title: Measurement of glomerular filtration rate in ICU patients using 99mTc-DTPA and inulin.
abstract: Improved and reliable methods for assessing glomerular filtration rate (GFR) in intensive care patients are needed in light of known deficiencies using creatinine clearance. We compared simultaneous two-hour clearances of inulin (CIn), creatinine (CCr), and 99mTc-diethylenetriaminepentaacetic acid (CDTPA) in 18 medical or surgical intensive care patients (range, 49 to 92 years old) with blood urea nitrogen (BUN) levels greater than 17.9 mmol/liter (0.5 mg/ml), serum creatinine levels greater than 150 mumol/liter (0.02 mg/ml), or estimated Cockcroft clearance less than 60 ml/min. Patients had severe renal dysfunction with average GFR of 35 ml/min (range, 2 to 69 ml/min). CDTPA and CCr correlated significantly with CIn, although CDTPA tended to provide a closer approximation. Cockcroft clearance (32 +/- 4 ml/min) was grossly similar to CDTPA and CIn and correlated significantly, especially when weight was calculated using actual as opposed to ideal body weight. In a subset of 13 patients with CIn less than 30 ml/min, only CDTPA was significantly correlated with CIn. In patients in the intensive care unit, CDTPA provides a rapid, accurate, and inexpensive clinical assessment of GFR, even at very low GFRs.
authors.affiliation: Department of Medicine, Letterman Army Medical Center, San Francisco, California.
authors.forename: W W
authors.initials: WW
authors.lastname: Wharton
authors.forename: J L
authors.initials: JL
authors.lastname: Sondeen
authors.forename: M
authors.initials: M
authors.lastname: McBiles
authors.forename: S E
authors.initials: SE
authors.lastname: Gradwohl
authors.forename: C E
authors.initials: CE
authors.lastname: Wade
authors.forename: D P
authors.initials: DP
authors.lastname: Ciceri
authors.forename: H G
authors.initials: HG
authors.lastname: Lehmann
authors.forename: R E
authors.initials: RE
authors.lastname: Stotler
authors.forename: T R
authors.initials: TR
authors.lastname: Henderson
authors.forename: W R
authors.initials: WR
authors.lastname: Whitaker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000378:metabolism; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007362:Intensive Care Units; D007444:Inulin / Q000493:pharmacokinetics; D007677:Kidney Function Tests / Q000379:methods; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D016284:Technetium Tc 99m Pentetate / Q000493:pharmacokinetics
chemical_list: D007444:Inulin; D003404:Creatinine; D016284:Technetium Tc 99m Pentetate