• The Korean Journal of Nuclear Medicine Technology
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• v.25 no.2
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• pp.35-40
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• 2021

Purpose Glomerular filtration rate(GFR) is an important indicator for the diagnosis, treatment, and follow-up of kidney disease and is also used by healthy individuals for drug use and evaluating kidney function in donors. The gold standard method of the GFR test is to measure by continuously injecting the inulin which is extrinsic marker, but it takes a long time and the test method is complicated. so, the method of measuring the serum concentration of creatinine is used. Estimated glomerular filtration rate (eGFR) is used instead. However, creatinine is known to be affected by age, gender, muscle mass, etc. eGFR formulas that are currently used include the Cockroft-Gault formula, the modification of diet in renal disease (MDRD) formula, and the chronic kidney disease epidemilogy collaboration (CKD-EPI) formula for adults. For children, the Schwartz formula is used. Measurement of GFR using ⁵¹Cr-EDTA (diethylenetriamine tetraacetic acid), ^99mTc-DTPA (diethylenetriamine pentaacetic acid) can replace inulin and is currently in use. Therefore, We compared the GFR measured using ^99mTc-DTPA with the eGFR using CKD-EPI formula. Materials and Methods For 200 kidney transplant donors who visited Asan medical center.(96 males, 104 females, 47.3 years ± 12.7 years old) GFR was measured using plasma(Two-plasma-sample-method, TPSM) obtained by intravenous administration of ^99mTc-DTPA(0.5mCi, 18.5 MBq). eGFR was derived using CKD-EPI formula based on serum creatinine concentration. Results GFR average measured using ^99mTc-DTPA for 200 kidney transplant donors is 97.27±19.46(ml/min/1.73m²), and the eGFR average value using the CKD-EPI formula is 96.84±17.74(ml/min/1.73m²), The concentration of serum creatinine is 0.84±0.39(mg/dL). Regression formula of ^99mTc-DTPA GFR for serum creatinine-based eGFR was Y = 0.5073X + 48.186, and the correlation coefficient was 0.698 (P<0.01). Difference (%) was 1.52±18.28. Conclusion The correlation coefficient between the ^99mTc-DTPA and the eGFR derived on serum creatinine concentration was confirmed to be moderate. This is estimated that eGFR is affected by external factors such as age, gender, and muscle mass and use of formulas made for kidney disease patients. By using ^99mTc-DTPA, we can provide reliable GFR results, which is used for diagnosis, treatment and observation of kidney disease, and kidney evaluation of kidney transplant patients.

• Clinical and Experimental Pediatrics
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• v.55 no.4
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• pp.136-142
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• 2012

Purpose: Urinary excretion of N acetyl-beta-D glucosaminidase (NAG) and ${\beta}_2$-microglobulin (${\beta}_2$-M) was increased in the presence of proximal tubular damage. Based on these urinary materials, we investigated the ability of expecting renal function in chronic glomerular diseases. In this study, we evaluated the relationship between glomerular filtration rate (GFR) urinary NAG, and urinary ${\beta}_2$-M. Methods: We evaluated 52 children with chronic kidney disease at the Chung-Ang University Hospital between January 2003 and August 2009. We investigated the 24-hour urinalysis and hematologic values in all 52 patients. Serum creatinine, creatinine clearance (Ccr), serum cystatin C, urinary ${\beta}_2$-M and urinary NAG were measured. Results: Out of 52 patients, there were 13 children with minimal change in disease, 3 children with focal segmental glomerulosclerosis, 17 children with immunoglobulin A nephropathy, 15 children with Henoch-Sch$\ddot{o}$nlein purpua nephritis, 3 children with poststreptococcal glomerulonephritis, and 1 child with thin glomerular basement membrane disease. In these patients, there were significant correlation between the Ccr and urinary NAG (r=-0.817; $P$ <0.01), and between the GFR (as determined by Schwartz method) and urinary NAG (r=-0.821; $P$ <0.01). In addition, there was a significant correlation between the GFR (as determined by Bokencamp method) and urinary NAG (r=-0.858; $P$ <0.01). Conclusion: In our study, there was a significant correlation between the GFR and urinary NAG, but there was no correlation between the GFR and urinary ${\beta}_2$-M, suggesting that the GFR can be predicted by urinary NAG in patients with chronic glomerular disease.

