are both patient- and chemistry analyzer-specific.
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Affiliation(s)
- Lucy Ma
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA; New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Zhen Zhao
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA; New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Sabrina E Racine-Brzostek
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA; New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - He S Yang
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA; New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
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Yilmaz NS, Sen B, Gulbahar O. Contribution of the laboratory to a diagnosis process by sequential reflective testing: Paraprotein interference on a direct bilirubin assay. Biochem Med (Zagreb) 2021; 31:020801. [PMID: 33927558 PMCID: PMC8047781 DOI: 10.11613/bm.2021.020801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/02/2021] [Indexed: 11/26/2022] Open
Abstract
Errors in laboratory medicine occur in the preanalytical, analytical, and postanalytical phases. The errors are mostly detected in the preanalytical period. However, analytical errors are still an important source of error, despite their frequency is reduced significantly in years thanks to developments in laboratories. In this case, an analytical error was noticed during the verification of a patient’s results. The direct bilirubin of a 66-year-old male patient admitted to the emergency department was higher than the total bilirubin. The patient’s symptoms were fatigue and dyspnoea. Albumin and haemoglobin (Hb) concentrations of the patient were significantly low. After considering the patient’s demographics and laboratory results, the laboratory specialist suspected a paraproteinemia interference. Total protein was performed as a reflective test. The albumin/globulin ratio was reversed. Thereafter, serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE) were performed as another reflective tests, respectively. SPEP and IFE results were in favour of monoclonal gammopathy. The patient was directed to a haematologist, underwent a bone marrow biopsy, and the result was reported as Waldenstrom’s macroglobulinemia with plasma cell differentiation expressing IgM-Kappa. The patient went on a chemotherapy protocol, and his condition has been improved in subsequent months. Detection of analytical errors is of great importance, like in our case, and may be used as a tool to identify patients who have not yet been diagnosed. The laboratory specialist must dominate the entire process of each test in the laboratory, be aware of the limitations of tests, and turn these disadvantages into advantages when necessary.
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Affiliation(s)
- Niyazi Samet Yilmaz
- Department of Medical Biochemistry, Polatli Duatepe State Hospital, Ankara, Turkey
| | - Bayram Sen
- Department of Medical Biochemistry, Recep Tayyip Erdogan University Research and Training Hospital, Rize, Turkey
| | - Ozlem Gulbahar
- Department of Medical Biochemistry, Gazi University Faculty of Medicine, Ankara, Turkey
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Mase H, Hamano N, Mizuhara R, Nozaki T, Saso T, Wada T, Asai S, Miyachi H, Fukagawa M. Falsely Elevated Serum Creatinine Associated With IgM Paraproteinemia. Kidney Int Rep 2019; 5:377-381. [PMID: 32154461 PMCID: PMC7056855 DOI: 10.1016/j.ekir.2019.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hiroyasu Mase
- Department of Laboratory Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Naoto Hamano
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Ryoko Mizuhara
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Tsukasa Nozaki
- Clinical Laboratory, Tokai University Hospital, Isehara, Japan
| | - Takayuki Saso
- Clinical Laboratory, Tokai University Hospital, Isehara, Japan
| | - Takehiko Wada
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Satomi Asai
- Department of Laboratory Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Hayato Miyachi
- Department of Laboratory Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine, Isehara, Japan
- Correspondence: Masafumi Fukagawa, Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, 143 Shimo-Kasuya, Isehara, 259-1193, Japan.
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Leitch S, Charlewood R. Paraprotein implicated in hardware failures in nucleic acid testing of blood donors. Vox Sang 2019; 115:140-147. [PMID: 31777099 DOI: 10.1111/vox.12870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Analyser blockage due to gel formation by paraproteins leading to invalid results is a rare problem in viral nucleic acid testing (NAT) at New Zealand Blood Service (NZBS) despite many blood samples tested without problems from individuals with known paraproteins. This study aimed to identify common factors in samples causing blockages. METHOD Retrospective data were gathered on blood samples known to have blocked analysers at NZBS testing sites. Patients with plasma cell dyscrasia undergoing haematopoietic stem cell (HSC) harvest formed the comparator arm. These patients were identified from registry data of individuals undergoing autologous stem cell transplantation at Auckland City Hospital between 2013 and 2017. RESULTS Four individuals were identified as having blocked analysers between 2010 and 2018. A total of 184 HSC transplant patients were identified, with contemporaneous paraprotein levels available for 177 (96%). Patients with intact immunoglobulin subtypes (134, 73%) were further analysed. Of these, 119 patients (65%) also had total protein and globulin levels available. Mean paraprotein (37.5 g/l), total protein (95.3 g/l), globulin levels (51.5 g/l) and proportion of lambda subtype (75%) were higher in the blocker group compared with non-blocking comparators (4.7 g/l, 66.8 g/l, 27.7 g/l, 36.6% respectively) (P = 0·03, 0·02, 0·007, 0·12). The highest paraprotein and total protein levels from the non-blocking cohort overlapped with the lowest of the blocker group. DISCUSSION High protein levels (paraprotein >20 g/l, total protein >75 g/l) and a trend towards lambda subtype were associated with NAT analyser blockage. The overlap with non-blocking donor samples suggests factors in addition to protein quantity that are also important.
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Seegmiller JC, Eckfeldt JH, Lieske JC. Challenges in Measuring Glomerular Filtration Rate: A Clinical Laboratory Perspective. Adv Chronic Kidney Dis 2018; 25:84-92. [PMID: 29499892 DOI: 10.1053/j.ackd.2017.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 11/11/2022]
Abstract
The assessment of kidney function is a cornerstone in the clinical management and health of the patient. Although the kidneys perform many physiologic functions and are essential for maintaining homeostasis, kidney function is typically evaluated, quantitated, and understood using the glomerular filtration rate (GFR). Although GFR can be directly measured using a variety of externally administered glomerular filtration markers, in general practice, the GFR is usually estimated (eGFR) using endogenous markers that are cleared primarily by kidney filtration. Common situations exist where the GFR needs to be measured (mGFR) in order to proceed with care. This manuscript will review laboratory challenges in the assessment of GFR. Key points to consider when implementing a mGFR testing protocol are the following: marker selection, clearance methodology (urinary vs solely plasma measurements of filtration marker), sample collection, number of samples to collect, staff required, and analytical measurement technology for the filtration marker selected. We suggest those wanting to implement mGFR testing examine site-specific institutional resources along with patient population and proceed with the approaches best suited for their clinical needs and laboratory resources available.
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Metraiah EHA, Regan H, Louw J, Kidder D. Deceiving proteins! A case of lymphoma and high creatinine. BMJ Case Rep 2017; 2017:bcr-2016-217946. [PMID: 28115403 PMCID: PMC5278318 DOI: 10.1136/bcr-2016-217946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Estimation of kidney function by measuring serum creatinine is one the commonest laboratory tests conducted in clinical practice. Enzymatic methods are often used to measure serum creatinine. Clinicians should be aware of the limitations of these methods, such as test interference with paraproteins.We present a case of falsely elevated serum creatinine in a patient referred for renal biopsy. The combination of fluctuating creatinine and normal blood urea level was unusual. Serum protein electrophoresis revealed the presence of an IgM paraprotein. Further investigations confirmed an underlying diagnosis of lymphoplasmacytoid lymphoma. This case highlights how IgM paraprotein can interfere with creatinine estimation by enzymatic assay and the utility of alternative methods of estimating serum creatinine.
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Affiliation(s)
| | | | - Johanna Louw
- Renal Unit, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Dana Kidder
- Renal Unit, Aberdeen Royal Infirmary, Aberdeen, UK
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