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Warwick J, Holness J. Measurement of Glomerular Filtration Rate. Semin Nucl Med 2022; 52:453-466. [DOI: 10.1053/j.semnuclmed.2021.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 12/21/2021] [Indexed: 01/21/2023]
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Dhondt L, Croubels S, De Cock P, Dhont E, De Baere S, De Paepe P, Devreese M. Volumetric absorptive microsampling as alternative sampling technique for renal function assessment in the paediatric population using iohexol. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1171:122623. [PMID: 33735803 DOI: 10.1016/j.jchromb.2021.122623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 02/07/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
The glomerular filtration rate (GFR) is considered the best overall index for the renal function. Currently, one of the most promising exogenous markers for GFR assessment is iohexol. In this study, the suitability of volumetric absorptive microsampling (VAMS) as alternative for the conventional blood sampling and quantification of iohexol in paediatric plasma was assessed. Therefore, a new, fully validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed. Subsequently, the clinical suitability was evaluated in 20 paediatric patients by comparing plasma iohexol concentrations and associated GFR values obtained by the VAMS method with those obtained by conventional blood sampling and quantification of iohexol in plasma. The developed, simple and cost-effective LC-MS/MS-method fulfilled all pre-set validation acceptance criteria. Iohexol could be accurately quantified within a haematocrit range of 20-60% and long-term stability of iohexol in VAMS was demonstrated up to 245 days under different storage temperatures. Both iohexol plasma concentrations (r = 0.98, mean bias: -4.20%) and derived GFR values (r = 0.99; mean bias: 1.31%), obtained by a conventional plasma and the VAMS method, demonstrated good correlation and acceptable bias. The agreement between the two methods was especially good for GFR values higher than 60 mL/min/1.73 m2. Nevertheless, for GFR values <60 mL/min/1.73 m2 the accuracy compared to the plasma method was lower. However, small adjustments to the sampling protocol could probably solve this problem.
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Affiliation(s)
- Laura Dhondt
- Department of Pharmacology, Toxicology and Biochemistry, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, Belgium
| | - Siska Croubels
- Department of Pharmacology, Toxicology and Biochemistry, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, Belgium
| | - Pieter De Cock
- Department of Pharmacy, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium; Heymans Institute of Pharmacology, Ghent University, Corneel Heymanslaan 10, Ghent, Belgium; Department of Paediatric Intensive Care, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium
| | - Evelyn Dhont
- Department of Paediatric Intensive Care, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium
| | - Siegrid De Baere
- Department of Pharmacology, Toxicology and Biochemistry, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, Belgium
| | - Peter De Paepe
- Heymans Institute of Pharmacology, Ghent University, Corneel Heymanslaan 10, Ghent, Belgium
| | - Mathias Devreese
- Department of Pharmacology, Toxicology and Biochemistry, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, Belgium.
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Marx MA, Shuler CL, Golper TA. Plasma Iohexol Clearance in Automated Peritoneal Dialysis -its Role in Adequacy Determination. Perit Dial Int 2020. [DOI: 10.1177/089686089801800509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To compare the relationship of plasma iohexol clearance to standard adequacy measures in an automated peritoneal dialysis (APD) population. Design Prospective, nonrandomized, open label, simultaneous clearance studies of novel (iohexol) and traditional (urea and creatinine) markers of dialysis quantitation. Setting Outpatient peritoneal dialysis units associated with tertiary care university hospitals. Patients Eighteen stable patients, 13 undergoing continuous cycling peritoneal dialysis (CCPD) and 5 receiving intermittent dialysis, who underwent 24-hour clearance studies were enrolled in and completed the study. Interventions Each subject received 15 mL of iohexol intravenously the morning of a scheduled dialysis night. Blood was obtained for determination of serum concentrations of urea nitrogen and creatinine, and plasma iohexol concentration. Dialysate and urine were collected over 24 hours. Main Outcome Measures Urea and creatinine data from the total pooled dialysate and from the 24-hour urine collection were used to calculate daily Kt/V urea and normalized total daily creatinine clearance (CrCI). Total plasma iohexol clearance was calculated using a one-compartment model with the Bröchner-Mortensen correction. Results Normalized [to 1.73 m2 body surface area (BSA)] iohexol clearance correlated very well with normalized CrCI (r2 = 0.777; p < 0.001). A weaker correlation was observed between Kt/V urea and normalized iohexol clearance (r2 = 0.213; 0.05 < p < 0.1). When data are not normalized using BSA or urea distribution volume, the regressions are improved for both creatinine (r2 = 0.820) and urea (r2 = 0.533). These results were comparable between those on CCPD and those on intermittent therapy. Conclusion Total plasma iohexol clearance provides a simple assessment for APD adequacy by eliminating collection problems inherent to the methodologies currently employed. Such simplicity allows for more frequent assessments of delivered dialysis dose and efficacy of prescription changes.
