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GFR determination in adults with a single-sample iohexol plasma clearance method based on the mean sojourn time
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
2007 (English)In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 22, no 11, 3166-3173 p.Article in journal (Refereed) Published
Abstract [en]

Background. Glomerular filtration rate is a key parameter in kidney disease. The Radionuclides in Nephrourology Committee has recommended a single-sample method with 99mTc-DTPA based on the mean sojourn time. This study was done to develop the method for use with iohexol making the method more available.

Methods. The single-sample formula was derived for group I (n = 48, Cl = 8–188 ml/min) and applied on group II (n = 47) and on group III (n = 123). In groups I and II, reference clearance was determined according to Sapirstein and in group III according to Brøchner-Mortensen.

Results. The formula (a = (−6.49 × 10−6×t + 8.85 × 10−4)×t, b = 1.143 × t and c = ln[(C(t))×(ECV/Q0)](ECV) was derived for patients with estimated Cl > 30 ml/min with the best result if the single sample was obtained between 4 and 5 h. Extracellular volume was estimated as ECV =9985 × BSA − 3431.

The formula ClS(24 h) = −ln[(C(t))×(ECV/Q0)](ECV)/(t) was developed for patients with estimated Cl <30 ml/min with a single sample at 24 h. With this combined approach SDdiff was 2.7 ml/min in group II and 3.1 ml/min in group III.

Conclusions. An accurate determination of iohexol clearance can be obtained from a single plasma sample applying the mean sojourn time approach. A separate formula must be used for patients with low clearance values. Body surface area (BSA), injected amount of iohexol (Q0), time when the single sample is drawn (t) and the concentration of iohexol [C(t)] in the sample are needed for the calculations.

Place, publisher, year, edition, pages
2007. Vol. 22, no 11, 3166-3173 p.
Keyword [en]
glomerular filtration rate, iohexol clearance, renal function, single sample, 24 h sample
Identifiers
URN: urn:nbn:se:umu:diva-8295DOI: 10.1093/ndt/gfm411PubMedID: 17675331OAI: oai:DiVA.org:umu-8295DiVA: diva2:147966
Available from: 2008-01-16 Created: 2008-01-16 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Glomerular filtration rate in adults: a single sample plasma clearance method based on the mean sojurn time
Open this publication in new window or tab >>Glomerular filtration rate in adults: a single sample plasma clearance method based on the mean sojurn time
2011 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Glomerular filtration rate (GFR) is a key parameter in evaluating kidney function. After a bolus injection of an exogenous GFR marker in plasma an accurate determination of GFR can be made by measuring the marker concentration in plasma during the excretion. Simplified methods have been developed to reduce the number of plasma samples needed and yet still maintain a high accuracy in the GFR determination. Groth previously developed a single sample GFR method based on the mean sojourn time of a GFR marker in its distribution volume. This method applied in adults using the marker 99m Tc-DTPA is recommended for use when GFR is estimated to be ≥ 30 mL/min. The aim of the present study was to further develop the single plasma sample GFR method by Groth including patients with severely reduced renal function and different GFR markers. Three different GFR markers 51Cr-EDTA, 99mTc-DTPA and iohexol were investigated. Formulas were derived for the markers 51Cr-EDTA and iohexol when GFR is estimated to be ≥ 30 mL/min. For patients with an estimated GFR < 30 mL/min a special low clearance formula with a single sample obtained about 24 h after marker injection was developed. The low clearance formula was proven valid for use with all three markers. The sources of errors and their influence on the calculated single sample clearance were investigated. The estimated distribution volume is the major source of error but its influence can be reduced by choosing a suitable sampling time. The optimal time depends on the level of GFR; the lower GFR the later the single sample should be obtained. For practical purpose a 270 min sample is recommended when estimated GFR ≥ 30 mL/min and a 24 h sample when estimated GFR < 30 mL/min. Sampling at 180 min after marker injection may be considered if GFR is estimated to be essentially normal.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2011. 53 p.
Series
Licentiatuppsats, Klinisk fysiologi
Research subject
Clinical Physiology
Identifiers
urn:nbn:se:umu:diva-42319 (URN)978-91-7459-158-3 (ISBN)
Presentation
2011-05-12, Biblioteket, Enheten för klinisk fysiologi, våning 1, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2011-04-12 Created: 2011-04-07 Last updated: 2011-04-12Bibliographically approved

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