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Title: A comparison of the plasma disappearance of iohexol and 99mTc-DTPA for the measurement of glomerular filtration rate (GFR) in diabetes.
Austin Authors: Houlihan, Christine A ;Jenkins, Margaret A;Osicka, Tanya M;Scott, Andrew M ;Parkin, John Desmond;Jerums, George 
Affiliation: Department of Medicine, University of Melbourne, Austin and Repatriation Medical Centre, Vic.
Issue Date: 1-Oct-1999
Publication information: Australian and New Zealand Journal of Medicine; 29(5): 693-700
Abstract: Changes in glomerular filtration rate (GFR) provide a valuable indicator of the progression of diabetic nephropathy. GFR is most commonly measured by the plasma clearance of radioisotopes, however, use of iohexol, a non-ionic radiocontrast medium, is a recently described alternative and has shown good agreement with inulin clearance. A one-compartment model is used for calculating GFR in most Australian centres but a two-compartment model is more accurate.To set up a non-radioisotopic method for assessment of GFR using iohexol, and to compare this with the currently used 99mTc-diethylene-triamine-penta-acetic acid (DTPA) method. Secondly, to compare GFR results using an unmodified one-compartment model with a one-compartment model subjected to the Brochner-Mortensen modification.Twenty-one patients with diabetes had assessment of GFR with simultaneous measurements of 99mTc-DTPA and iohexol plasma clearance. Plasma clearance was determined by the slope intercept method and then modified according to the Brochner-Mortensen equation. Plasma iohexol concentrations were determined by capillary electrophoresis.There was no significant difference between iohexol and 99mTc-DTPA derived GFR values, difference 4.3+/-7.7 mL/minute (mean+/-SD). This was despite 99mTc-DTPA protein binding demonstrated in the range of 5-10%. Comparison of GFR results using an unmodified one-compartment model with a Brochner-Mortensen corrected one-compartment model showed higher GFR values with the former, in the range of 20-30% for GFR values > 100 mL/minute.Iohexol provides an efficient alternative to radioisotopic methods for serial measurement of GFR in diabetic patients with hyperfiltration, incipient and overt nephropathy. A one-compartment model with its inherent overestimation of GFR should be replaced by the Brochner-Mortensen modified one-compartment model.
Gov't Doc #: 10630650
Journal: Australian and New Zealand Journal of Medicine
Type: Journal Article
Subjects: Adult
Contrast Media
Diabetes Mellitus.blood.physiopathology
Electrophoresis, Capillary
Glomerular Filtration Rate
Iohexol.diagnostic use
Metabolic Clearance Rate
Middle Aged
Technetium Tc 99m Pentetate.blood.diagnostic use
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