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European Radiology

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Open Access 01-02-2014 | Nuclear Medicine

Improved measurement of the glomerular filtration rate from Tc-99m DTPA scintigraphy in patients following nephrectomy

Authors: Yong-il Kim, Seunggyun Ha, Young So, Won Woo Lee, Seok-Soo Byun, Sang Eun Kim

Published in: European Radiology | Issue 2/2014

Abstract

Objective

We aimed to improve Tc-99m DTPA glomerular filtration rate (GFR) scintigraphy (Gates’ method) in a prospective study using Cr-51 EDTA GFR test as a gold standard.

Methods

Fifty-seven Tc-99m DTPA GFR scintigrams in 45 subjects (male/female = 33:12, age = 45.9 ± 17.6 years, 14 healthy volunteers and 31 nephrectomised patients) were compared using Cr-51 EDTA GFR tests. Using the %renal uptake of Tc-99m DTPA and Cr-51 EDTA GFR, a revised equation for GFR was established through linear regression analysis.

Results

The revised equation for improved GFR was GFR(mL/min) = (%renal uptake × 11.7773) − 0.7354. Gates’ original GFRs (70.1 ± 20.5 mL/min/1.73 m²) were significantly lower than Cr-51 EDTA GFRs (97.0 ± 31.9 mL/min/1.73 m²; P < 0.0001), but the improved GFRs (98.0 ± 26.3 mL/min/1.73 m²) were not different from (P = 0.7360) and had a significant correlation with (r = 0.73, P < 0.0001) the Cr-51 EDTA GFRs. The revised GFR equation effectively demonstrated perioperative GFR changes in kidneys that were operated on and the contralateral kidneys at 3 and 6 months post-partial nephrectomy (n = 25).

Conclusions

GFR measurement using Tc-99m DTPA scintigraphy could be significantly improved by a revised equation derived from the comparison with Cr-51 EDTA GFR.

Key Points

• Measurement of glomerular filtration rate is difficult following nephrectomy.

• Measurements can be significantly improved by new renal sctintigraphic methods.

• This helps physicians to measure kidney function of patients following nephrectomy.

• Management of renal tumour patients should become more effective.

Stevens LA, Levey AS (2009) Measured GFR as a confirmatory test for estimated GFR. J Am Soc Nephrol 20:2305–2313PubMedCrossRef

Levey AS, de Jong PE, Coresh J et al (2011) The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney Int 80:17–28PubMedCrossRef

Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351:1296–1305PubMedCrossRef

Levey AS, Eckardt KU, Tsukamoto Y et al (2005) Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 67:2089–2100PubMedCrossRef

Prescott LF, Freestone S, McAuslane JA (1991) Reassessment of the single intravenous injection method with inulin for measurement of the glomerular filtration rate in man. Clin Sci (Lond) 80:167–176

Lee CS, Cha RH, Lim YH et al (2010) Ethnic coefficients for glomerular filtration rate estimation by the Modification of Diet in Renal Disease study equations in the Korean population. J Korean Med Sci 25:1616–1625PubMedCentralPubMedCrossRef

Perrone RD, Steinman TI, Beck GJ et al (1990) Utility of radioisotopic filtration markers in chronic renal insufficiency: simultaneous comparison of 125I-iothalamate, 169Yb-DTPA, 99mTc-DTPA, and inulin. The modification of diet in renal disease study. Am J Kidney Dis 16:224–235PubMed

Levey AS, Coresh J, Greene T et al (2006) Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 145:247–254PubMedCrossRef

Myers GL, Miller WG, Coresh J et al (2006) Recommendations for improving serum creatinine measurement: a report from the Laboratory Working Group of the National Kidney Disease Education Program. Clin Chem 52:5–18PubMedCrossRef

10.

Walser M (1998) Assessing renal function from creatinine measurements in adults with chronic renal failure. Am J Kidney Dis 32:23–31PubMedCrossRef

11.

Ma YC, Zuo L, Chen JH et al (2006) Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol 17:2937–2944PubMedCrossRef

12.

Stevens LA, Coresh J, Greene T, Levey AS (2006) Assessing kidney function–measured and estimated glomerular filtration rate. N Engl J Med 354:2473–2483PubMedCrossRef

13.

Stevens LA, Coresh J, Feldman HI et al (2007) Evaluation of the modification of diet in renal disease study equation in a large diverse population. J Am Soc Nephrol 18:2749–2757PubMedCrossRef

14.

Thompson RH, Boorjian SA, Lohse CM et al (2008) Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol 179:468–471PubMedCrossRef

15.

Weight CJ, Larson BT, Fergany AF et al (2010) Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses. J Urol 183:1317–1323PubMedCrossRef

16.

Lane BR, Gill IS, Fergany AF, Larson BT, Campbell SC (2011) Limited warm ischemia during elective partial nephrectomy has only a marginal impact on renal functional outcomes. J Urol 185:1598–1603PubMedCrossRef

17.

Simmons MN, Fergany AF, Campbell SC (2011) Effect of parenchymal volume preservation on kidney function after partial nephrectomy. J Urol 186:405–410PubMedCrossRef

18.

Herts BR, Sharma N, Lieber M, Freire M, Goldfarb DA, Poggio ED (2009) Estimating glomerular filtration rate in kidney donors: a model constructed with renal volume measurements from donor CT scans. Radiology 252:109–116PubMedCrossRef

19.

Vivier PH, Storey P, Rusinek H et al (2011) Kidney function: glomerular filtration rate measurement with MR renography in patients with cirrhosis. Radiology 259:462–470PubMedCrossRef

20.

