title: Arterio-venous concentration difference of [51Cr]EDTA after a single injection in man. Significance of renal function and local blood flow.
abstract: The present investigation was undertaken in order to study (1) the difference in arterial (Ca) and venous (Cv) concentration of [51Cr]EDTA (ethylenediaminetetraacetate) after a single intravenous injection, (2) the impact of different physiological variables on this difference, and (3) the error introduced in the measurement of renal plasma clearance and total plasma clearance by using venous blood samples instead of arterial. In 13 patients with GFR ranging from 29 to 150 ml min-1, Ca was higher than Cv immediately after the injection. After mean 38 min (range 12-82 min) the two curves crossed, and 180-300 min post-injection (p.i.) Cv was 5.9% higher than Ca (range 0.5-13.9%, P less than 0.001). The more reduced renal function, the smaller was the concentration difference. The areas under the arterial and the venous plasma concentration curves did not differ significantly at either 0-infinity or 0-300 min p.i. whereas the venous area 0-100 min p.i. underestimated the arterial area in the same period by 4.1% (P less than 0.05). In a computer simulation model, variation in the forearm capillary permeability-surface area product did not have any significant influence on the Cv-Ca difference, whereas the difference was very sensitive to even small changes in forearm blood flow within the physiological range. For measurement of renal plasma clearance it is recommended to use one long period: from the time of injection until 300 min p.i. or longer. If the clearance period is too short, the use of venous samples will overestimate the true renal clearance. Plasma clearance determined by venous and arterial blood samples does not differ significantly as long as the concentration is followed from the time of injection and a long period is applied. When simplified plasma clearance techniques are used, different results may be obtained from venous and arterial samples. The simplified techniques using venous blood samples--which usually include some empirical corrections--should be sufficiently reliable in daily clinical practice provided the forearm blood flow is reasonably high, e.g. exposure to cold should be avoided.
authors.affiliation: Department of Clinical Physiology, Hvidovre Hospital, University of Copenhagen, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Rehling
authors.forename: L
authors.initials: L
authors.lastname: Hyldstrup
authors.forename: J H
authors.initials: JH
authors.lastname: Henriksen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries; D003198:Computer Simulation; D004492:Edetic Acid / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007275:Injections, Intravenous; D007668:Kidney / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D009994:Osmolar Concentration; D004369:Pentetic Acid; D012079:Renal Circulation; D013667:Technetium; D016284:Technetium Tc 99m Pentetate; D014680:Veins
chemical_list: D009942:Organometallic Compounds; D013667:Technetium; D004369:Pentetic Acid; D004492:Edetic Acid; D016284:Technetium Tc 99m Pentetate