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We came across a somewhat peculiar case of terminal renal insufficiency in an elderly lady. We believe this case illustrates well the difficulties that a clinician faces on daily basis regarding the evaluation of glomerular filtration rate building on serum Creatinine level measurement alone. We have witnessed a Creatinine clearance plunging till less than 2 ml/min without real need for renal replacement therapy. We have performed a Cystatine c serum level measurement for comparison. Creatinine clearance calculated based on validated formulas are known to perform poorly in the extremes of age. Serum Cystatin-C based formulas are not yet standard of practice, yet were said to better perform in the elderly. At one point, for our patient, simple Cystatin-C formula showed higher clearance (6 ml/min Vs 2 ml/ min using the CKD-EPI formula) we cannot tell whether combining both measurements approached better the true clearance. Hypothyroidism is the most frequent thyroid abnormality associated with chronic Kidney disease (CKD). For More: https://www.omicsonline.org/open-access/how-low-can-creatinine-clearance-go-and-yet-life-remains-sustained-in-elderly-2161-0959-1000197.php?aid=48226
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