CREATININE AND CREATINE KINASE RATIO IN BLOOD OF DIFFERENT BODY TYPES - A NEW APPROACH.

Purpose: The inconsistencies and variations of creatine kinase level due to modifiable and non-modifiable factors were the basis of this study. The aim was to find out the relationships between creatinine and creatine kinase in the blood of somatotypes. Methods: The 122 males, aged 10 to 20 years, were classified according to their somatotypes. Somatotypes were measured by the ISAK method. By standard laboratory methods, creatinine and creatine kinase estimate. The IBM SPSS version 24 is used for calculation. One way ANOVA followed by post hoc tests was performed to compare the variables among the three groups (p<0.05). Results: Creatinine level in the blood insignificantly deferred among the three somatotypes. The significant differences (p<0.05) were found in creatine kinase level in the blood and creatinine/creatine kinase ratio among the three dominant Somatotypes. Creatine Kinase was significantly higher in Ectomorphs (212 U/L) than Endomorphs. Ectomorphs and mesomorphs have crossed normal creatine kinase levels (35 -175 U/L). The creatinine/creatine kinase ratio was found highest in endomorphs and lowest in the ectomorphs and significantly differed in three Somatotypes. Conclusion: Creatinine production remains the same, indicating production of Creatinine is independent of specific body types. A significant higher Creatine Kinase level in Ectomorphs over Endomorphs showed fat content was not associated with it. Significant differences in Creatinine / Creatine Kinase ratio among Somatotypes suggested its relevance between cellular and morphological relationships and might uses as biomarkers.

Rapidly Progressive Proximal Weakness

A 53-year-old woman had development of subacute-onset muscle weakness resulting in difficulty climbing stairs, rising from a chair, and reaching over her shoulders. She reported no dysphagia, dysarthria, dyspnea, or diplopia. She also disclosed no rash, joint pain, or urine discoloration. She had no history of statin exposure. There was no family history of neuromuscular disorders, early cataracts, cardiac arrhythmia, or cardiomyopathy. Two months of treatment with prednisone had resulted in no clinical improvement. Neurologic examination indicated moderate neck flexor, shoulder, and hip girdle muscle weakness, with sparing of cranial muscles. There was no action- or percussion-induced myotonia. Needle electromyography showed short-duration, low-amplitude, and complex motor unit potentials, predominantly affecting proximal muscles, associated with fibrillation potentials and myotonic discharges in proximal and axial muscles. Her creatine kinase level was increased. Biopsy of the left quadriceps showed variation in muscle fiber size, a moderate increase in internalized nuclei, fiber splitting, and scattered necrotic and regenerating fibers. There was a mild increase in perimysial fibrous and fatty connective tissue. 3-Hydroxy-3-methylglutaryl–coenzyme A reductase antibodies were strongly positive. The patient was diagnosed with hydroxy-3-methylglutaryl–coenzyme A reductase antibody–positive necrotizing autoimmune myopathy. The patient received intravenous immunoglobulin and mycophenolate mofetil while continuing prednisone. At 1-year follow-up, she had no weakness, and her creatine kinase value was normal while she continued taking prednisone, mycophenolate mofetil, and intravenous immunoglobulin. Necrotizing autoimmune myopathy, or immune-mediated necrotizing myopathy, is a subtype of immune-mediated myopathy, clinically characterized by subacute, progressive, proximal limb weakness and persistently increased creatine kinase level. Pathologically, it is characterized by myonecrosis with minimal or no inflammation. One-third of patients with necrotizing autoimmune myopathy have myalgia.

Hydroxychloroquine-Induced Creatine Kinase Elevation

Long-term administration of hydroxychloroquine and chloroquine leads to deposition in the tissues including muscles, nerves and retina. Here, we report a case of hydroxychloroquine induced creatine kinase elevation after loading dose. An 80-year-old man with comorbidities, presented with a dry cough, high fever, diarrhea and general condition disorder ongoing for the last 3 days. The patient was admitted to the intensive care unit. The treatment was commenced with hydroxychloroquine. On the first day of treatment, the loading dose of hydroxychloroquine was started as 400 mg q12h, and treatment was continued as 200 mg q12h from the 3rd dose. After the hydroxychloroquine loading dose, the patient’s creatine kinase level increased, and after drug cessation, the level decreased. Hydroxychloroquine-induced creatine kinase elevated may be on not only long-term use but also acute period. Clinicians should have a high suspicion for hydroxychloroquine toxicity in patients with risk factors.