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Affiliation(s)
- Michael A. Marx
- University of Arkansas for Medical Sciences, Little Rock, Arkansas,
| | | | - Thomas A. Golper
- University of Arkansas for Medical Sciences, Little Rock, Arkansas,
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Stake G, Monclair T, Berg KJ, Rootwelt K, Brekke O. Effect of Iopentol on Renal Function and its Use for Calculation of Glomerular Filtration Rate in Children. Acta Radiol 2016. [DOI: 10.1177/028418519503600111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nineteen children received 99mTc-DTPA for renography. The next day they received a simultaneous injection of the non-ionic contrast medium iopentol for urography and another injection of 99mTc-DTPA. The glomerular filtration rate (GFR) was estimated from the plasma elimination of 99mTc-DTPA as well as iopentol. Serum concentrations of creatinine and β2-microglobulin, and urine concentrations of creatinine, β2-microglobulin, alkaline phosphatase, N-acetyl-glucosaminidase, and albumin were determined. A significant reduction (12 ± 3%) of GFR was observed after the injection of iopentol, without a subsequent rise in serum creatinine or β2-microglobulin. The urinary excretion of albumin and β2-microglobulin remained unchanged, while the excretion of alkaline phosphatase and N-acetyl-glucosaminidase was significantly increased after the urography, indicating some tubular effects of iopentol. Iopentol caused few and mild adverse events, the diagnostic yield was high, and the small changes in the renal tubular function parameters are presumed to be without clinical importance. The observed depressive effect on the GFR demands further investigations before iopentol can be recommended as a GFR-marker in children.
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Heiene R, Eliassen KA, Risøen U, Neal LA, Cowgill LD. Glomerular filtration rate in dogs as estimated via plasma clearance of inulin and iohexol and use of limited-sample methods. Am J Vet Res 2010; 71:1100-7. [DOI: 10.2460/ajvr.71.9.1100] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Filler G, Browne R, Seikaly MG. Glomerular filtration rate as a putative 'surrogate end-point' for renal transplant clinical trials in children. Pediatr Transplant 2003; 7:18-24. [PMID: 12581323 DOI: 10.1034/j.1399-3046.2003.00015.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Only with prospective randomized controlled trials is it possible to evaluate the several immunosuppressive regimens available to renal allograft recipients. Commonly used surrogate markers of clinical outcome, such as patient and graft survival, are constantly improving. Current immunosuppressive protocols have improved 1-yr graft survival to over 90%. The small differences in graft survival among the various immunosuppressive regimes require large patient cohorts in order to establish statistical significance. Such studies are often difficult to conduct in a timely manner, particularly in children. This necessitates the search for better surrogate markers sensitive enough to detect differences in smaller cohorts and in a shorter period of time. While the degree of fibrosis in transplant biopsies might well predict long-term graft survival, protocol biopsies are expensive, invasive, and unpopular among clinicians. In native kidneys, glomerular filtration rate (GFR) closely correlates with disease progression and interstitial fibrosis and appears to be well positioned as a less invasive surrogate marker for long-term outcome. Nonetheless, the ideal marker for GFR remains obscure. Serum creatinine has several major drawbacks, making it a poor predictor of GFR. This review discusses the several methods used to estimate or measure GFR with emphasis on 125I-iothalamate clearance and serum cystatin C (cys-C). Of all the serum markers, cys-C is the most reliable and the most promising. However, cys-C and other endogenous markers cannot replace the diagnostic sensitivity and reliability of radiolabeled markers of GFR such as 125I-iothalamate in renal transplant clinical trials. Unfortunately, clearance of most radiolabeled markers of GFR including 125I-iothalamate remain costly and time consuming.