Funahashi Y, Hattori R, Yamamoto T, Kamihira O, Kato K, Gotoh M (2009) Ischemic renal damage after nephron-sparing surgery in patients with normal contralateral kidney. Eur Urol 55:209–215PubMedCrossRef

21.

Gates GF (1982) Glomerular filtration rate: estimation from fractional renal accumulation of 99mTc-DTPA (stannous). AJR Am J Roentgenol 138:565–570PubMedCrossRef

22.

Gates GF (1984) Computation of glomerular filtration rate with Tc-99m DTPA: an in-house computer program. J Nucl Med 25:613–618PubMed

23.

Li Q, Zhang CL, Fu ZL, Wang RF, Ma YC, Zuo L (2007) Development of formulae for accurate measurement of the glomerular filtration rate by renal dynamic imaging. Nucl Med Commun 28:407–413PubMedCrossRef

24.

De Santo NG, Anastasio P, Cirillo M et al (1999) Measurement of glomerular filtration rate by the 99mTc-DTPA renogram is less precise than measured and predicted creatinine clearance. Nephron 81:136–140PubMedCrossRef

25.

Ma YC, Zuo L, Zhang CL, Wang M, Wang RF, Wang HY (2007) Comparison of 99mTc-DTPA renal dynamic imaging with modified MDRD equation for glomerular filtration rate estimation in Chinese patients in different stages of chronic kidney disease. Nephrol Dial Transplant 22:417–423PubMedCrossRef

26.

Itoh K (2003) Comparison of methods for determination of glomerular filtration rate: Tc-99m-DTPA renography, predicted creatinine clearance method and plasma sample method. Ann Nucl Med 17:561–565PubMedCrossRef

27.

Assadi M, Eftekhari M, Hozhabrosadati M et al (2008) Comparison of methods for determination of glomerular filtration rate: low and high-dose Tc-99m-DTPA renography, predicted creatinine clearance method, and plasma sample method. Int Urol Nephrol 40:1059–1065PubMedCrossRef

28.

Kim Y-I, Lee WW, Byun S-S, Kim SE (2013) Improvement of gamma camera based measurement of glomerular filtration rate (GFR) in patients with high GFR: a comparative study with Cr-51 EDTA GFR test. J Nucl Med 54:2035

29.

Blaufox MD, Aurell M, Bubeck B et al (1996) Report of the radionuclides in nephrourology committee on renal clearance. J Nucl Med 37:1883–1890PubMed

30.

Fleming JS, Zivanovic MA, Blake GM, Burniston M, Cosgriff PS (2004) Guidelines for the measurement of glomerular filtration rate using plasma sampling. Nucl Med Commun 25:759–769PubMedCrossRef

31.

Florijn KW, Barendregt JN, Lentjes EG et al (1994) Glomerular filtration rate measurement by "single-shot" injection of inulin. Kidney Int 46:252–259PubMedCrossRef

32.

Levey AS, Greene T, Schluchter MD et al (1993) Glomerular filtration rate measurements in clinical trials. Modification of diet in renal disease study group and the diabetes control and complications trial research group. J Am Soc Nephrol 4:1159–1171PubMedCentralPubMed

33.

Bird NJ, Peters C, Michell AR, Peters AM (2008) Reproducibilities and responses to food intake of GFR measured with chromium-51-EDTA and iohexol simultaneously and independently in normal subjects. Nephrol Dial Transplant 23:1902–1909PubMedCrossRef

34.

Becker F, Roos FC, Janssen M et al (2011) Short-term functional and oncologic outcomes of nephron-sparing surgery for renal tumours >/= 7 cm. Eur Urol 59:931–937PubMedCrossRef

35.

Roos FC, Brenner W, Jager W et al (2011) Perioperative morbidity and renal function in young and elderly patients undergoing elective nephron-sparing surgery or radical nephrectomy for renal tumours larger than 4 cm. BJU Int 107:554–561PubMedCrossRef

36.

Krohn AG, Ogden DA, Holmes JH (1966) Renal function in 29 healthy adults before and after nephrectomy. JAMA 196:322–324PubMedCrossRef

37.

Huang WC, Levey AS, Serio AM et al (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7:735–740PubMedCentralPubMedCrossRef

38.

Sambataro M, Thomaseth K, Pacini G et al (1996) Plasma clearance rate of 51Cr-EDTA provides a precise and convenient technique for measurement of glomerular filtration rate in diabetic humans. J Am Soc Nephrol 7:118–127PubMed

39.

Chantler C, Garnett ES, Parsons V, Veall N (1969) Glomerular filtration rate measurement in man by the single injection methods using 51Cr-EDTA. Clin Sci 37:169–180PubMed

40.

Kim HO, Chae S-Y, Baek S, Moon DH (2010) Factors affecting changes in the glomerular filtration rate after unilateral nephrectomy in living kidney donors and patients with renal disease. Nucl Med Mol Imaging 44:69–74CrossRef

Title: Improved measurement of the glomerular filtration rate from Tc-99m DTPA scintigraphy in patients following nephrectomy
Authors: Yong-il Kim
Seunggyun Ha
Young So
Won Woo Lee
Seok-Soo Byun
Sang Eun Kim
Publication date: 01-02-2014
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 2/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-013-3039-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Improved measurement of the glomerular filtration rate from Tc-99m DTPA scintigraphy in patients following nephrectomy

Abstract

Objective

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Key Points

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