Mulay A V, Gokhale S M
Department of Nephrology, Dialysis Unit, Inlaks and Budhrani Hospital, Pune, Maharashtra, India; Kidney Research and Support Network Trust, Pune, Maharashtra, India.
Department of Nuclear Medicine, Inlaks and Budhrani Hospital, Pune, Maharashtra, India.
Indian J Nephrol. 2017 Mar-Apr;27(2):124-128. doi: 10.4103/0971-4065.200515.
In clinical practice, serum creatinine-based predicting equations and Gates protocol based on gamma camera imaging of kidneys after injection of Tc99m-diethylenetriaminepentaacetic acid (DTPA) are commonly used to assess glomerular filtration rate (GFR). Comparison of these methods, especially the chronic kidney disease-epidemiology collaboration (CKD-EPI) equation with gold standard method of assessment of GFR by plasma clearance of Tc-99mDTPA is not well-studied in Indian population. We conducted this study to compare GFR estimation by gamma camera-based Gates protocol and serum creatinine-based predicting equations with GFR measured by plasma clearance of Tc-99mDTPA. One hundred and five patients (65 male and 40 female) underwent Tc-99m DTPA renal scan followed by withdrawal of venous blood samples at 2, 3, and 4 h as per predefined protocol. Gates method GFR (GFR) was assessed using standard protocol. GFR by plasma sampling (GFR) was calculated by slope-intercept method with provision for corrections. Estimated GFR was calculated by Cockroft-Gault formula, four variable modification of diet in renal disease (MDRD) equation, and CKD-EPI equation (GFR GFR, GFR, respectively). GFR measured by gold standard method (GFR) was compared with that estimated by other methods by calculating correlation coefficient, bias, precision, and accuracy. GFR estimated by all three estimating equations correlated better than GFR with GFR For estimating GFR, GFR had highest correlation with GFR with least bias and highest precision. Gamma camera-based Gates protocol was the least precise and least accurate method for estimating GFR. To conclude, all three estimating equations based on serum creatinine are superior to Tc-99m DTPA scintigraphy for estimating GFR; CKD-EPI equation being the most accurate and precise.
在临床实践中，基于血清肌酐的预测方程以及基于注射锝-99m二乙三胺五乙酸（DTPA）后肾脏γ相机成像的盖茨方案常用于评估肾小球滤过率（GFR）。在印度人群中，这些方法的比较，尤其是慢性肾脏病流行病学协作组（CKD-EPI）方程与通过锝-99mDTPA血浆清除率评估GFR的金标准方法的比较，尚未得到充分研究。我们开展这项研究，旨在比较基于γ相机的盖茨方案和基于血清肌酐的预测方程所估算的GFR与通过锝-99mDTPA血浆清除率测量的GFR。105例患者（65例男性和40例女性）接受了锝-99m DTPA肾扫描，然后按照预先定义的方案在2小时、3小时和4小时采集静脉血样。使用标准方案评估盖茨方法GFR（GFR）。通过斜率截距法并进行校正计算血浆采样GFR（GFR）。通过Cockcroft-Gault公式、肾脏病饮食改良四变量（MDRD）方程和CKD-EPI方程分别计算估算的GFR（分别为GFR GFR、GFR）。通过计算相关系数、偏差、精密度和准确性，将金标准方法测量的GFR（GFR）与其他方法估算的GFR进行比较。所有三个估算方程估算的GFR与GFR的相关性均优于GFR。对于估算GFR，GFR与GFR的相关性最高，偏差最小，精密度最高。基于γ相机的盖茨方案是估算GFR最不精确和最不准确的方法。总之，基于血清肌酐的所有三个估算方程在估算GFR方面均优于锝-99m DTPA闪烁显像；CKD-EPI方程最为准确和精确。
