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Acta medica Medianae
2019, vol. 58, iss. 3, pp. 168-176
article language: English
document type: Original Paper
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



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


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.


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


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