• The Korean Journal of Nuclear Medicine Technology
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• v.13 no.1
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• pp.98-103
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• 2009

Purpose: Correct estimation of Glomerular filtration rate (GFR) is very important for an accurate clinical assessment of the kidney function. This study compares four GFR markers, a serum creatinine-based estimation using MDRD formula, Cystatin-C, Cr-51 EDTA 2 samples and 6 samples. Materials and Methods: Serum creatinine concentrations, Cystatin-C serum concentrations and Cr-51 EDTA clearance are measured in 43 patients who received or donated kidney. Results: The correlation coefficient between serum based estimated GFR (MDRD) and Cr-51 EDTA 6 samples was 0.817 (p<0.01). The correlation coefficient between Cystatin-C based GFR and EDTA 6 samples was 0.7322 (p<0.01). Regression analysis showed a statistically significant correlation between Cr-51 EDTA 2 samples and 6 samples (r=0.971, p<0.01). Mean value and ${\pm}2SD$ for the difference between Cr-51 EDTA 2 samples and 6 samples were 4.7 mL/min and ${\pm}9.3$ respectively. Conclusions: The estimation of two samples Cr-51 EDTA showed that the method can be simplified by reducing blood samples without losing its high accuracy.

• Journal of Korean Physical Therapy Science
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• v.11 no.1
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• pp.28-35
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• 2004

The purpose of the present study was to investigate the effectiveness of silver spike point (SSP) low frequency electrical stimulation on glomerular filtration rate (GFR), specifically, such as diuretic action in 24 hour urine and in plasma analysis from normal volunteer. The current of 1 Hz continue type (CT) of SSP low frequency electrical stimulation significantly decreased in plasma creatine from normal volunteer. However, the urine creatinine clearance (Ccr) was significantly increased by SSP low frequency electrical stimulation in normal volunteer. These results suggest that the SSP low frequency electrical stimulation, especially current of 1 Hz continue type, significantly regulates urine creatinine clearance and glomerular filtration rate from normal volunteer. Therefore, the SSP low frequency electrical stimulation is a good regulator through a diuretic action of hypertension.

• The Korean Journal of Nuclear Medicine Technology
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• v.22 no.2
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• pp.97-100
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• 2018

Purpose The glomerular filtration rate (GFR) test is an important indicator of glomerular filtration and has been used to test renal function and the extent of its function. The GFR test is performed by intravenous injection of radioactive medicines made of $^{51}Cr$-EDTA, and blood concentration is measured by taking blood according to the elapsed time. also, PET-CT, bone scan, transfusion and so on will affect the outcome. Therefore, we will improve the quality of the test by providing guidelines for the GFR test for more accurate testing. Materials and Methods 5 mL of physiological saline solution and 2 mL of $^{51}Cr$-EDTA solution are used to make 5 mL of the radiopharmaceutical solution to be injected into the patient. First, the syringe weight is measured before the injection, and then the radioactive medicine is injected into the patient's vein and the syringe weight is measured after the injection. Blood sampling is performed twice in total. In adults, blood is collected 3 hours / 5 hours after injection and in children 2 hours / 5 hours after injection. The blood sample is centrifuged at 3300 rpm for 5 minutes. Standard solution is prepared by filling diluent water up to the scale indicated in the 200-mL volumetric flask, discarding $500{\mu}L$, injecting $500{\mu}L$ of GFR reagent and mixing well. $500{\mu}L$ each of the standard solution is dispensed into two test tubes, and $500{\mu}L$ of each of the plasma samples collected in time is dispensed into two test tubes and measured with a Cobra Counter. Results At present, the reference range applied in this study is $119.5{\pm}30.3ml/min/1.73m2$ for males and $125.2{\pm}28.2ml/min/1.73m^2$ for females. Conclusion The GFR test is conducted using radioactive medical products. GFR testing is performed as a scheduled test, but PET-CT, dialysis and transfusion, which may affect GFR testing, may be scheduled during GFR testing. Therefore, we could get accurate GFR test results by notifying the ward and department beforehand when booking.

