Also Known As
Creatinine Clearance, Urine
CRCL
CCT
Formal Name
Creatinine Clearance
This article was last reviewed on
This article waslast modified on December 29, 2017.
At a Glance
Why Get Tested?

To help evaluate the health of your kidneys; to help diagnose kidney dysfunction or disease; to detect decreased blood flow to the kidneys

When To Get Tested?

When your results of a routine blood creatinine test and/or estimated glomerular filtration rate (eGFR) are not within the normal ranges; when you have signs and symptoms that may be due to kidney disease or damage or when you have a problem affecting the function of your kidneys, such as an obstruction within the kidney or acute or chronic kidney failure, or dysfunction due to another disease, such as congestive heart failure

Sample Required?

Both a urine sample (24-hour collection) and a blood sample drawn from a vein in your arm

Test Preparation Needed?

You may be instructed to fast overnight or refrain from eating cooked meat; some studies have shown that eating cooked meat prior to testing can temporarily increase the level of creatinine.

You may be able to find your test results on your laboratory's website or patient portal. However, you are currently at Lab Tests Online. You may have been directed here by your lab's website in order to provide you with background information about the test(s) you had performed. You will need to return to your lab's website or portal, or contact your healthcare practitioner in order to obtain your test results.

Lab Tests Online is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called "normal" values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

For more information, please read the article Reference Ranges and What They Mean.

What is being tested?

Creatinine is a waste product produced by muscles from the breakdown of a compound called creatine. Creatinine is filtered from the blood by the kidneys and released into the urine. A creatinine clearance test measures creatinine levels in both a sample of blood and a sample of urine from a 24-hour urine collection. The results are used to calculate the amount of creatinine that has been cleared from the blood and passed into the urine. This calculation allows for a general evaluation of the amount of blood that is being filtered by the kidneys in a 24-hour time period.

The amount of creatinine produced in the body is dependent on muscle mass and is relatively constant for an individual. The amount of creatinine removed from the blood depends on both the filtering ability of the kidneys and the rate at which blood is carried to the kidneys.

The amount of blood filtered per minute by the kidneys is known as the glomerular filtration rate (GFR). If the kidneys are damaged or diseased, or if blood circulation is slowed, then less creatinine will be removed from the blood and released into the urine and the GFR will be decreased.

GFR is difficult to measure directly. Therefore, it is recommended to estimate GFR by measuring the creatinine level in the blood and using the results in an equation to calculate estimated GFR. The calculation that takes into account several factors, such as age, gender and race of the person tested (see the article on Estimated Glomerular Filtration Rate).

Another, less common way to estimate GFR is to calculate creatinine clearance. There are several versions of the creatinine clearance calculation. All of them include the measurement of the amount of creatinine in a blood sample collected just before or after the urine collection, the amount of creatinine in a 24-hour urine sample, and the 24-hour urine volume. Since the amount of creatinine produced depends on muscle mass, some calculations also use a correction factor that takes into account a person's body surface area (using their height and weight).

How is the sample collected for testing?

The test requires a 24-hour urine collection and a blood sample drawn either at the beginning or end of the urine collection. The blood sample is drawn by needle from a vein in the arm. The person being tested will also usually be asked to provide their current height and weight.

Is any test preparation needed to ensure the quality of the sample?

You may be instructed to fast overnight or refrain from eating cooked meat. Some studies have shown that eating cooked meat prior to testing can temporarily increase the level of creatinine.

Accordion Title
Common Questions
  • How is it used?

    A creatinine clearance test may be used to help detect and diagnose kidney dysfunction. It may be used in follow up to abnormal results on a blood creatinine test and estimated glomerular filtration rate (eGFR).

    A creatinine clearance may also sometimes be used to detect the presence of decreased blood flow to the kidneys, as may occur with congestive heart failure.

    In people with known chronic kidney disease or congestive heart failure, the creatinine clearance test may be ordered to help monitor the progress of the disease and evaluate its severity. It may also be used to help determine if and when kidney dialysis may be necessary.

  • When is it ordered?