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Affiliation(s)
- Guido Filler
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada
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Sacamay TE, Bolton WK. Use of iohexol to quantify hemodialysis delivered and residual renal function: technical note. Kidney Int 1998; 54:986-91. [PMID: 9734627 DOI: 10.1046/j.1523-1755.1998.00060.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Classically, urea (molecular wt = 60) is used to determine the urea reduction ratio (URR) or clearance, based on volume of distribution (Kt/V). These methods are subject to many errors. The purpose of this study was to determine whether iohexol (Io; molecular wt = 821) could be used instead of urea and provide better information as well as middle molecule clearance data. METHODS Ten hemodialysis (HD) patients were evaluated. All were dialyzed for three hours, and a single bolus of 100 ml of Io was injected immediately post-HD. For direct dialysis quantification (DDQ), the spent dialysate was collected in a drum, and urea and iodine (I) determined immediately prior to, at the end of, and 30 minutes post-HD. As routinely used, DDQ measures clearance directly rather than estimates the levels. RESULTS Calculated Kt/V urea (1.21+/-0.05) significantly overestimated DDQ Kt/V urea (0.78+/-0.04, P < 0.001) whereas calculated and DDQ Kt/V Io were similar (1.44+/-0.10 vs. 1.36+/-0.05). The URR and iohexol reduction ratio (IoRR) were also different (0.63+/-0.02 vs. 0.69+/-0.02; P < 0.002) with a urea but not Io rebound (URR30 min 0.59+/-0.02, P < 0.05). Calculated urea clearance (C(urea)), 247+/-21 ml/min, significantly overestimated DDQ C(urea) (157+/-10 ml/min P < 0.001). Calculated CIo and DDQ CIo, however, were similar (109+/-8 vs. 104+/-7 ml/min). Total body clearance (TBC) in six anuric subjects was 2.5+/-0.3 ml/min, and in four oliguric subjects was 5.2+/-0.5 ml/min. In 10 additional patients, direct urine measurements demonstrated a non-renal clearance (NRC) of 2.97+/-0.18 ml/min, which was 4.0+/-0.3% of body wt. Use of this factor allowed an estimation of residual renal function (RRF) that accurately reflected measured RRF (1.32+/-0.53 vs. 1.42+/-0.55 ml/min) CONCLUSION A single injection of Io can be used to determine Kt/V, RR, and RRF without rebound or the inconvenience of urine collection. It may also represent middle molecule clearance better than urea kinetics, and may serve as a superior method for determining HD delivered and dialysis adequacy.
