Clinical Investigation

Kidney International (1992) 42, 174–178; doi:10.1038/ki.1992.275

Measurement of glomerular filtration rate in ICU patients using 99mTc-DTPA and inulin

William W Wharton III, Jill L Sondeen, Michael McBiles, Stephen E Gradwohl, Charles E Wade, David P Ciceri, Heinz G Lehmann, Richard E Stotler, Thomas R Henderson, W Roscoe Whitaker and Jill S Lindberg

Department of Medicine, Nuclear Medicine Service, Department of Radiology, and Pharmacy Service, Letterman Army Medical Center, and the Division of Military Trauma Research, Letterman Army Institute of Research, Presidio of San Francisco, San Francisco, California; Life Sciences Division, NASA Ames Research Center, Moffett Field, California; and Department of Internal Medicine, Section on Nephrology, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana, USA

Correspondence: Jill S Lindberg MD, Department of Internal Medicine, Section on Nephrology, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana 70121, USA.

Received 19 April 1991; Revised 24 January 1992; Accepted 30 January 1992.

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Abstract

Measurements of glomerular filtration rate in ICU patients using 99mTc-DTPA and inulin. 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 >17.9 mmol/liter (0.5 mg/ml), serum creatinine levels >150 micromol/liter (0.02 mg/ml), or estimated Cockcroft clearance <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 plusminus 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 <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.

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