    The creatinine clearance test may be ordered when a healthcare practitioner wants to evaluate the filtration ability of a patient's kidneys. It may be ordered as follow up when a person has, for example, increased blood creatinine concentrations on a routine chemistry panel (CMP) or protein in the urine on a routine urinalysis. It may be ordered when there is a suspected kidney disorder because of certain signs and symptoms.

    Signs and symptoms that may be an indication of kidney problems include:

    • Swelling or puffiness, particularly around the eyes or in the face, wrists, abdomen, thighs, or ankles
    • Urine that is foamy, bloody, or coffee-colored
    • A decrease in the amount of urine
    • Problems urinating, such as a burning feeling or abnormal discharge during urination, or a change in the frequency of urination, especially at night
    • Mid-back pain (flank), below the ribs, near where the kidneys are located
    • High blood pressure
    • Blood and/or protein in the urine

    The creatinine clearance may also be ordered periodically when it is known that someone has a kidney disorder or decreased blood flow to the kidneys due to a condition such as congestive heart failure.

  • What does the test result mean?

    A decreased creatinine clearance may suggest kidney disease or other conditions that can affect kidney function. These can include:

    For more on these, see Kidney Disease.

    Increased creatinine clearance rates may occasionally be seen during pregnancy, exercise, and with diets high in meat, although this test is not typically used to monitor these conditions.

  • Is there anything else I should know?

    People with one dysfunctional and one normal kidney will usually have normal creatinine clearance rates as the functional kidney will increase its rate of filtration in compensation.

    Creatinine clearance rates tend to fall later in life as the glomerular filtration rate (GFR - the rate at which the glomeruli filter the blood) declines.

    Certain drugs, such as aminoglycosides, cimetidine, cisplatin, and cephalosporins, can decrease the creatinine clearance measurement. Diuretics can increase the result.

  • Why do I have to collect my urine for 24 hours?

    A 24-hour urine sample is required instead of a random urine sample because the amount of creatinine in the urine will vary somewhat during the course of a day. By collecting all urine for 24 hours, the amount of creatinine in the urine can be averaged over the entire day and will give a better indication of what is going on in the body.

  • What should I do if I forget to save one urine sample during the collection?

    If you do not have a complete collection, the results will not be valid. You should call your healthcare practitioner's office or the laboratory where you obtained your collection container to ask if you should discontinue the test and begin again another day.

  • Are there other ways to estimate or determine the glomerular filtration rate (GFR) of my kidneys?

    Yes. The GFR can be estimated with a simple blood creatinine test (see the article on eGFR). Given a measurement of the amount of creatinine in a blood sample, the healthcare practitioner will use a formula to estimate the rate at which the kidneys are filtering blood. The formulas take relevant factors into account, such as the person's age, weight, height, and ethnicity.

    The collection of a 24-hour urine specimen needed for the creatinine clearance test can be impractical to obtain, so the eGFR calculations are usually the preferred method for evaluating kidney function. The creatinine clearance test specifically may be ordered when a healthcare practitioner suspects a problem with blood flow to the kidneys.

View Sources

Sources Used in Current Review

(December 2014). Horowitz, G. Creatinine. Medscape. Available online at http://emedicine.medscape.com/article/2054342-overview. Accessed January 2017.

(2013) National Kidney Foundation. Calculating Kidney Function. Available online at https://www.kidney.org/atoz/content/kidneytests. Accessed January 2017.

(June 2013) E. Sandilands, et al. Measurement of renal function in patients with chronic kidney disease. British Journal of Clinical Pharmacology. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3791974/. Accessed January 2017.

(August 2015). U.S. National Library of Medicine. Creatinine Clearance. MedlinePlus. Available online at https://medlineplus.gov/ency/article/003611.htm. January 2017.

Sources Used in Previous Reviews

Clinical Chemistry: Theory, Analysis, Correlation. 3rd Edition. Lawrence A. Kaplan and Amadeo J. Pesce, St. Louis, MO. Mosby, 1996.

