Serum Creatine Kinase Test Research Articles

Detecting early signs in Duchenne muscular dystrophy: comprehensive review and diagnostic implications.

Despite the early onset of clinical signs suggestive of Duchenne muscular dystrophy (DMD), a diagnosis is often not made until four years of age or older, with a diagnostic delay of up to two years from the appearance of the first symptoms. As disease-modifying therapies for DMD become available that are ideally started early before irreversible muscle damage occurs, the importance of avoiding diagnostic delay increases. Shortening the time to a definite diagnosis in DMD allows timely genetic counseling and assessment of carrier status, initiation of multidisciplinary standard care, timely initiation of appropriate treatments, and precise genetic mutation characterization to assess suitability for access to drugs targeted at specific mutations while reducing the emotional and psychological family burden of the disease. This comprehensive literature review describes the early signs of impairment in DMD and highlights the bottlenecks related to the different diagnostic steps. In summary, the evidence suggests that the best mitigation strategy for improving the age at diagnosis is to increase awareness of the early symptoms of DMD and encourage early clinical screening with an inexpensive and sensitive serum creatine kinase test in all boys who present signs of developmental delay and specific motor test abnormality at routine pediatrician visits.

An efficacy analysis of whole-body magnetic resonance imaging in the diagnosis and follow-up of polymyositis and dermatomyositis.

ObjectivesTo evaluate the value of whole-body magnetic resonance imaging (WBMRI) in diagnosing muscular and extra muscular lesions in patients with polymyositis (PM) and dermatomyositis (DM).MethodsA retrospective analysis of WBMRI data from PM/DM patients who met the Bohan and Peter diagnostic criteria was performed. X2 test was used to compare the rate of positive diagnosis of newly diagnosed patients using WBMRI, serum creatine kinase test, and EMG. McNemar test was used to compare the performance of WBMRI and chest CT in detecting interstitial lung disease (ILD).ResultsThe study included 129 patients (30 PM cases and 99 DM cases). Of them, 81.4% (105/129) showed a visible inflammatory muscular edema on their WBMRI; 29.5% (38/129) had varying degrees of fatty infiltration (9 cases with clear muscular atrophy). Of the 66 newly diagnosed patients, the positive rates of WBMRI, muscle biopsy, serum creatine kinase test and EMG were 86.4% (57/66), 92.4% (61/66), 71.2% (47/66) and 71.1% (32/45), respectively. There was no significant difference in the positive rates between WBMRI and muscle biopsy (X2 = 1.28, P = 0.258). The WBMRI had a higher positive rate than both serum creatine kinase test (X2 = 4.53, P = 0.033) and EMG (X2 = 3.92, P = 0.047). In addition to muscular changes, WBMRI also detected interstitial lung disease (ILD) in 38 cases (29.5%), osteonecrosis in 15 cases (11.6%), and neoplastic lesions (5 malignant; 7 benign) in 12 cases (9.3%). Of the 61 patients who underwent routine chest CT examinations, the WBMRI and CT revealed ILD in 29 cases and 35 cases respectively. There was no significant difference in the sensitivity between WBMRI and CT (p = 0.146).ConclusionsWBMRI is a sensitive, non-invasive and efficient imaging method. It comprehensively displays the extent of muscular involvement in PM/DM patients, and it has the ability to diagnose other associated extra muscular diseases, such as ILD and systemic malignancy. WBMRI can also help screen steroid-induced osteonecrosis.

