Article metrics

  • citations in SCindeks: 0
  • citations in CrossRef:0
  • citations in Google Scholar:[=>]
  • visits in previous 30 days:22
  • full-text downloads in 30 days:14
article: 9 from 574  
Back back to result list
Acta medica Medianae
2019, vol. 58, iss. 3, pp. 168-176
article language: English
document type: Original Paper
doi:10.5633/amm.2019.0324
Creative Commons License 4.0
Comparison of Schwartz eGFR-Cr with GFR measured by Tc-99m-DTPA clearance in healthy children and in children with urinary tract infection with and without vesicoureteral reflux
aUniverzitet u Nišu, Medicinski fakultet + Klinički centar Niš, Centar za nuklearnu medicinu, Niš
bKlinički centar Niš, Klinika za dečiju hirurgiju i ortopediju, Niš
cKlinički centar Niš, Klinika za nefrologiju, Niš
dKlinički centar Niš, Klinika za rehabilitaciju, Niš
eFaculty of Medicine - Clinical Center of Serbia
fKlinički centar Kragujevac, Centar za nuklearnu medicinu, Kragujevac

e-mail: vlajkovicm@gmail.com

Project

Joint research of measurements and effects of ionizing and UV radiation in medicine and environmental protection (MESTD - 43011)

Abstract

The aim of this study was to assess the diagnostic reliability of the estimated glomerular filtration rate based on serum creatinine and body height (eGFR-Cr Schwartz) as compared to the glomerular filtration rate (GFR) measured by a radioisotope method using Tc-99mDTPA clearance in healthy children and in children with urinary tract infections (UTI) with and without a vesicoureteral reflux (VUR) using Bland-Altman analysis. The retrospective study enrolled 451 paediatric patients (104 male and 347 female, aged 7.07 ± 3.02, range of 2-15) from a single-institution database. Groups of participants were formed according to their diagnosis: the control group (CG, n = 64), the group with UTI with no documented VUR (UTI, n = 299), and the group with UTI and VUR (VUR, n = 88). The GFR was measured by the Tc-99m-DTPA clearance from a single blood sample drawn 180 minutes after administering the radiopharmaceutical. The eGFR-Cr was determined from an equation which included body height and the serum creatinine level. When compared to Tc-99m-DTPA GFR, the eGFR-Cr yielded the following mean deviation values in the examined groups: CG: 1.937 ml/min/1.73m2 (95% limits of agreement [LOA]: -36.759-40.633 ml/min/1.73m2), UTI: -3.010 ml/min/1.73m2 (LOA: -57.292-51.272 ml/min/1.73m2) and VUR: 2.183 ml/min/1.73m2 (LOA: -64.019-68.385 ml/min/1.73m2). eGFR-Cr demonstrated comparable accuracy to Tc-99m-DTPA GFR in the CG and UTI groups with 95% and 82% of values within 30% of the Tc-99m-DTPA GFR. The eGFR-Cr demonstrated a lower measurement reliability in the VUR group, amounting to only 68% of the values within 30% of the Tc-99m-DTPA clearance. The results proved eGFR-Cr to be a reliable alternative to the radioisotope method in children with preserved renal function and children with a urinary tract infection with no reflux, but a less reliable method in children with both VUR and renal impairment.

Keywords

estimated glomerular filtration rate; Tc-99m-DTPA clearance; children; vesicoureteral reflux; urinary tract infection