• Journal of radiological science and technology
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• v.46 no.5
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• pp.417-425
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• 2023

The glomerular filtration rate (GFR) has been the subject of much research as a key indicator for diagnosing, treating, and monitoring kidney function. The gamma camera method (Gates method) is simple and allows simultaneous acquisition of GFR and renal scintigraphy for each kidney, however its accuracy is inferior. This study aimed to investigate changes in GFR depending on how region of interest (ROI) are set up, which is one of many factors influencing accuracy. GFR was calculated by setting the ROI for each phase of the image acquisition time (Gates-1: 0~1 minutes, Gates-2: 1~3 minutes, Gates-3: 3~27 minutes), and statistical significance was verified based on probability value 0.05 through ANOVA analysis. While there was no statistically significant difference among results from Gates-1, 2, 3 (p=0.481>0.05), overall results from the Gates method tended to overestimate compared to those from the multiple blood sampling-dual exponential (MBSDE) method. When comparing averages between phases, results from Gates-2 were most similar to those from the MBSDE method. Moreover, paired t-test p-values between MBSDE method and phases were as follows Gates-1: 0.021 (p<0.05), Gates-2: 0.280 (p>0.05), and Gates-3: 0.164 (p>0.05) indicating that only Gates-1 had statistically significant differences compared with MBSDE method. Thus, setting ROI around 2~3 minutes is calculated can aid in accurately determining GFR when Gates Method.

• The Korean Journal of Nuclear Medicine
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• v.26 no.1
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• pp.95-100
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• 1992

The radioisotopic measurement of glomerular filtration rate (GFR) has required analysis of serial blood or urine samples over several hours, and does not allow measurement of separate renal function unless separate catherterization of individual ureters is done. Gates described isotopic method for the measurement of global and unilateral GFR based on the determination by scintillation camera of the fraction of the injected dose of $^{99m}Tc-diethylenetriaminepentaacetic$ acid (DTPA) present in the kidneys 2-3 minutes after its administration. We calculated GFR according to Gates' method in 58 adult patients with various levels of global renal function using $^{99m}Tc$ DTPA and validated this technique by correlation with 24 hour creatinine clearance. A good correlation was observed between 24 hour creatinine clearance and GFR calculated by Gates' formula, with an r value of 0.91 (p<0.01). We concluded that determination of GFR according to the Gates' formula allows good and reproducible prediction of GFR with great rapidity and simplicity rendering this technique suitable for clinical practice.

• The Korean Journal of Nuclear Medicine Technology
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• v.23 no.1
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• pp.40-44
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• 2019

Purpose Glomerular filtration rate (GFR) is an important index for evaluation of renal function, renal disease diagnosis and progress monitoring. Therefore, accurate measurement of GFR is clinically important. Among the factors that affect the GFR result, there have been many discussions on the methods such as the correction of the kidney depth, net syringe count, and the method of setting the ROI. However there has been no consideration of counting in the most basic factors like height and weight measurement. In this study, we investigate how height and weight changes affects the result of GFR and review the importance of standardized body measurements. Materials and Methods Fifty patients who underwent GFR test were randomly sampled and examined for changes in height and body weight within one month. From the normal patients without renal disease to the patients with severely decreased GFR, we applied the GFR formula of Gate with varying height and weight. Results: The result showed variation of the height at maximum three centimeters and six kilograms of weight. The first calculation of GFR was done with fixed height value and control variable as weight. Weight was incremented by one kilogram each time up to six kilograms. The GFR showed increased result with increasing weight. The result of GFR showed ten percent increase with six kilograms of weight increase. On the other hand, when height value was incremented by one centimeter up to three centimeters showed decreased GFR result with fixed weight value. Up to three centimeters of height increase showed two percent of decreased GFR with fixed weight. Conclusion This study showed varying GFR result when height and weight changes. Therefore it is clinically crucial not only to maintain and manage body measuring instrument but also to have a standardized measurement methods to derive accurate measured values and to achieve reproducibility.

