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March 28, 1977

Measurements of Serum Creatinine

JAMA. 1977;237(13):1314. doi:10.1001/jama.1977.03270400018012

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To the Editor.—  The advent of multiple analyzer systems has enabled physicians to screen a large variety of serum chemistries at a glance. The well-known SMA 12/60 offers one so much information that we have observed a natural tendency in ourselves and others to "pattern-read" the results.It is disturbing that of all the SMA 12/60 values, the most visually diminutive is the serum creatinine. The lowly serum creatinine must attain values of 3 or 4 mg/100 ml before it really strikes the eye. It clearly would be possible to overlook a creatinine value that rose from. 5 to 1.5 mg/100 ml, even though this may represent a 50% reduction in renal function. Minor elevations in uric acid and alkaline phosphatase levels can attract disproportionate attention (Fig 1, A). We wonder how much prerenal azotemia or how much needless nephrotoxic pharmacotherapy has been abetted by the creatinine's low profile on the