References

Andersen, T.B., Eskild-Jensen, A., Frøkiær, J., Brøchner-Mortensen, J. (2009) Measuring glomerular filtration rate in children: Can cystatin C replace established methods?: A review. Pediatric Nephrology, 24(5): 929-941
Back, S.E., Krutzen, E., Nilsson-Ehle, P. (1988) Contrast media as markers for glomerular filtration: A pharmacokinetic comparison of four agents. Scand J Lab Clin Invest, 48(3): 247-53
Bland, J.M., Altman, D.G. (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet, 1(8476): 307-10
Blaufox, M.D., Aurell, M., Bubeck, B., Fommei, E., Piepsz, A., Russell, C., Taylor, A., Thomsen, H.S., Volterrani, D. (1996) Report of the radionuclides in nephrourology committee on renal clearance. J Nucl Med, 37(11):1883-90
Blufpand, H.N., Westland, R., van Wijk, J.A.E., Roelandse-Koop, E.A., Kaspers, G.J.L., Bökenkamp, A. (2013) Height-independent estimation of glomerular filtration rate in children: An alternative to the Schwartz equation. Journal of Pediatrics, 163(6): 1722-1727
Bröchner-Mortensen, J. (1985) Current status on assessment and measurement of glomerular filtration rate. Clinical Physiology, 5(1): 1-17
Bubeck, B., Piepenburg, R., Grethe, U., Ehrig, B., Hahn, K. (1992) A new principle to normalize plasma concentrations allowing single-sample clearance determinations in both children and adults. European Journal of Nuclear Medicine, 19(7): 511-516
Chantler, C., Barratt, T.M. (1972) Estimation of glomerular filtration rate from plasma clearance of 51-chromium edetic acid. Archives of Disease in Childhood, 47(254): 613-617
Dharnidharka, V.R., Kwon, C., Stevens, G. (2002) Serum cystatin C is superior to serum creatinine as a marker of kidney function: A meta-analysis. American Journal of Kidney Diseases, 40(2): 221-226
Filler, G., Huang, S., Yasin, A. (2012) The usefulness of cystatin C and related formulae in pediatrics. Clinical Chemistry and Laboratory Medicine, 50(12): 2081-91
Filler, G., Yasin, A., Medeiros, M. (2014) Methods of assessing renal function. Pediatric Nephrology, 29(2): 183-192
Filler, G., Bökenkamp, A., Hofmann, W., Le, B.T., Martínez-Brú, C., Grubb, A. (2005) Cystatin C as a marker of GFR: History, indications, and future research. Clinical Biochemistry, 38(1): 1-8
Fleming, J.S., Zivanovic, M.A., Blake, G.M., Burniston, M., Cosgriff, P.S. (2004) Guidelines for the measurement of glomerular filtration rate using plasma sampling. Nuclear Medicine Communications, 25(8): 759-769, British Nuclear Medicine Society
Gretz, N., Schock, D., Sadick, M., Pill, J. (2006) Bias and precision of estimated glomerular filtration rate in children. Pediatric Nephrology, 22(2): 167-169
Ham, H.R., Piepsz, A. (1991) Estimation of glomerular filtration rate in infants and children using a simple plasma sample method. J Nucl Med, 32: 1294-1297
Harmon, W.E. (2009) Glomerular filtration rate in children with chronic kidney disease. Clinical Chemistry, 55(3): 400-401
Haycock, G.B., Schwartz, G.J., Wisotsky, D.H. (1978) Geometric method for measuring body surface area: A height-weight formula validated in infants, children, and adults. Journal of Pediatrics, 93(1): 62-66
KDIGO (2013) 2012 Clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl, 3: 136-50
Klopper, J.F., Hauser, W., Atkins, H.L., Eckelman, W.C., Richards, P. (1972) Evaluation of 99m Tc-DTPA for the measurement of glomerular filtration rate. J Nucl Med, 13(1): 107-10
Krutzen, E., Back, S.E., Nilsson-Ehle, I., Nilsson-Ehle, P. (1984) Plasma clearance of a new contrast agent, iohexol: A method for the determination of glomerular filtration rate. J Lab Clin Med, 104(6): 955-61
Murray, A.W., Barnfield, M.C., Waller, M.L., Telford, T., Peters, A.M. (2013) Assessment of glomerular filtration rate measurement with plasma sampling: A technical review. Journal of Nuclear Medicine Technology, 41(2): 67-75
Nilsson-Ehle, P. (2002) Iohexol clearance for the determination of glomerular filtration rate: 15 years' experience in clinical practice. J Int Fed Clin Chem, 13(2): 1-5
Piepsz, A., Colarinha, P., Gordon, I., Hahn, K., Olivier, P., Sixt, R., et al. (2001) Guidelines for glomerular filtration rate determination in children. Eur J Nucl Med, 28(3): 31-6, http://www.eanm.org/scientific_inf, European Association of Nuclear Medicine, Pediatric Committee
Piéroni, L., Delanaye, P., Boutten, A., Bargnoux, A., Rozet, E., Delatour, V., Carlier, M., Hanser, A., Cavalier, E., Froissart, M., Cristol, J. (2011) A multicentric evaluation of IDMS-traceable creatinine enzymatic assays. Clinica Chimica Acta, 412(23-24): 2070-2075
Pottel, H., Vrydags, N., Mahieu, B., Vandewynckele, E., Croes, K., Martens, F. (2008) Establishing age/sex related serum creatinine reference intervals from hospital laboratory data based on different statistical methods. Clinica Chimica Acta, 396(1-2): 49-55
Prévot, A., Martini, S., Guignard, J.P. (2002) Glomerular filtration markers in pediatrics. Rev Med Suisse Romande, 122(12): 625-630
Rehling, M., Møller, M.L., Thamdrup, B., Lund, J.O., Trap-Jensen, J. (1984) Simultaneous measurement of renal clearance and plasma clearance of 99mTc-labelled diethylenetriaminepenta-acetate, 51Cr-labelled ethylenediaminetetra-acetate and inulin in man. Clinical Science (Lond), 66(5): 613-619
Sapirstein, L.A., Vidt, D.G., Mandel, M.J., Hanusek, G. (1955) Volumes of distribution and clearances of intravenously injected creatinine in the dog. American Journal of Physiology-Legacy Content, 181(2): 330-336
Schwartz, G.J., Haycock, G.B., Edelmann, C.M. J., Spitzer, A. (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics, 58(2): 259-63
Schwartz, G.J., Work, D.F. (2009) Measurement and estimation of GFR in children and adolescents. Clinical Journal of the American Society of Nephrology, 4(11): 1832-1843
Smith, H.W. (1951) The kidney: Structure and function in health and disease. New York: Oxford University Press, 836-837
Whyte, D.A., Fine, R.N. (2008) Chronic kidney disease in children. Pediatrics in Review, 29(10): 335-341
Zappitelli, M., Zhang, X., Foster, B.J. (2010) Estimating glomerular filtration rate in children at serial follow-up when height is unknown. Clinical Journal of the American Society of Nephrology, 5(10): 1763-1769