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Creatinine is a metabolic by-product of muscle metabolism, and normally appears in urine in relatively constant quantities over a 24 hour period with normal liquid intake. Therefore, urine creatinine can be used as an indicator of urine water content or as a marker identifying a specimen as urine. Greater than normal intake of water will increase the urine water content (lowering the creatinine level) consequently diluting the amount of drug in urine. Conversely, a limited intake of water can lead to an abnormally concentrated urine specimen (as occurs with dehydration) resulting in elevated creatinine levels.
The measurement of creatinine can aid in establishing if any of these products were used. Creatinine production and excretion is directly related to muscle mass and is sex and age dependent. Normal random urine creatinine concentrations range from 40-300 mg/dL in males and 37-250 mg/dL in females. Values as low as 17 mg/dL have been observed in rare instances. Certain physiological conditions such as diabetes may result in consistently dilute urine specimens.