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Affiliation(s)
- T E Sacamay
- Division of Nephrology, University of Virginia School of Medicine, Charlottesville, USA
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Braselton WE, Stuart KJ, Kruger JM. Measurement of serum iohexol by determination of iodine with inductively coupled plasma–atomic emission spectroscopy. Clin Chem 1997. [DOI: 10.1093/clinchem/43.8.1429] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
We used inductively coupled plasma–atomic emission spectroscopy to measure serum iodine to determine plasma clearance of iohexol, an iodinated radiographic contrast agent. We determined I at 178.276 nm on the phosphorus 178.287 nm channel of the polychromator by utilization of spectrum shifter offset software, while correcting for P with the sequential P 214.914 nm emission line. Determination of I on the polychromator provided excellent precision in the measurement of serum I, even though the interelement correction of P was done with a sequential P line. Total imprecision (CV) (n = 13) was 16% (at 13.7 mg/L I), 8.6% (28.7 mg/L), 3.6% (59.0 mg/L), 2.6% (120.5 mg/L), 1.7% (237.8 mg/L), 1.2% (478.7 mg/L), and 1.8% (597 mg/L). The linear range was 15 to 600 mg/L. Iohexol added to serum (mg/L I) and recoveries (%) were 15 (91.3%), 30 (95.7%), 60 (98.3%), 120 (100.4%), 240 (99.1%), 480 (99.7%), and 600 (99.5%). Studies on dogs and cats administered a single intravenous injection of iohexol indicated that a dose of 300 mg I/kg body weight was sufficient for measurement of glomerular filtration rate by using a single compartment model for plasma clearance with three samples drawn 3 to 7 h after treatment. With this protocol, correlation coefficients were >0.99 on the β phase of the plasma disappearance curve.
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Affiliation(s)
- W Emmett Braselton
- Departments of Pharmacology and Toxicology and
- Small Animal Clinical Sciences, and Animal Health Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, E. Lansing, MI 48824
| | - Kirk J Stuart
- Small Animal Clinical Sciences, and Animal Health Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, E. Lansing, MI 48824
| | - John M Kruger
- Small Animal Clinical Sciences, and Animal Health Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, E. Lansing, MI 48824
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Affiliation(s)
- Suzanne K Swan
- Division of Nephrology, Hennepin County Medical Center, 701 Park Ave., Minneapolis, MN 55415, Fax 612-347-2003
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Swan SK, Halstenson CE, Kasiske BL, Collins AJ. Determination of residual renal function with iohexol clearance in hemodialysis patients. Kidney Int 1996; 49:232-5. [PMID: 8770973 DOI: 10.1038/ki.1996.32] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Residual renal function (RRF) may contribute significantly to the total dialysis prescription. Conventional quantitation of RRF in hemodialysis (HD) patients is measured by urea clearance and requires a 24-hour urine collection which is often difficult to perform and inaccurate. The renal clearance of iohexol was evaluated as an alternative method for RRF assessment (iohexol-derived RRF) in hemodialysis patients. An intravenous bolus of iohexol (12 ml; 300 mg iodine/ml) was administered to 42 hemodialysis patients following routine HD. A single blood sample was obtained approximately 44 hours later (pre-HD) to determine the plasma clearance of iohexol using x-ray fluorescence methods. Total body clearance of iohexol (CTBio) and non-renal clearance of iohexol (CNRio) 2.87 +/- 0.3 ml/min (mean +/SEM) were used to calculate iohexol-derived RRF (CTBio-CNRio). Iohexol-derived RRF determinations were then compared to urea clearance-derived RRF measurements. The RRF contribution to the dialysis prescription was also calculated utilizing iohexol-derived RRF compared to urea-derived RRF. Iohexol-derived RRF did not differ from urea-derived RRF (2.48 +/- 0.3 vs. 2.64 +/- 0.4 ml/min, P = 0.21). The RRF contribution to the weekly dialysis prescription (Kt/V) did not differ when iohexol-derived RRF was compared to urea-derived RRF (0.94 +/- 0.1 vs. 0.93 +/- 0.1, P = 0.9). Additionally, the effect of iohexol on RRF was assessed in 17 HD patients. Urea-derived RRF determinations one week after iohexol exposure did not differ from those measured one week prior to iohexol exposure (3.17 +/- 0.6 vs. 2.91 +/- 0.5 ml/min, respectively). Thus, renal clearance of iohexol can be an accurate and safe measure of RRF in HD patients and potentially simplify delivery of the dialysis prescription.
