Clinical Investigation

Kidney International (1992) 41, 1595–1598; doi:10.1038/ki.1992.230

Hydrated clearance of gadolinium-DTPA as a measurement of glomerular filtration rate

Peter L Choyke1, Howard A Austin1, Joseph A Frank1, Mary E Girton1, Richard L Diggs1, Andrew J Dwyer1, LaGrieta Miller1, Robert Nussenblatt1, Henry McFarland1 and Theodore Simon1

1Departments of Radiology and Nuclear Medicine, and Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Eye Institute, and National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA

Correspondence: Peter L Choyke MD, Department of Radiology, Building 10, Room IC 660, National Institutes of Health, Bethesda, Maryland 20892, USA.

Received 11 April 1991; Revised 12 November 1991; Accepted 26 December 1991.

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Abstract

Hydrated clearance of gadolinium-DTPA as a measurement of glomerular filtration rate. Technetium (99mTc)-diethylene triamine pentaacetic acid (DTPA) hydrated clearance studies are accurate for determining GFR but require special facilities for handling and measuring samples. We investigated the potential of a non-radioactive paramagnetic analog, Gadolinium (Gd)-diethylene triamine pentaacetic acid (DTPA), an approved NMR contrast agent, as a glomerular filtration marker. Instead of relying on the radioactivity of technetium, this test is based on the fact that gadolinium induces alterations in the NMR Tl relaxation times in blood and urine samples. Ninety patients underwent simultaneous determinations of GFR using 1 mCi of Tc-DTPA and 0.05 mmol/kg Gd-DTPA (Berlex Labs) IV. The patients were hydrated with oral and intravenous fluid. Following a one hour equilibrium period, three or four consecutive urine collections were obtained; plasma samples were acquired at the beginning and end of each approximately 20-minute interval. 99mTc-DTPA radioactivity was determined with a scintillation counter. Tl relaxation times were measured on a 10 MHz NMR spectrometer. These were converted to Gd-DTPA concentration by comparison with standard solutions. The Gd-DTPA derived GFR closely approximated the 99mTc-DTPA derived GFR which ranged from 15 to 147 ml/min. The equation and correlation coefficient of the regression line is y = 1.04 times -2.2, r = 0.94. Thus, Gd-DTPA is a safe, non-radioactive indicator of GFR that may provide an alternative renal clearance method for clinical studies of progressive renal disease and nephrotoxicity.

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