Estimation of Glomerular Filtration Rate in Children Using 99m‐Technetium DTPA

Abstract

The usefulness of radionuclide imaging studies with 99m-technetium diethylenetriaminepentaacetic acid (Tc-DTPA) for quantitating the glomerular filtration rate (GFR) in children was studied. This was compared to the conventional methods for measuring GFR using 51-chromium-EDTA clearance (Cr-EDTA), creatinine clearance and a height/plasma creatinine formula. In the 22 children studied, the correlation coefficient between renal uptake of DTPA and Cr-EDTA was 0.90 (p less than 0.001). In contrast, there was a poorer correlation between Cr-EDTA and creatinine clearance (r = 0.69) or the derived GFR using height/creatinine formula (r = 0.83). The regression line between Tc-DTPA uptake and Cr-EDTA clearance was used to derive a formula for calculating the predicted GFR. This was tested in 10 additional children, and the correlation between the predicted GFR and measured GFR (using Cr-EDTA clearance studies) was 0.92 (p less than 0.001). Quantitative estimation of the GFR during renal imaging studies is a feasible and convenient method of assessing renal function.

Estimating GFR in children with 99mTc‐DTPA renography: a comparison with single‐sample 51Cr‐EDTA clearance

“…Similar studies in children have been obtained comparing a DTPA camera-based GFR method with reference GFR modalities (Piepsz et al, 1977(Piepsz et al, , 1978Vivian & Gordon, 1983;Shore et al, 1984;Yap et al, 1985;Rehling et al, 1989;Inoue et al, 1998;Delpassand et al, 2000) with correlation coefficients between 0AE90 and 0AE97. However, except for one study (Rehling et al, 1989), these studies had the inconveniences of being more laborious including either a 20-min blood sample, estimation of the radiopharmaceutical dosage by syringe count and ⁄ or the need for correction of radiation attenuation within the patient.…”

“…With the use of 99m Tc-DTPA renography to estimate GFR, no blood samples are needed, and the study lasts only 21 min. Methods have therefore been proposed with the use of external imaging without plasma 0-1 min 1-3 min 3-6 min 6-9 min 9-12 min 18-21 min sampling to estimate GFR in adults (Piepsz et al, 1978;Moonen et al, 1994;Inoue et al, 1998;Petersen et al, 1999;Delpassand et al, 2000) and children (Piepsz et al, 1977(Piepsz et al, , 1978Vivian & Gordon, 1983;Shore et al, 1984;Yap et al, 1985;Rehling et al, 1989;Inoue et al, 1998;Delpassand et al, 2000). Previously, two other studies comparing the GFR obtained from 99m Tc-DTPA renography with that obtained from plasma clearance of 51 Cr-EDTA in adults found the limits of agreement to be )15-19 ml min )1 (Petersen et al, 1999) and the standard deviation to be 10AE7 ml min )1 in a subgroup of patients with GFR lower than 50 ml min )1 (Moonen et al, 1994), indicating larger limits of agreement than in the present study.…”

Comparison of glomerular filtration rate measured by plasma sample technique, Cockroft Gault method and Gates′ method in voluntary kidney donors and renal transplant recipients

“…The linear attenuation coefficient for Tc-99 m in water is 0.153/cm and our software program uses this value to correct for soft-tissue attenuation as is the case in other studies. [ 13 29 30 ] However, the effective attenuation coefficient is lower in soft-tissue than in water because of the presence of scattering photons. [ 31 ] This is another major drawback of the Gates method in the calculation of GFR.…”

Increased circulating nitric oxide in young patients with type 1 diabetes and persistent microalbuminuria: relation to glomerular hyperfiltration.

“…Tonnesen's formula was used to determine the renal depth in centimeters for normally positioned kidneys (22). The corrected renal counts were then determined, and the percentage renal uptake was calculated (23). Finally, to correct the GFR for body surface area, the following linear regression equation was used: GFR (ml · min -1 · 1.73 m -2 ) = 11.6065 -5.2975 (total renal uptake, 11.6065; regression coefficient, -5.2975 intercept).…”