Case of asymptomatic rhabdomyolysis diagnosed at medical check-up

AST (IU/L) 15e37 1066 723 39 ALT (IU/L) 3e41 314 339 115 ALP (IU/L) 50e136 65 TBI (mg/dL) 0.4e1.0 1.3 DBI (mg/dL) 0e0.3 0.2 BUN (mg/dL) 7e18 12 15 14 CRE (mg/dL) 0.8e1.3 1 1 1 TCH (mg/dL) 130e145 135 GGT (mg/dL) 15e85 16 Uric acid (mg/dL) 3.5e7.2 5.5 5.2 5.7 Potassium (mmol/L) 3.5e5.1 4.1 4.1 4 Occult blood <0.03 1.5 Urine protein (mg/dL) 10e20 20 Red blood cells count/HPF <3 0e2 Rhabdomyolysis is a potentially life-threatening syndrome. A serum creatine kinase (CK) level greater than five times the normal value is a criterion for diagnosis. Rhabdomyolysis with acute renal failure caused by statin-related myopathy is of most concern. However, exertional activity causing rhabdomyolysis, especially in untrained individuals or under extremely hot or humid conditions, is more commonly reported. The serum CK level begins to rise approximately 2e12 hours after the onset of muscle injury, peaks within 24e72 hours, and then declines at a relatively constant rate of 40% of the previous day's value. Rhabdomyolysis is treated by fluid administration and prevention of acute renal failure. A 50-year-old man came for his annual medical check-up. He maintained a healthy lifestyle, did not smoke or drink alcohol, and exercised regularly. He was not taking any medication, and had no history of hepatitis or known drug allergies. His father had hypertension, diabetes mellitus, and gastric cancer. Since his serum CK level was abnormally high (970 IU/L) at his last check up 1 year earlier at another hospital, he requested a serum CK test, although it is not a recommended screening item at our hospital. On examination, his body mass index was found to be 22.7 kg/ m2. His general physical examination showed no abnormalities or physical distress. The body temperature was 36.8 C, blood pressure 128/76 mmHg, pulse 86 beats per minute, and respiratory rate 16 breaths per minute. He was physically fit, without complaints of malaise or changes in appetite or weight. He reported mild muscle aching that might have been associated with jogging for 4e5 hours in the previous 48 hours.

Motor and Cognitive Delay in Duchenne Muscular Dystrophy: Implication for Early Diagnosis

To examine the relationship between delay in the age of first independent walking and cognitive impairment in boys with Duchenne muscular dystrophy (DMD) to assess how age of diagnosis might be improved. We reviewed the records of 179 boys with DMD evaluated by the senior author between 1989 and June 2012. Delay in walking was defined as occurring at or greater than 16 months of age. Cognitive impairment was identified by school placement in special education or lower than expected grade level during the elementary school years. Delay in walking and cognitive impairment are highly correlated (P ≤ .0001). If cognitively delayed, boys with DMD were 3 times more likely to have a delay in walking. This association was shown to be independent from the rate of motor degeneration (P = .9) and the age of diagnosis (P = .6, combined average = 5.1 ± 2 years). Delay in the onset of walking in boys with DMD is strongly associated with cognitive delay. We suspect that primary care givers overlook DMD as a possible cause of delay in the age of independent walking when early features of cognitive delay are also apparent. DMD should be included among those disorders causing global developmental delay. Recognition of this association could substantially decrease the age of diagnosis for many boys with DMD. We suggest that the standard evaluation for boys with global developmental delay include an inexpensive and sensitive serum creatine kinase test.

Creatine kinase testing: What and why?

The enzyme creatine kinase (CK) is present in large concentrations in skeletal muscle, smooth muscle and cardiac muscle. Elevated levels of CK in the blood can occur in conditions where there is damage to cardiac or skeletal muscle. This article briefly discusses the underlying biology and clinical applications of serum CK testing.

Are reference limits for serum creatine kinase valid in detection of the carrier state for Duchenne muscular dystrophy?

We evaluated serum creatine kinase (CK) as an index to heterozygosity in Duchenne muscular dystrophy. When the 97.5th percentile of the CK normal reference interval was selected as the cutoff point, only 31% of 28 obligate carrier mothers and 24% of 43 mothers of simplex cases (those with only one occurrence of dystrophy in the kindred) exceeded this cutoff value. The outcome depended to some degree on the method used for establishing the reference limit for 379 presumably non-carrier, ambulatory women. The considerable overlap of CK activities between the control and carrier population as well as the non-gaussian distribution of the data permitted no satisfactory approach for differentiating these two populations. Neither the application of likelihood ratios, which evaluates a continuum of results without the dichotomy of a cutoff point, nor the application of predictive value based on sensitivity and specificity, which involves use of a cutoff value for decision making, provided a reliable estimate of carrier status. There was no significant difference (2 alpha = .19) between the median CK activity of obligate carrier mothers and mothers of simplex cases. The serum CK test does not provide data that either support or reject the Haldane hypothesis.