Urinary creatine

[forestglip]

I just wanted to look at at further evidence for one claim supporting biochemical pathology from the response from Margaret Williams to Jonathan Edwards' hypothesis paper:

I mention just one more illustration: in 2001 evidence was presented by SCM Richards et al (including psychiatrist Anthony Cleare, who works with and co-authors papers on ME/CFS with Simon Wessely) at the British Rheumatologists’ Conference in Edinburgh showing that 53% of ME/CFS patients were excreting in their urine significant levels of creatine and other muscle-related metabolites including choline and glycine, indicating on-going muscle damage, as creatine has been shown to be a sensitive marker of muscle inflammation and this is objective evidence of muscle pathology.

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This paper tested creatine in urine before and after exercise (along with 1400 other metabolites): Urine Metabolomics Exposes Anomalous Recovery after Maximal Exertion in Female ME/CFS Patients (Glass, Hanson, et al, 2023)

Not much was significant after multiple test correction, and they didn't mention creatine in the paper. But I pulled up the supplementary data and creatine looks like this:

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The fold change in figure 4a in this study seems to show urinary creatine is decreased, though I only quickly skimmed so I'm not positive I'm reading it correctly: Metabolic profiling reveals anomalous energy metabolism and oxidative stress pathways in chronic fatigue syndrome patients (Armstrong et al, 2015)

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The abstract for this one on middle schoolers with CFS seems to show decreased urinary creatine: [Comparison of differential metabolites in urine of the middle school students with chronic fatigue syndrome before and after exercise] (Chi et al, 2018)

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A paper on urinary metabolites in fibromyalgia: A diagnostic biomarker profile for fibromyalgia syndrome based on an NMR metabolomics study of selected patients and controls (Malatji et al, 2021)

In the intro, they mention the Richards evidence that Margaret mentioned. I couldn't find the actual evidence published anywhere though (the citation title says it was on fibromyalgia and CFS).

In a pilot study, presented only as a poster at an Annual Meeting of the Rheumatologic Society of the UK [12], Richards and co-workers (2001) reported that muscle metabolites detected in the urine of fibromyalgia patients may suggest a prevailing muscle damage. Although not by definition a metabolomics study, their targeted metabolite analysis of urine by nuclear magnetic resonance (NMR) spectroscopy revealed significant levels of creatine in FMS patients and elevated (t-test p < 0.05) urinary excretion of choline, taurine, citrate and trimethylamine N-oxide (TMAO) relative to matched controls.

The actual linked study found that urinary creatine was significant and useful for predicting fibromyalgia, but I'm not quite sure if it was increased or decreased:

a good and significant relationship was shown between creatine and the symptoms pain and energy (p = 0.024 and 0.003, respectively)

 

[hotblack]

Given I had a serious kidney infection around onset or at least that was involved in my significant worsening I had repeated urine tests then and in the time after (along with the usual blood tests). There were nothing flagged. At least some of these, if not all, would have been when I was at or exceeding my physical capacity.

I suppose it could be the case that it’s within normal range but indicative of something when looked at in conjunction with other things? Or that it wasn’t looked at in the way it was in these studies? But I thought creatine was a pretty standard kidney test?

Edit: maybe I’m getting my creatine and creatinine confused though