Comparing the Reliability of the Glomerular Filtration Rate Estimated with 99m-Technetium Diethylene-Triamine-Pentaacetate versus the Effective Renal Plasma Flow Obtained with 99m-Technetium Ethylene Dicysteine: A Prospective Observational Study

Abstract

The glomerular filtration rate (GFR) is important for assessing renal function and must be calculated reliably and reproducibly. This study aimed to compare the reliability and accuracy of GFR estimated with 99m-technetium diethylene-triamine-pentaacetate (99mTc-DTPA) versus that calculated from the effective renal plasma flow (ERPF) (GFR is 20% of ERPF) determined by the 99m-technetium ethylene dicysteine (99mTc-EC) technique. Forty-five patients suffering from cancer requiring platinum compound-based chemotherapy or from chronic renal failure were recruited. The patients were divided into two cohorts: (1) those with normal serum creatinine (SCr) levels (≤2 mg/dL) and (2) deranged SCr levels (>2 mg/dL). For all patients, the relative renal function was estimated by the 99mTc-DTPA and 99mTc-EC methods, 2-4 days apart. A 24-h urine sample for estimating 24-h creatinine clearance (CrCl) was obtained. GFR was also calculated using the Modification of Diet in Renal Disease (MDRD) formula. The GFR estimated via 24-h urine CrCl, 99mTc-DTPA, and ERPF obtained with 99mTc-EC were examined by quantile comparison plots, and all showed evidence of following a non-Gaussian distribution. For SCr values ≤2 mg/dL, the GFR estimated by the MDRD formula consistently shows significantly higher values than the GFR estimated with 99mTc-DTPA or 99mTc-EC. We found a high degree of correlation between the 99mTc-DTPA and 99mTc-EC radionuclide methods of estimating GFR. However, in patients with renal dysfunction, GFR estimated through Gates' method using a gamma camera overestimated the GFR; in these patients, calculating the GFR from the ERPF obtained with 99mTc-EC is more accurate.