title: The clearance concept with special reference to determination of glomerular filtration rate in patients with fluid retention.
abstract: In subjects without fluid retention, the total plasma clearance of a renal filtration indicator (inulin, (99m) Tc-DTPA, (51) Cr-EDTA) is close to the urinary plasma clearance. Conversely, in patients with fluid retention (oedema, pleural effusions, ascites), there is a substantial discrepancy between the total plasma clearance and the urinary plasma clearance. This is owing to delayed indicator distribution to smaller or larger parts of the interstitial space, which in patients with ascites may simulate a peritoneal dialysator. In patients with fluid retention, urinary plasma clearance should be assessed to obtain a correct measurement of the glomerular filtration rate (GFR). In theory, total plasma clearance with late samples (24-h, 48-h) may be applied in patients with fluid retention, but validation hereof has not been performed. Until such studies are completed, it is recommended that patients with fluid retention have their GFR measured by a urinary plasma clearance technique with controlled quantitative urinary sampling within a few hours after indicator injection.
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, 239, The Medical and Health Faculty, Center for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Ulrik L
authors.initials: UL
authors.lastname: Henriksen
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, 239, The Medical and Health Faculty, Center for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jens H
authors.initials: JH
authors.lastname: Henriksen
mesh_terms: D003198:Computer Simulation; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism*; D008657:Metabolic Clearance Rate; D008954:Models, Biological; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014883:Water-Electrolyte Imbalance / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism*
chemical_list: D019275:Radiopharmaceuticals
keywords: 51Cr-EDTA; ascites; capillary filtration; extraction; glomerular filtration rate; interstitial space; inulin; oedema; plasma clearance; volume of distribution
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