RESUMO
A simple method is presented for estimating extracellular fluid volume from the plasma clearance of [99mTc])DTPA or [169Yb]DTPA. Two plasma samples are required, at 1 and 3 hr, following a single intravenous injection. (The same plasma samples can be used for measurement of glomerular filtration rate.) Using the complete plasma clearance curve as a reference (eight samples at 10 to 240 min), the error of the two-sample method in 40 patients was 1.5 I for [99mTc]DTPA, 2.1 I for [169Yb]DTPA (residual standard deviation).
Assuntos
Espaço Extracelular , Testes de Função Renal/métodos , Compostos Organometálicos , Ácido Pentético , Tecnécio , Humanos , Compostos Organometálicos/metabolismo , Ácido Pentético/metabolismo , Tecnécio/metabolismo , Pentetato de Tecnécio Tc 99mRESUMO
Glomerular filtration rate (GFR) can be calculated from the plasma clearance of any of several radiopharmaceuticals that are excreted by glomerular filtration. Simplified methods have been proposed that require only one or two plasma samples in lieu of a more complete clearance curve. We examined the error introduced by this simplification. Forty patients were studied using a dual-isotope technique employing [99mTc]DTPA and [169Yb]DTPA, obtaining eight plasma samples for each clearance curve at intervals from 10 to 240 min after injection. Data were fit to several empirical or semiempirical formulae and also to a two-compartment computer model that permitted GFR estimation from only one or two data points. The computer model gave good fit, but so did several simpler methods. The error that results from replacing the complete clearance curve by a single 3-hr sample was about 8 ml/min (residual s.d.). By using two samples (at 1 and 3 hr), the error could be reduced to 4 ml/min. Recommended one- and two-sample methods are presented.
Assuntos
Taxa de Filtração Glomerular , Ácido Pentético/metabolismo , Radioisótopos/metabolismo , Tecnécio/metabolismo , Itérbio/metabolismo , Humanos , Taxa de Depuração Metabólica , Plasma/fisiologia , Pentetato de Tecnécio Tc 99m , Urina/metabolismoRESUMO
When technetium-99m DTPA is used to measure glomerular filtration rate (GFR), the accuracy depends on the supplier of the radiopharmaceutical. The error in GFR is due to protein binding, as we have shown by direct measurement. In 19 patients, GFR measured with Tc-DTPA and corrected for protein binding agreed with that measured simultaneously using Yb-169 DTPA (correlation coefficient 0.991). Without correction, Tc-DTPA gave falsely low values in patients having good renal function, in whom unbound activity cleared rapidly while bound activity remained in the circulation. When Tc-DTPA is used to measure GFR, the in vivo protein binding should be measured and used to correct the data.
Assuntos
Taxa de Filtração Glomerular , Ácido Pentético/normas , Tecnécio/normas , Animais , Humanos , Masculino , Matemática , Camundongos , Ligação Proteica , Controle de Qualidade , Radioisótopos , Pentetato de Tecnécio Tc 99m , ItérbioRESUMO
Ionic charge, complexation equilibria, and acid-base equilibria can be measured at tracer concentrations by ion-exchange chromatography. To characterize better the principal components found in [99mTc]pyrophosphate preparations used for diagnostic bone and heart scanning, these were studied in two ion-exchange chromatographic systems: (A) DEAE-cellulose in pyrophosphate form at pH 6.0-7.5, and (B) DEAE-cellulose in perchlorate form at pH 3.7-4.8. The chromatographic retention times were measured as a function of pH and electrolyte concentration, and compared with those of trisoxalatochromium(III) complex, which was chosen as reference ion because of its similarity in charge and retention to the Tc-pyrophosphate complexes. The pyrophosphate complexes were even more sensitive to electrolyte concentration than was the triply negative reference ion: the calculated mean net charge in the mobile phase for the two principal Tc-pyrophosphate species were -4.5 +/- 0.5 and -4.9 +/- 0.5 at pH 4.3, and -11.2 +/- 1.3 and -10.1 +/- 1.0 at pH 7.0. It can be concluded that the two principal radioactive components in clinical Tc-pyrophosphate preparations both bear a high, pH-dependent negative charge.
Assuntos
Difosfatos/análise , Tecnécio/análise , Compostos de Estanho , Cromatografia por Troca Iônica , Pirofosfato de Tecnécio Tc 99m , EstanhoRESUMO
A variety of methods have been proposed to estimate the glomerular filtration rate (GFR) from the renal uptake of technetium Tc 99m-DTPA using a gamma camera. To compare alternative methods, we calculated the GFR in several different ways from measurements in 33 patients and compared the results with an independent GFR measurement based on eight-point plasma clearance of ytterbium Yb 169-DTPA. The best agreement was obtained using an algorithm that has not been described previously, in which correction was made for overlap of the kidneys by the liver and spleen. The correlation coefficient was 0.958, and the residual standard deviation was 12.1 ml/min. This method required a single 20-min blood sample as well as the camera data. The best method not requiring a blood sample was significantly less accurate, with a correlation coefficient of 0.837 and a residual standard deviation of 23.1 ml/min. The accuracy of these methods was comparable to that reported for creatinine clearance, the most commonly used estimate of the GFR in current clinical practice.