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DOI: 10.1055/s-2003-36657
Validität der Iohexol-Clearance bei chronischer Niereninsuffizienz und normaler Nierenfunktion im Vergleich zur 99mTc-DTPA-Clearance
Validity of iohexol clearance in patients with normal renal function and renal failure. A comparison of iohexol- and 99mTc-DTPA-clearancePublikationsverlauf
eingereicht: 6.5.2002
akzeptiert: 22.11.2002
Publikationsdatum:
16. Januar 2003 (online)
Hintergrund und Fragestellung: Zur dynamischen Nierenfunktionsuntersuchung wird im klinischen Alltag am häufigsten die Kreatinin-Clearance verwendet. Fehlerquellen stellen unter anderem die variable Muskelmasse des Patienten und die nicht erfassbare tubuläre Sekretion des Kreatinins dar. Nuklearmedizinische Untersuchungen als exakte Messmethoden stehen nur begrenzt zur Verfügung, sie sind kosten- und zeitintensiv. In dieser Studie wurde die Iohexol-Clearance mit der etablierten 99mTc-Diethylentriamin-pentaessigsäure (DTPA)- Clearance verglichen. Ziel der Untersuchungen war es nachzuweisen, dass die Iohexol-Clearance als eine einfache, leicht durchführbare Methode zur Bestimmung der glomerulären Filtrationsrate (GFR) eingesetzt werden kann und eine vergleichbare Sensitivität zu nuklearmedizinischen Methoden bietet.
Patienten und Methodik: 120 Patienten (49 Frauen, 71 Männer) im Alter von 20 - 84 Jahren sowohl mit normaler Nierenfunktion als auch in verschiedenen Stadien der chronischen Niereninsuffizienz (Kreatinin-Clearance 1,8 bis 181,8, Mittelwert 61,6 ± 44,9 ml/min/1,73m 2 ) erhielten 10 ml des nichtionischen mittelosmolaren Röntgenkontrastmittels Iohexol als intravenösen Bolus. Entsprechend des Einkompartiment-Models wurden nach 150, 240, 480 Minuten Blutproben entnommen, die Abnahme der Plasmakonzentration von Iohexol mittels Röntgenfluoreszenzanalyse ermittelt und die Clearance errechnet. Die Bestimmung der 99mTc-DTPA-Clearance erfolgte nach einem Standardprotokoll.
Ergebnisse: Es zeigte sich eine hohe Korrelation zwischen der Iohexol- und der 99mTc-DTPA-Clearance (r = 0,95). Die mittlere Abweichung der Iohexol-Clearance von der 99mTc-DTPA-Clearance betrug 7,4 ml/min/1,73m2. Allergische oder nephrotoxische Nebenwirkungen traten nicht auf.
Folgerung: Die Iohexol-Clearance ist eine valide Methode zur Bestimmung der GFR in allen Bereichen der chronischen Niereninsuffizienz. Sie ist einfach durchzuführen und wenig kostenintensiv.
Background and objective: The most common method used for testing dynamic renal function is creatinine clearance, but it has some limitations, e. g. variable muscle mass and tubular secretion of creatinine. The use of radionuclides as an exact method is limited in terms of availability, cost and time needed for examination. We compared the plasma clearance of iohexol with the established 99mTc-diethylenetriaminepentaacetate acid (DTPA) clearance. The aim of the present study was to validate iohexol clearance as a simple and suitable method for measuring to determine GFR with a comparable sensitivity to radioisotopec methods.
Methods: 120 patients (49 females, 71males), mean age of 56 (range 20 to 84) years with normal renal function and different stages of renal failure, mean creatinine clearance of 61,6 ± 44,9 (range 1,8 - 181,1) ml/min/1,73m2 received a bolus injection of 10 ml iohexol, a non-ionic low osmolar x-ray contrast medium. Using the one-compartment model, plasma samples were taken after 150, 240 and 480 minutes. The total plasma disappearance of iohexol was measured by x-ray fluorescence analysis and the clearance was calculated. The 99mTc-DTPA clearance was determined in accordance with a standard protocol.
Results: A high correlation was found between the clearance of iohexol and 99mTc-DTPA (r = 0,95). The average deviation between Iohexol and 99mTc-DTPA clearance was 7,4 ml/min/1,73m2. Allergic and nephrotoxic side effects were not observed.
Conclusion: Iohexol clearance is a valid method for measuring GFR in patients at any stages of renal failure. It is easy to perform and inexpensive.
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