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Single-Sample Methods to Measure GFR with Technetium-99m-DTPA

Department of Nuclear Medicine, The Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York

Correspondence: For correspondence or reprints contact: M. Donald Blaufox. MD, PhD, Department of Nuclear Medicine, 1695A Eastchester Rd., Bronx, NY 10461.

ABSTRACT

Many single-sample methods have been suggested to simplify the methodology of glomerular filtration rate (GFR) measurement. The relative accuracy of these competing methods is still not clear for clinical practice. Methods: Fifty-four GFR studies with ^99mTc-DTPA were performed on 37 adult patients (serum creatinine 0.8-10 mg/dl). Each study included a UV/P, plasma clearance method (three-sample) and single-sample methods. The single-sample methods used were those of Christensen and Groth (modified by Watson), Constable, Dakubu, Groth and Aasted, Jacobsson, Morgan, Russell and Tauxe. Results: When the GFR 30 ml/min (n = 26), all of the single-sample methods were highly correlated with UV/P. The correlation of the single-sample method with the plasma clearance was higher than with UV/P. In this group (GFR 30 ml/min), the Groth 4-hr sample method had the best value of both absolute difference and percent absolute difference (mean ±s.e. = 11.05 ± 2.51 ml/min and 14.08% ± 2.43%, respectively). Most single-sample methods do not perform well at GFR 30 ml/min (n = 28), and none of them has a good correlation with UV/P or plasma clearance at this level of renal function. However, the Groth and Aasted's 4-hr sample method was the best compared with others (mean ± s.e.= 8.43 ± 1.30 ml/min for absolute difference, and 65.91% ± 16.70% for percent absolute difference). Conclusion: Single-sample methods may not correctly predict GFR in advanced renal failure. Groth and Aasted's method with 4-hr plasma sample has both the lowest mean absolute difference and percent absolute difference in both the group with GFR ;30 ml/min and GFR 30 ml/min. All methods perform acceptably at GFR 30ml/min.

Key Words: glomerular filtration rate • technetium-99m-DTPA • plasma clearance • urinary clearance • single-sample method

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