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Affiliation(s)
- S K Swan
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
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Marx MA, Shuler CL, Tattersall JE, Golper TA. Plasma iohexol clearance as an alternative to creatinine clearance for CAPD adequacy studies. Kidney Int 1995; 48:1994-7. [PMID: 8587263 DOI: 10.1038/ki.1995.502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M A Marx
- University of Arkansas for Medical Sciences, Little Rock, USA
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Gaspari F, Mosconi L, Viganò G, Perico N, Torre L, Virotta G, Bertocchi C, Remuzzi G, Ruggenenti P. Measurement of GFR with a single intravenous injection of nonradioactive iothalamate. Kidney Int 1992; 41:1081-4. [PMID: 1513089 DOI: 10.1038/ki.1992.164] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- F Gaspari
- Mario Negri Institute for Pharmacological Research, Ospedali Riuniti di Bergamo, Italy
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Stake G, Monn E, Rootwelt K, Monclair T. The clearance of iohexol as a measure of the glomerular filtration rate in children with chronic renal failure. Scand J Clin Lab Invest 1991; 51:729-34. [PMID: 1806987 DOI: 10.3109/00365519109104587] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The plasma clearances of technetium-99m-labelled DTPA ([99Tcm]-DTPA) and the non-ionic contrast medium iohexol were estimated in 11 children with chronic renal failure for determination of the glomerular filtration rate (GFR). Equal values were obtained with the two substances provided plasma sampling was simultaneous, but when plasma was sampled within 3.5 h after injection of iohexol and [99Tcm]-DTPA the GFR was overestimated by more than 50%. For clearance values below 20 ml min-1 1.73 m-2, valid GFR estimates were obtained both from two plasma samples taken 3 h and 24 h after the injection of iohexol and from a single plasma sample taken 24 h after the injection.
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Affiliation(s)
- G Stake
- Department of Paediatric Radiology, Rikshospitalet, University Hospital, Oslo, Norway
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Stake G, Monn E, Rootwelt K, Monclair T. A single plasma sample method for estimation of the glomerular filtration rate in infants and children using iohexol, II: Establishment of the optimal plasma sampling time and a comparison with the 99Tcm-DTPA method. Scand J Clin Lab Invest 1991; 51:343-8. [PMID: 1947719 DOI: 10.1080/00365519109091625] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The glomerular filtration rate (GFR) can be determined from the plasma disappearance rate of the non-ionic contrast medium iohexol. A preceding study established the empirical formulae enabling the development of a single plasma sample method for estimation of GFR in infants and children. In the present study the validity of these empirical formulae was confirmed in examinations in 143 patients. The results of the single plasma sample method were similar to those of a standard 99Tcm-DTPA method, and also with those of a two plasma sample iohexol method. Evaluation of the results obtained with plasma sampling 1 h, 2 h, 3 h and 4 h after the injection of the contrast medium showed that the optimal sampling time was about 3 h after the injection.
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Affiliation(s)
- G Stake
- Department of Pediatric Radiology, Rikshospitalet, University Hospital, Oslo, Norway
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Stake G, Monclair T. A single plasma sample method for estimation of the glomerular filtration rate in infants and children using iohexol, I: Establishment of a body weight-related formula for the distribution volume of iohexol. Scand J Clin Lab Invest 1991; 51:335-42. [PMID: 1947718 DOI: 10.1080/00365519109091624] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study was performed in order to develop a method for estimation of the glomerular filtration rate (GFR) from a single plasma sample based upon the plasma disappearance rate of the non-ionic contrast medium iohexol. The apparent distribution volume for iohexol was measured in 100 infants and children and used for establishment of a weight-related empirical formula for the distribution volume. Using the distribution volume obtained by this formula, a preliminary GFR was calculated from the iodine concentration measured in a plasma sample taken 3 h after injection of iohexol. When this estimate was corrected by another empirically established correction factor, a high degree of agreement was found between a GFR reference method and the 3-h single plasma sample method. In another group of 13 children the 3-h single plasma sample GFR was estimated twice with a 2-day interval, and the day-to-day variations were found to be similar to those obtained with other standard methods.
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Affiliation(s)
- G Stake
- Department of Paediatric Radiology, Rikshospitalet, University Hospital, Oslo, Norway
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