Plasma clearance of iodine contrast media as a measure of glomerular filtration rate in critically ill patients

Erley, Christiane M.; Bader, Birgit; Berger, Elke D.; Vochazer, Anika; Jorzik, Jork J.; Dietz, Klaus; Risler, T.

doi:10.1097/00003246-200108000-00008

Cited by 94 publications

(72 citation statements)

References 23 publications

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“…Erley et al (10) have measured GFR by nonradioactive radiocontrast in critically ill patients using a single injection technique and found good correlation between inulin clearance and limited sampling single shot plasma clearance technique. These authors used radiographic fluorescence, which is less sensitive than the HPLC technique and requires administration of large volume of radiocontrast (11).…”

Section: Plasma Clearance Methodsmentioning

confidence: 99%

Newly Developed Techniques to Study and Diagnose Acute Renal Failure

Dagher¹,

Herget–Rosenthal

Ruehm

et al. 2003

Journal of the American Society of Nephrology

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Abstract. Progress in treating human acute renal failure (ARF) is dependent on developing techniques that allow for the rapid diagnosis, quantification of injury, further understanding of the pathophysiology, and the effects of therapy. Therefore, four techniques that will facilitate this progress are described and illustrated by four different investigative teams. Techniques to measure rapid changes in GFR are available for rapid diagnosis and quantification of ARF in humans. State-of-the-art magnetic resonance imaging (MRI) presently allows for enhanced resolution of regional renal blood flow and functional evaluations in patients. Furthermore, new probes and techniques for MRI that allow for identification and quantitation of inflammation, applicable to human ARF, are being developed and tested in animal models. Finally, two-photon microscopy will allow for four-dimensional cellular and subcellular studies in animal models of ARF providing rapid insights into pathophysiology and the therapeutic effects of a variety of promising agents. Further development and utilization of these techniques, especially in concert with genetic, proteomic, and molecular approaches, will allow for needed insights into the pathophysiology and therapy in human ARF.Advances in human ARF therapy have been limited to prevention and dialytic support. Interpatient and disease process heterogeneity, as well as a limited number of patients, are barriers to successful interventional therapeutic studies over which there is limited control. However, other relative barriers such as risk factor assessment, early diagnosis and initiation of therapy, and quantitation of ARF severity are now within the reach of clinicians. Quantitation of ARF severity, and the ability to effectively evaluate the response to early therapeutic approaches, are of paramount importance if success is to be achieved. Development of rapid diagnostic tests to allow for randomization of patients on the basis of GFR and ARF severity index is necessary for accurate randomization of patients for therapeutic studies. This, in turn, will minimize interpatient variability and allow for smaller, less expensive, and more reliable studies. To this end, the following four approaches are presented in a very concise format. We have specifically progressed from more clinically applicable techniques to studies aimed at understanding pathophysiologic and therapeutic concepts. Also, many complimentary and powerful investigative techniques have not been discussed. These include the use of "knock out" and "knock in" animal models, genomic and proteomic approaches, and molecular techniques such as silencing RNA and antisense approaches. In combination, these approaches will allow for extremely rapid progress in human ARF diagnosis and therapy.

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Section: Plasma Clearance Methodsmentioning

confidence: 99%

Newly Developed Techniques to Study and Diagnose Acute Renal Failure

Dagher¹,

Herget–Rosenthal

Ruehm

et al. 2003

Journal of the American Society of Nephrology

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“…In practice, the major peak, eluting at about 5 min, is used for determining serum/plasma concentrations [69]. Most studies indicate close agreement between GFR (measured by inulin clearance) and clearance of iohexol, measured as standard renal clearance or plasma disappearance [65,[69][70][71][72]. There is not only a very good correlation between plasma iohexol clearance and that of 51 Cr-EDTA, but also no difference between the methods by Bland-Altman analysis [73].…”

Section: Iohexolmentioning

confidence: 99%

Glomerular filtration rate measurement and estimation in chronic kidney disease

2007

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Glomerular filtration rate (GFR) assesses kidney function. GFR is measured by renal clearance techniques; inulin clearance is the gold standard but is not easily measured. Thus, other methods to determine GFR have been utilized. Endogenous creatinine clearance (CrCl) is the most widely used, but creatinine secretion falsely elevates GFR. Cimetidine inhibits creatinine secretion, such that CrCl equals GFR, provided there are no difficulties with bladder emptying. Estimation of GFR from serum creatinine (e.g. Schwartz formula) is useful clinically; however, such formulae have not been updated for enzymatic creatinine autoanalyzers. Cystatin C, a small protein, is produced at a relatively constant rate and is reabsorbed in the proximal tubule. Cystatin C may be more sensitive than creatinine in detecting a reduction in GFR, but further studies are needed to prove this. Single injection (plasma) clearance techniques are the most precise measures of GFR. Iohexol is an exogenous marker that is comparable to inulin and 51 Cr-EDTA and can be measured by high-performance liquid chromatography (HPLC). Our pilot and the Chronic Kidney Disease in Children (CKiD) North American studies show that iohexol can accurately measure GFR using a four-point plasma disappearance curve national studies show that iohexol can accurately measure GFR using a four-point plasma disappearance curve (10, 30, 120, and 300 min) or, in most cases, a two-point disappearance time (120 and 300 min).

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“…Several investigators have demonstrated real-time changes in renal function using thermodilution techniques, although this is an invasive procedure, requiring placement of a catheter in the renal vein (62). Others have shown a strong correlation between sparse blood sampling after administration of iodinated contrast compared with the gold standard of inulin clearance (63), although concerns about the use of contrast in the context of patients who are at risk for AKI suggest a limited role for this approach. Others have looked at radioactive and nonradioactive means of continuously monitoring renal function in the ICU (15), including a noninvasive bedside radiation detector the size of an automated BP cuff (64).…”

Section: Early Recognition Of Renal Damage and New Biomarkersmentioning

confidence: 99%

Potential Interventions in Sepsis-Related Acute Kidney Injury

Ronco¹,

Kellum²,

Bellomo³

et al. 2008

Clinical Journal of the American Society of Nephrology

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Sepsis is an important cause of morbidity and mortality. Acute kidney injury often complicates sepsis, leading to greater complexity, cost of care, and worsening prognosis. In recent years, a consensus definition of acute kidney injury has been developed, facilitating research into the pathophysiology and epidemiology of this disorder. New and emerging biomarkers to recognize kidney injury before functional abnormalities are manifest may allow early recognition and facilitate prevention or treatment. Furthermore, advances in the clinical management of sepsis may have secondary benefits with respect to renal outcomes. Existing and hybrid extracorporeal therapies are being investigated not only as means to replace lost kidney function but also to modulate the immune response to sepsis. For those who have more advanced forms of kidney injury, strategies to promote renal recovery are being sought to minimize the long-term consequences of impaired kidney function. This review provides an update on the current state of the science and a glimpse toward the future of intervention in sepsis-related acute kidney injury.

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Plasma clearance of iodine contrast media as a measure of glomerular filtration rate in critically ill patients

Abstract: These findings indicate that the determination of plasma clearance of iohexol/iopromide is a simple, rapid, and accurate method that can indeed be used for estimating GFR in ICU patients with normal renal function or even different degrees of renal insufficiency.

Cited by 94 publications

References 23 publications

Newly Developed Techniques to Study and Diagnose Acute Renal Failure

Newly Developed Techniques to Study and Diagnose Acute Renal Failure

Glomerular filtration rate measurement and estimation in chronic kidney disease

Potential Interventions in Sepsis-Related Acute Kidney Injury

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