Abstract
This study investigated a simple method for calculating the single-kidney glomerular filtration rate (GFR) using dynamic hyperpolarized 13C-urea magnetic resonance (MR) renography. A retrospective data analysis was applied to renal hyperpolarized 13C-urea MR data acquired from control rats, prediabetic nephropathy rats, and rats in which 1 kidney was subjected to ischemia-reperfusion. Renal blood flow was determined by the model-free bolus differentiation method, GFR was determined using the Baumann–Rudin model method. Reference single-kidney and total GFRs were measured by plasma creatinine content and compared to 1H dynamic contrast-enhanced estimated GFR and fluorescein isothiocyanate-inulin clearance GFR estimation. In healthy and prediabetic nephropathy rats, single-kidney hyperpolarized 13C-urea GFR was estimated to be 2.5 ± 0.7 mL/min in good agreement with both gold-standard inulin clearance GFR (2.7 ± 1.2 ml/min) and 1H dynamic contrast-enhanced estimated GFR (1.8 ± 0.8 mL/min), as well as plasma creatinine measurements and literature findings. Following ischemia-reperfusion, hyperpolarized 13C-urea revealed a significant reduction in single-kidney GFR of 57% compared with the contralateral kidney. Hyperpolarized 13C MR could be a promising tool for accurate determination of GFR. The model-free renal blood flow and arterial input function-insensitive GFR estimations are simple to implement and warrant further translational adaptation.
Highlights
Glomerular filtration rate (GFR) measures are essential to the daily care of patients, as either an estimate or an exact quantifiable measure [1]
This study investigated a simple method for calculating the single-kidney glomerular filtration rate (GFR) using dynamic hyperpolarized 13C-urea magnetic resonance (MR) renography
A retrospective data analysis was applied to renal hyperpolarized 13C-urea MR data acquired from control rats, prediabetic nephropathy rats, and rats in which 1 kidney was subjected to ischemia-reperfusion
Summary
Glomerular filtration rate (GFR) measures are essential to the daily care of patients, as either an estimate or an exact quantifiable measure [1]. GFR is often estimated by the serum creatinine levels or creatinine clearance, derived from both blood and urine samples. The specificity is lacking in both methods, as the total GFR can overshadow alterations in single kidney function or even in intrarenal differences [1]. Nuclear medicine-based techniques remain the reference method for quantification of the single-kidney GFR (skGFR) [1]; widespread application of these, has been limited by the ionizing radiation associated with the examination. The methods in general show great promise, the clinical translation is lacking. This may be largely because of the lack of general consensus on model standardization, a direct consequence of the complex system in question and the obtainable signal-to-noise ratio in MR
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