Creatinine

Question

Poz for 11 years. Noticed my creatinine levels have been below normal, on the last few labs. I know high levels are concerning. I've read lower levels are usually nothing to worry about. In fact, many sites say it means you have good kidneys. However, many sites also discuss a gradual decline in creatinine could be indicative of liver disease.

Just curious about your take. I have been diagnosed with non-alcoholic fatty liver disease, but my liver labs are all within normal ranges. The creatinine levels are just a few points below normal, but they were always in the normal range before. On the last few labs, I've also had my neutrophils a tad below normal and my lymphs a tad above normal, when they were always normal before. This also comes at a time when my CD4 dropped about 160 points. My CD4 has always been high 600-700's and it dropped to 517. I know this is just one lab, but that's not happened before either. These changes for the first time just have me a little curious.

Answer

I am not aware that NASH or NAFLD is associated with decreased blood creatinine levels. They can be associated with decreased creatinine clearance indicative of kidney dysfunction. You dont' indicate what your serum creatinine level is or what the trend has been. Decreased serum creatinine is usually not associated with significant clinical problems, but can be seen in older people, and those who may be losing muscle mass, as the elderly or people with poor dietary indicate could have. I don't think your CD4 count changes have anything to do with this. In addition, I would follow your CD4 percent as well, which is a more stable number over time, as the CD4 count can fluctuate for a variety of reasons.