• Korean Journal of Clinical Pharmacy
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• v.22 no.2
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• pp.103-112
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• 2012

Performance of coronary angiography for exact diagnosis and treatments of cardiovascular disease have been increased recently and it also brings increase of the contrast-induced nephropathy (CIN) referred from increasing use of radiological contrast agents. The variation of estimated glomerular filtration rate (eGFR) is an indicator of CIN, which is known to increase when renal function is decreased. Therefore, this study was to evaluate the affecting factors including concomitant drug on variation of eGFR of patients who underwent coronary angiography according to the conditions of renal function. Medical records of 66 patients were evaluated retrospectively and the patients underwent coronary angiography or angioplasty with nonionic and isotonic contrast media (iodixanol) at Chungnam national university hospital from 1 Jan 2008 to 30 Jul 2010. Patients group was divided into 2 groups; the patients in stages 3-4 chronic kidney disease (CKD) and the patients in stage 2 CKD. Each group was researched about the effect of concomitant drug and clinical characteristics on eGFR variation. The change of eGFR was compared among baseline and 2 or 3 day after coronary angiography. In results, the eGFR variation in group over age 75 was significantly decreased after radiological contrast agents exposure (p $$\leq_-$$ 0.05). The eGFR variation in anemia was significantly decreased after radiological contrast agents exposure in stage 2 CKD (p > 0.05). The eGFR variation in group under $HbA_{1c}$ 6.5% was significantly decreased after radiological contrast agents exposure in stages 3-4 CKD (p $$\leq_-$$ 0.05). The eGFR variation by taking statins, angiotensin converting enzyme inhibitors, calcium channel blockers and nitroglycerin was increased after radiological contrast agents exposure in stage 2 CKD (p $$\leq_-$$ 0.05). The eGFR variation by using of diuretics was significantly decreased after radiological contrast agents exposure in stages 3-4 CKD (p $$\leq_-$$ 0.05). The eGFR variation by taking statins, nitroglylcerin was increased after radiological contrast agents exposure in stages 3-4 CKD(p > 0.05). The eGFR variation in group over contrast dosage 150 ml was significantly decreased after radiological contrast agents exposure in stages 3-4 CKD (p $$\leq_-$$ 0.05). Therefore, when undergoing coronary angiography, contrast dosage should be minimized less than 150 ml, and diuretics should be restricted as possible in stages 3-4 CKD. Patients over age 75 require special attention to prevent CIN, and if patients undergo coronary angiography in stages 3-4 CKD, $HbA_{1c}$ is also requried to maintain below 6.5% to prevent CIN.

• Clinical and Experimental Pediatrics
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• v.52 no.9
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• pp.999-1004
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• 2009

Purpose : Glomerular filtration rate (GFR) is a fundamental parameter in assessing renal function and predicting the progression of chronic renal disease. Because the use of serum creatinine has several disadvantages, many studies have investigated the use of cystatin C for estimating GFR. We compared creatinine clearance and GFR with formulas using serum creatinine and cystatin C. Methods : We retrospectively analyzed 211 patients with various renal diseases and classified them into two groups according to creatinine clearance (Group 1: CrCl >$90mL/min/1.73m^2$, Group 2: CrCl <$90mL/min/1.73m^2$). We measured serum creatinine, cystatin C, and creatinine clearance. We calculated GFR using the Schwartz, Counahan, Filler and Lepage, Bokencamp et al, and Grubb et al formulas. Results : GFR determined by the Schwartz formula had the highest correlation to creatinine clearance (r=0.415, P=0.00). GFR determined by various formulas using cystatin C had lower correlation to creatinine clearance (r=0.187, r=0.187, r=0.291). The Schwartz and Counahan formulas showed greater diagnostic accuracy in detecting decreased GFR than cystatin C in group 2 (areas under the curve: Schwartz, 0.596; Counahan, 0.572; Filler, 0.512; Bokencamp, 0.508; and Grubb, 0.514). Conclusion : GFR determined by the Schwartz and Counahan formulas using serum creatinine showed higher correlation coefficient than that determined by formulas using cystatin C. The formulas using cystatin C were not superior to those using serum creatinine in detecting decreased GFR. Cystatin C measurement was not satisfactory for assessing GFR in patients whose renal function was not severely decreased.