A Spreadsheet Calculation Example

Body Surface Area & Creatinine Clearance

Introduction This spreadsheet is provided as an educational tool to illustrate the impact of changing variables on the clinically important parameters calculated. The creatinine clearance test is commonly ordered to estimate the mL/min of blood flow through glomerular filtration system in a patient's kidneys. The creatinine level in mg/dL is determined from both a timed urine specimen (typically a 24 hour or 1,440 min collection) and a serum sample. The volume of urine collected is also required for the clearance estimate. Calculation of the creatinine clearance using only those three parameters is typically called an "uncorrected creatinine clearance". Because the amount of creatinine produced by a patient varies according to the lean body mass of the patient, the creatinine clearance calculation result is typically corrected for the body surface area (BSA) of the patient and that calculated BSA is compared to the BSA of the standard 70Kg man (1.73 BSA) to yield the more clinically useful "corrected creatinine clearance." Creatinine Clearance Calculation The formula for caculating creatinine clearance depends on if the clearance is corrected for patient body surface area or not as shown below.
Uncorrected 24 Hour Clearance mL/min= (serum creat/urine creat) x (urine mL vol/1444 min)

Creatinine Clearance Calculations

Uncorrected Creatinine Clearance Calculation Uncorrected Creatinine Clearance mL/min 57 115 143 Alternate Formulas for Calculating Body Surface Area

Serum Urine Creatinine Creatinine Urine Volume mg/dL mg/dL mL 2 110 1500 1 110 1500 0.8 110 1500

Formula Authors
MOSTELLER DUBOIS HAYCOCK GEHAN

Patient's Height (Inches)

70 70 70 70

Patient's Weight (Pounds)

170 170 170 170

Patient's BSA (Calculated)

1.95 1.95 1.96 1.96

Corrected Creatinine Clearance Calculation The Mosteller formula Patient's Height (Inches) 70 70 68 Patient's Weight Patient's BSA (Pounds) (Calculated) 170 1.95 160 1.90 200 2.04 Corrected Creatinine Clearance mL/min 51 104 121
BSA (m) = ( [Height(cm) x Weight(kg) ]/ 3600 ) e.g. BSA = SQRT( (cm*kg)/3600 ) or in inches and pounds: BSA (m) = ( [Height(in) x Weight(lbs) ]/ 3131 ) (Mosteller RD: Simplified Calculation of Body Surface Area. N Engl J Med 1987
Oct 22;317(17):1098)

Corrected 24 Hour Clearance mL/min= (serum creat/urine creat) x (urine mL vol/1444 min) X (1.73/BSA)
If a patient's serum creatinine is 2.0 mg/dL, urine creatinine 110 mg/dL, urine volume 1500 mL, and BSA of 1.50, the corrected creatinine clearance would be

The DuBois and DuBois formula

BSA (m) = 0.20247 x Height(m)0.725 x Weight(kg)0.425 A variation of DuBois and DuBois thats gives virtually identical results is: BSA (m) = 0.007184 x Height(cm)0.725 x Weight(kg)0.425 (DuBois D; DuBois EF: A formula to estimate the approximate surface area if
height and weight be known. Arch Int Med 1916 17:863-71)

mL/min = (2.0/110) x (1500/1440) x (1.73/1.5) = 66 mL/min.

Body Surface Area Calculation The formula for caculating the patient's body surface area (BSA) used in the corrected creatinine clearance calculation requires that the patient's height in inches and weight in pounds be supplied. The BSA spreadsheet formula is:

Enter values in the spreadsheet above to see the impact of changing the variables on the calculated values. Do not enter variables into the cells containing Bold face numbers as those are calculated parameters. Sample Creatinine Clearance Reference Intervals: Male: younger than 12 years: 50-90 mL/minute 12 years and older: 97-137 mL/minute Female: younger than 12 years: 50-90 mL/minute 12 years and older: 88-128 mL/minute

The Haycock formula

BSA (m) = 0.024265 x Height(cm)0.3964 x Weight(kg)0.5378 (Haycock G.B., Schwartz G.J.,Wisotsky D.H. Geometric method for measuring
body surface area: A height weight formula validated in infants, children and adults. The Journal of Pediatrics 1978 93:1:62-66)

As used in Cell L16: =EXP(((0.425*(LOG(K16/2.2)))+(0.725*(LOG(J16*2.54)))-2.144)/0.4343) or As used in Cell T10: =0.007184*((POWER((R10*2.54),0.725))*(POWER((S10/2.2),0.425)))

The Gehan and George formula

BSA (m) = 0.0235 x Height(cm)0.42246 x Weight(kg)0.51456 (Gehan EA, George SL, Estimation of human body surface area from height
and weight. Cancer Chemother Rep 1970 54:225-35)

where K16 is the patient's weight in pounds from the K16 column and row on the spreadsheet to the right and J16 is the patient's height in inches from that same spreadsheet. The BSA can be calculated by simply substituting value for the height and weight parameters if the calculation was to be done without using a spreadsheet.

********************************************** Note: All of the above formulas use Kg and Cm. To convert Kg to pounds divide Kg by 2.2 and to converty Cm to inches multiply Cm x 2.54 as done in the formulas used in the spreadsheet.

ngl J Med 1987

ntical results

for measuring