Clinical Chemistry: Principles, Procedures, Correlations. Michael L. Bishop, Janet L. Duben-Engelkirk, Edward P. Fody. Lipincott Williams & Wilkins, 4th Edition.

Mitchell G. Scott, PhD. Division of Laboratory Medicine, Washington University School of Medicine, St. Louis, MO.

Martin H. Kroll, MD. Director of Clinical Chemistry, VA Medical Center, Dallas, TX.

Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.

(2002 March). Medical Tests of Kidney Function. National Kidney and Urologic Diseases Information Clearinghouse, NIH Publication No. 02; 4623 [On-line information]. Available online at http://kidney.niddk.nih.gov/kudiseases/pubs/kidneytests/index.htm.

Esson, M. and Schrier, R. (2002). Diagnosis and Treatment of Acute Tubular Necrosis. Ann Intern Med 2002;137:744-752 [On-line journal]. PDF available for download at http://www.annals.org/cgi/reprint/137/9/744.pdf.

Agha, Irfan (2004 February 11, Updated). Creatinine - serum. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003475.htm.

Agha, Irfan (2004 February 11, Updated). Creatinine - urine. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003610.htm.

Agha, Irfan (2004 February 11, Updated). Creatinine clearance. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003611.htm.

Agha, Irfan (2003 August 7, Updated). BUN. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003474.htm.

Agrawal, M. and Swartz, R. (2000 April 1). Acute Renal Failure. American Family Physician [On-line journal]. Available online at http://www.aafp.org/afp/20000401/2077.html.

Nissl, J. (2004 September 20, Updated). Creatinine and Creatinine Clearance WebMD [On-line information]. Available online at http://my.webmd.com/hw/kidney_failure/hw4322.asp.

Pagana K, Pagana T. Mosby's Manual of Diagnostic and Laboratory Tests. 3rd Edition, St. Louis: Mosby Elsevier; 2006, Pp 209-211.

Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER and Bruns DE, eds. 4th ed. St. Louis, Missouri: Elsevier Saunders; 2006, Pp 797-798; 818-819.

Clarke, W. and Dufour, D. R., Editors (2006). Contemporary Practice in Clinical Chemistry, AACC Press, Washington, DC, Pg 43.

(February 2009) National Kidney and Urologic Diseases Information Clearinghouse. The Kidneys and How they Work. Available online at http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/index.htm#tests. Accessed September 2009.

(Updated September 4, 2007) Silberberg, C. MedlinePlus Medical Encyclopedia: Creatinine Clearance. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003611.htm. Accessed September 2009.

Dugdale, D. (Updated 2011 August 21). Creatinine clearance. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003611.htm. Accessed November 2012.

Medscape Editorial Staff (Updated 2012 October 1). Creatinine Clearance. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/2117892-overview. Accessed November 2012.

(© 1995-2012). Creatinine Clearance. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/8500. Accessed November 2012.

Wilhelm, S. and Kale-Pradhan, P. (2011 July 29). Estimating Creatinine Clearance. Medscape News Today from Pharmacotherapy. 2011;31(7):658-664 [On-line information]. Available online at http://www.medscape.com/viewarticle/746232. Accessed November 2012.

Arora, P. (Updated 2012 March 28). Chronic Kidney Disease. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/238798-overview. Accessed November 2012.

(Updated 2012 March 23). The Kidneys and How They Work. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) [On-line information]. Available online at http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/. Accessed November 2012.

Pagana, K. D. & Pagana, T. J. (© 2011). Mosby's Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 329-333.

Clarke, W., Editor (© 2011). Contemporary Practice in Clinical Chemistry 2nd Edition: AACC Press, Washington, DC. Pp 78-79.

Ask a Laboratory Scientist

 

Your questions will be answered by a laboratory scientist as part of a voluntary service provided by one of our partners, the American Society for Clinical Laboratory Science (ASCLS). Click on the Contact a Scientist button below to be re-directed to the ASCLS site to complete a request form. If your question relates to this web site and not to a specific lab test, please submit it via our Contact Us page instead. Thank you.

Contact a Scientist